Influencing the Healthcare Debate

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I was tipped off about this letter and was given permission by the author to post it here. We doctors are not alone. Enjoy and please leave some comments for her!

“This is the first letter I have ever written to influence the healthcare debate and I pray that someone will bring this letter to your attention. I have been a physician for close to 30 years. I am a second-generation pediatrician struggling to keep an independent solo practice alive. Not one politician has addressed what I feel is the major threat to health care…the physician-patient relationship. Without this, there is no quality of care no matter what you do. Physician-patient relationships require time with the patient. Most of my diagnosis is derived from my patient-parent interview and a “hands on exam” of the child. You cannot possibly read a cookbook of medical questions and treatments and have the same result. The current insurance treadmill model of primary care makes this impossible.

There is a hemorrhaging exodus of well-trained physicians unwilling to jeopardize this patient relationship.
Insurance companies are pushing the small man, like myself, out and replacing us with cheaper, less qualified “health care extenders” i.e. nurse practitioners, physician’s assistants, pharmacists, or whomever they can place in a white coat for less money. This is at the expense of the patient and the profit of the insurance company.

I have done everything by the book. During my 12 years of postgraduate training I earned a degree in chemistry and biology, a Master degree in Microbiology, and MD degree from Georgetown University Medical School where I also completed my pediatric residency. I am board certified and recertified. I have a spotless record and a loyal patient following. I am not saying this to fluff my feathers but to emphasize my dedication to my calling. It is not just a job to me, this is what I was meant to do, and I will only do it the correct way.

Coming from generations of physicians, I take my job very seriously. My father was also a pediatrician and started his office in the basement of our home. I know what quality care is, and what it is not. I grew up knowing that medicine can exist without the interference of insurance companies. At that time, people paid a fair price for an office visit and had catastrophic hospital coverage for hospitalization and procedures. (My father actually was the physician who saved John F. Kennedy’s son John John. His name is Dr. Ira Seiler M.D. It is a true story accessible through the archives. He also attended John F. Kennedy’s inaugural ball and parade).

My father instilled in me a respect for the patient-physician relationship without which there is no quality care. Insurance companies have continued to decrease our payments knowing that we will need to see more patients in a shorter amount of time to make up for the decreasing reimbursement rates. You do not have time to foster a patient relationship. This may result in more medical mistakes but ultimately bring in more money to the pockets of the insurance company. This is a very dangerous game, and I have refused to play it. For that I have been threatened and penalized.

I am trying desperately to keep my small practice alive. I spend at least 30 minutes with each patient, they have access to me via my personal cell phone 24/7. I have no wait times, will always see a sick patient that day, try to avoid ER/Urgent Care visits by seeing the patient after hours myself ( to avoid medical mistakes since after hours clinics usually are not staffed by pediatricians and I end up correcting the mistakes at 3am for free anyway). Many times I’ll bring a chart home and research a condition and if I don’t know something I will find out. And for this I am listed as a physician that is not cost effective, or in other words I spend too much time per patient which results in less revenue to the insurance company.

Medicine is not a 9-to-5 job, it is a calling and my greatest fear is that no one is going to want to do this job for a salary of $6000 a year, which after all my office expenses, I earned. And that is not from poor business skills or lack of patients. It is from decreasing reimbursement rates and higher overhead. This is why most physicians have left private practice to join hospital settings or larger groups. Many people don’t know that I have to pay not one but two malpractice payments in the state of Pennsylvania, licensing and board fees, rising medical and office supply fees which total @ 15,000 a month. I have one nurse, a receptionist, myself and one part-time relief doctor who is amazing having trained at both Duke and Northwestern. I have not taken a paycheck in 8 months.

I continue to do this job because that’s what I was meant to do and I don’t want to give up on my patients. I should not be subject to prejudice for practicing good medicine. I am scared who will take care of these children or my family when those like me are finally forced out completely. I am not a “healthcare provider”. I am a “physician” and there is a very big difference.

I hope that you will think about this in your fight for repealing healthcare because it’s more than just repealing Obamacare, it is putting medicine back into the hands of the patient, consumer, and the physician. Insurance companies are for profit companies, parasitizing my expertise and exploiting your savings. If they are getting paid for my expertise and training maybe the CEO’s of these insurance companies should try doing the surgeries and treating the patients themselves.”

Sharon Jellinek MD

 

Editor’s Note: This is why Direct Pediatric Care would work for great physicians like Dr. Jellinek.  She could give 10% away free to help those in need and still make a great living.

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] 

  16 comments for “Influencing the Healthcare Debate

  1. Soccerdoc
    February 20, 2016 at 9:29 pm

    Well stated Dr. Jellinek. I started my solo family medicine practice in two rooms next to a hair salon 36 years ago. As I often explain to patients, “no matter how bad your day, someone is having a worse day”. You are having a worse day than I am. Trying to balance the good I can do with the crap I put up with makes every day the last one before I retire.

  2. Kurt
    February 17, 2016 at 4:15 pm

    Leave? Yeah, Doctor is right. All the FP’s I know want to retire as soon as they can.
    ABFM sent out a blurb they’ll give a discount on the MOC crap to anyone who wants
    to maintain certification after age 70. Who are they kidding? I see the disgruntled want to change
    careers by age 55 and leave.

    Kurt

  3. DrPhil
    February 15, 2016 at 7:16 am

    The typical politician does not trust this patient-doctor relationship… is very suspicious of something out of their control that they can never be a part of (remember most politicians start as lawyers)

  4. Steve O'
    February 13, 2016 at 8:54 pm

    PS- Pam Wible is brave enough to talk about how A Million Patients lose their Physicians To Suicide every year.

  5. Melinda
    February 13, 2016 at 7:21 pm

    I am a veterinarian and I applaud this letter, too. I have watched over the years as you physicians have had to deal with more and more control of your income and independence and ability to practice medicine, and as pet health insurance has gotten established more slowly, have feared having similar issues. They have not happened as yet, mainly because we are still at the level that the consumer still pays the bill then gets whatever portion is covered reimbursed from the insurance company. I will never have to deal with what you have to deal with because I had to take a medical retirement recently, but as I see numerous doctors for myself, I have great sympathy for all of them. I have a platinum policy through Obamacare (I could pay my premiums, I just had no employer after I sold my practice, so having a place to get health insurance not through an employer turned out to be very helpful to me–this after opposing Obamacare before it passed…) and am now on SSD (I paid into it for all those years, and I may not live long, so of course I am claiming it). I just received in the mail a “Welcome to Medicare” packet even though I’m only 59. My husband wants me to cancel the platinum policy and stop paying premiums but I am concerned that I will have fewer treatment and doctor options and they will get reimbursed less. I don’t want to do that to my doctors because I understand somewhat of what they are dealing with, so I’m not sure what to do for my own cancer care and my doctors who have been dealing with such terrible pressures.

    Great job on this letter. I hope it somehow makes some meaningful difference for doctors, which in turn will benefit patients.

  6. Jeff
    February 13, 2016 at 5:57 pm

    I agree with almost everything that is said, minus the underhanded attack on PA and NP.

    Yes physician training is more rigorous, but to say that only a boarded physician can care for a patient is a logic error. By this logic only a cardiologist should care for HTN and Lipids, and only an Ortho should handle the sprained ankles.

    What we need is not a physician centric system where a group of physicians starts some of the first health insurance companies so they can charge more and get paid (S Cal Blue Shield) or another closed door meeting dominated by specialist physicians setting the ‘value’ of all the CPT codes (true story even to this day).

    We also do not need our best most caring physicians (which you sound as one) burning themselves out on the front lines and slinging mud on other professions, because your own profession has essentially become dominated by specialists and the GP/internist/Peds doc got sacrificed with ever decreasing reimbursements while speciality pay continues to rise.

    What we do need is for an amazing physician like yourself to realize that medicine as an industry has done a HORRID job of utilizing technology to any meaningful way, as well as realizing that the medicicine of today and tomorrow is no longer an individual sport.

    As a practice owner and one who has embraced the roles of PA and NP I can say they are highly valuable intellengetn caring professions. We need to look forward and work together to protect primary care from further degradations at the hands of the establishment.

    On a side note, with two business degrees and following the amazing advancement of the medical establishment in the past 10 years, I can say we will be in a better place when technology is leveraged to aide and assist the providers do an even better job. Those who refuse to adapt and change will be a thing of the past and be slowly forced out. Innovate or die.

    Realize that MD, DO, PA, NP area all great providers and add a huge amount to the medical delivery for our nation.

    On a more argumentative note(and I apologize for it), I find it strange that doc’s are so upset with the system that has developed, when they themselves had a role in developing it. Same thing goes for the opiate epidemic – doctors helped create it. I tire of the PHYSICIANS hiding behind the “patient relationship” and at the same time take bribes, speaker fees, pay offs, and other less then ethical propositions all while saying they are pure and 100% committed to the patient. Do you really believe drug companies would have spent BILLIONS of dollars on lunches, pens, trips, CME, presents and the like if it did not directly influence prescribing habits? I think not – yet it was a force OUTSIDE the medical establishment that ended most these processes. I for one am glad they are gone.

    Everyone needs to realize they are both a part of the problem and solution and anyone that laments the “good old days” and talks down about the solutions is someone who has been left behind due to a failure to adapt, or someone that was getting something for nothing.

    I am excited with what the future of medicine holds. I see my business school friends with amazing data mining and technology and I wonder what we could do for society if we had even one tenth of the computing power focused on the health and well being of our citizens. We as a country have basically failed our citizens if you look at any WHO study of health in the past 20 years……..

    • Pat
      February 13, 2016 at 7:31 pm

      “Under handed attack”? “Physician-centric”? “Amazing data mining”? “Realize that MD, DO, PA, NP area all great providers…” Thanks for devaluing the years and boatloads of cash I’ve invested.
      How clever, and how deceitful that you attack anyone as an adaptation-failure who doesn’t want to burn their days playing your redundant, wasteful point-and-click games.

      “Protect primary care from further degradations”? You ARE the degradation. “Innovate or die” – its not ‘innovation’ to dilute definitions and buy into mob mentality for its own sake. The establishment you criticize is one that you represent and serve, by your very own comments.

      Jeff, you truly are the future of health marketing, and a beautiful example of how I hope, one day, to find some other marketable skill and leave this rotten industry to the pretenders and med-robots.

    • Steve O'
      February 13, 2016 at 8:47 pm

      I have not done one iota, committed one act that you condemn. You praise the “reforms” in technology that crush us uncaringly, inhumanely. You are part of the New Medicine? All I see is a white coat over a brown shirt. Here you go, take it! I am sick of ressentiment and the new Order. Take it, keep it for your Movement! When the EMT’s prescribe, let it happen! It’s reform and slay the dinosaurs. I Am one, good-bye.

    • Dave Mittman, PA, DFAAPA
      February 14, 2016 at 3:42 pm

      Thanks Jeff. Seriously, thank you. As I said, NPs and PAs are part of the solution and if physicians were smart they would realize that sooner rather than later. Over 50% of all family physicians work with NPs and PAs, maybe much higher numbers. And I bet the number of surgeons with PAs is even higher.
      We are all in this mess together. Stop taking pot shots at us.
      I know I and my friends are excellent clinicians. Not all of us-but not all of you either. Time to come together and not worry about if PAs can sign this form on their own or not…..
      Dave

  7. Patty Grossman
    February 13, 2016 at 12:38 pm

    Dave Mittman, she is not insulting you. We’ll take your word for it that you give good care. But I do hope that you won’t try to assert that your education, training, and care are equal to that of a specialist physician, because it’s not. That is her point – someone is replacing physicians with “cheaper help” and that someone is making a buck off the deal. That’s not right. Btw, I’m an RN myself and I would never try to claim that I’m just as good as a doctor. If I had wanted to be a doctor, I would have gone to medical school.

    Fantastic letter. Things have to change in this country or we will lose all our good people in every field, not just medicine.

  8. Dave Mittman, PA, DFAAPA
    February 13, 2016 at 11:56 am

    I fail to see why attacking PAs and NPs will help her problem?
    I have been a PA for many years and worked with a group of great physicians. Don’t hit me with the “independent” stuff, even in states where NPs are independent over 90% work in practices physicians own, as do PAs,keeping those practices alive. The quality of care I gave was excellent.
    We are not the problem.

  9. Fred Powell
    February 13, 2016 at 10:58 am

    This is the kind of physician I’d want to take my kids to. IMHO, it’s the way quality medicine is practiced. In the current system, solo practitioners have no leverage, so their payments suffer. And if they don’t jump through all of the overhead skyrocketing “quality” measures, then the payments suffer more.

    RE the comment above about Medicaid–I have no idea, but if she made 6k last year, the answer is likely yes. That’s the kind of money those who have an office full of Medicaid patients make. The rate is about 50% of the Medicare rate. Most of us who have our own offices pay about half of what we make to just run the office. So, if lucky, you might break even.

  10. Dr. J.
    February 13, 2016 at 10:42 am

    Dr. Jellinek sums up the devastating effects of the current system. I too was in solo private practice trying my best to actually take care of patients rather than taking care of the charting and coding. Meanwhile a patient who could not see me the same day went to the “Minute Clinic” where she was billed a 99204 and given a dozen pages of charting for a problem that required 10 minutes at most to fix. I am retired now and not a day goes by that I don’t celebrate being free from the nonsense.

  11. Pat
    February 13, 2016 at 9:03 am

    I wonder whether Dr. Jellinek was a supporter of the Affordable Care Act; and whether she sees children on Medicaid.

    • Rich
      February 13, 2016 at 10:25 am

      I don’t know if she accepts Medicaid or not, but it sounds obvious to me that she is not a fan of The Affordable Care Act. Honestly, I’m not a fan either but I do know one thing – based on what she has written, I would want her to care for my children. So sad that people have to politicize everything that is said or written. Maybe if that didn’t occur we could have a better system.

  12. Steve O'
    February 13, 2016 at 8:58 am

    Thank you so much, Dr. Jellinek. It is no coincidence that the corporate machines are doing what THEY do, and you are doing what YOU do. Humanity, dignity, empathy are considered suckers’ behavior by so many in our world; there is a way to loot the productivity of those who are, at their deepest levels, dignified and mature human beings like yourself.
    Pediatricians in particular are stewards of human lives, which are not yet mature enough to take on the world independently. They need other trustworthy decent people in their societies to flourish. Those of us who give the best of who we are, are becoming tired, broken, exhausted, demoralized.
    Many of us hope to become recognized again with honor and dignity towards us – in the same way we give honor and dignity to our patients. I fear that we will not see it during our practice lifetimes. Some avenues promise to allow for dignity and humanity, such as Direct Pediatric Care. I greatly fear that the DPC will be assaulted. Socialism never works when the back door is left open.
    The ineffectiveness and inhumanity of the system we have, and are racing to perfect, has been obvious to so many for so long, it is impossible to imagine it comes from naivete alone. The sick will bankrupt themselves, clinging at any thread for the hope of life. Those charlatans and quacks who knowingly sold ineffective treatments to the dying – they have inspired our business model today. Cruelty and deception can yield immense profits.
    -The ineffectiveness and inhumanity of the system we have has been obvious for many years. 75 years ago, Charlie Chaplin offered, in The Great Dictator, these words of wisdom:
    “Greed has poisoned men’s souls, has barricaded the world with hate, has goose-stepped us into misery and bloodshed. We have developed speed but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical, our cleverness hard and unkind. We think too much and feel too little. More than machinery, we need humanity. More than cleverness, we need kindness and gentleness. Without these qualities, life will be violent and all will be lost….Don’t give yourselves to these unnatural men, machine men, with machine minds and machine hearts! …Let us fight for a world of reason, a world where science and progress will lead to all men’s happiness.”
    Thank you for doing what you do, Doc. Many civilizations, cultures and societies have come and gone through our species’ brief lifespan on planet Earth. Ours will pass, to. What you are giving children is a little seed of hope, which may not emerge in this generation or the next, but sometime again when humans are valued for who they are, when human helplessness and vulnerability is cherished and protected again, some time when adults are permitted to grow into heroes again, rather than a clutter of selfish, petty adolescents. Whether your or I live to see it, is immaterial. Whether it happens is indisputable – it is a truth at the core of human nature. How long and how severe this winter of inhumanity lasts, depends on people such as us.
    Be a superhero – but beware the Kryptonite.

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