Hard Times


The article in Forbes entitled Why This Is The Hardest Of Times To Be A Physician In America is worth the read though I think I see where it is headed.  This is second of three installments by a Robert Pearl MD who is the CEO of The Permanente Medical Group, a certified plastic and reconstructive surgeon, and Stanford University professor.  Boy, he has a lot of titles but, alas, none of them are really applicable to those docs in the trenches.  Sorry, dude. That being said, here are some nuggets from this piece:

  • And given the recently announced mergers of the largest insurance companies into three mega-giants, we can expect this process to continue. Increasingly, we are seeing this approach take an adverse effect on patient care and physician satisfaction. And when doctors complain that these payments fail to cover even their office expenses, insurers threaten to exclude them from their company’s increasingly narrow networks. Already insurance companies prohibit about one-third of providers from participating in the state health care exchanges.
  • And being prevented from providing the right therapeutic option is frustrating and exhausting for physicians, particularly when they read that the insurance company used 15% or 20% of the patient’s premium for administrative expenses and return to shareholders.
  • Entering and retrieving information via EHR can take a physician inordinate time compared to entering the information in a paper medical record. And the high number of clicks required, even for relatively simple problems makes many physicians feel like data-entry clerks. Combining the added time to document with the need to see more patients a day, physicians are acutely aware of how much less time they now have with their families and each of their patients.
  • Were the government to run our health care system through a single payer, the inevitable red tape and politicization would be disastrous.
  • And selling your practice to a hospital or insurance system, which many doctors have embraced. proves even more frustrating for most as the demands imposed by these institutions once the deal is done more than offset the short-term advantages.
  • So what can be done? Already there are organizations like the Mayo Clinic, Kaiser Permanente and Geisenger Clinic that have overcome many of these problems and improved the lives of both patients and physicians as a result.

He does explain what is killing us doctors today.  I will give him that. He had me going and hooked for awhile until the last part.  That is when he started praising the “employers” of doctors in the last bullet point I give and he is doing that because he is an administrator who employs doctors. So, let’s see where this goes in part three. I would amazed if he mentions direct primary care.

(Had to put the Charles Bronson poster as the image.  Who doesn’t love Charles Bronson?)

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Hard Times

  1. August 20, 2015 at 8:36 am

    I agree. It sounded great until the last paragraph.

    I have patients who are hospital employees. The hospital contracted with Geisenger to administer their health plan. They are miserable. If you don’t see a doc who is owned by that hospital group, because they only contract with themselves, you get nothing covered. So much for “If you like your doctor, you can keep your doctor.” A lot of patients don’t want their employer to also be their healthcare provider. Just a little conflict of interest there…

    They claim that outside docs can be part of the network, but those who have tried get so much runaround when they try to order anything, that they give up and drop out.

    In their own mind, they are their own DPC. The only problem is that they are the exact opposite!

    • August 20, 2015 at 8:45 am

      And BTW:

      Charles Bronson is AWESOME!

  2. Perry
    August 17, 2015 at 10:45 am

    I like that, just become a member of the medical industrial complex and you’re life will be great!!

    • Perry
      August 17, 2015 at 10:46 am

      “your life will be great”

  3. JRDO
    August 17, 2015 at 10:21 am

    Re: EHR. I am to the point that I would welcome doing what another highly litigated job (cops) does- video taping all encounters with “customers”. I could significantly limit the time I spend on data entry and basically just check off on a billing encounter. If I get audited by an insurance company, the auditors would be welcome to sort through all the hours of video. I know what Dr. Farrago would say- DPC is the answer……

    • Doug Farrago
      August 17, 2015 at 11:54 am

      I LOVE that idea you have. Holy shit. Brilliant. Need to write about this. Some patients would not want filming done but then they would have to sign off of ever suing you. The problem would be with insurance companies counting this in their audit. Remember, THEY make the rules. So, yes, DPC would still end up being the only choice.

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