No Choice by Pat Conrad MD
Let me stipulate from the outset that this is not a criticism of Medical Economics magazine, a well-presented and generally upbeat publication. I like the mag, and enjoy browsing through it as a way to keep an eye on the current industry trends, beyond whatever lies, threats, and prevarications lately dispensed by HHS and the AMA.
So sitting here in the ER amidst a rare full-moon lull, I was catching up on a back issue or two, and began to peruse the December 10, 2011 issue. After a scanning the table of contents and the opening lines of a few salient articles, I flipped back to the cover to confirm that no, this was not the end-of-year “Doom & Gloom” issue. One might be forgiven for mistakenly thinking so. The lead editorial was from health law attorney Alice Gosfield entitled “Pull Up Your Socks”, straightforward advice to doctors to get on board proactively to prepare for “the looming advent of value-based physician payment in Medicare.” The article factually notes the federal penalties 2 years off for those practices “failing to report data”, and – logically – stresses that the “real mandate is to get going” with the work of clinic standardization, integration, and data collection, the better to collaborate with payers.
Another article warns of the impending mandatory transition to the 5010 HIPAA electronic standards, and the dreaded ICD-10. An inset window of bullet points smiles in Orwellian chill: “Despite the transitional effort and costs, ICD-10-CM is expected to be beneficial to everyone.” The reader learns that adopting these new mandatory standards will be akin to New Jersey retailers adopting protection from local “legitimate businessmen”: highly advised. It sure would be a shame if your EHR was to burn down.
Other articles feature more anecdotal evidence of the practical and philosophical shortcomings of Medicare/Medicaid, advice on retirement planning, and regular attorney-contributor Lee Johnson’s advice that “Optimism May Reduce Malpractice Risk.”
When this issue hit the mailbox in mid-December, I was beginning an annual stint teaching first-year medical students, two of which had been assigned to me in my little small town ER to get some experience interviewing patients, doing physical exams, and picking up a little of this or that. Every year their enthusiasm and the pleasure of teaching has been a professional booster shot for me, always the best time of year at work. I try to raise questions in a positive tone with them about their future and how they will best adapt themselves to the worsening professional upheavals before us. With the students now back to classes and with a little more time to reflect, I have to wonder whether my attempt at optimism best served my charges. Yes I’m glad to have work that is thus far, steady in contrast to sour economic days. But I also must admit that I am part of a profession that is participating in its own consumption; that I am helping to consign students to a lifetime of being ordered about by those who do not understand what it is they do, and who exist only by the efforts of those to whom they can attach ever more mandates. Would anyone who first read and comprehended this issue of M.E. still want to go into medicine? And if they did, what would that say about them?
No, they cover story of this issue was not “Doom & Gloom”, but it wasn’t much better. The centerpiece article was “Maintenance of Certification Process Sparks Debate.” Debate maybe, but like everything else now involving this job, the only choice for the doctor is whether or not to quit.
