houseofcards I was sitting in a conference recently;  the speaker was talking about the Medical Home and how one practice was getting nearly $150K for managing a patient population using a new computerized tool.  Sounds good. During the question and answer period I asked the speaker:  "Shouldn't we wait until insurance companies are willing to pay for this before adopting it?  If we start giving this care on our own, what motivation will they have to pay us for doing it?"

The speaker smiled and agreed that the "market would have to mature" before this technology could be adopted.  If we do adopt too soon, we run the risk of giving higher quality for nothing.  We do extra work - above and beyond what we are doing now - and do so "for the good of the patients."  Yet while the patients and payers benefit, our hourly rate goes down.


Here is a technology that improves care and potentially saves lives, and yet we are waiting for a good business case to do it.  Only in America.

A physician came up to me after the talk and said, "No matter what happens, we physicians are going to get screwed."

That is the climate we practice in.  Morale has never been lower among physicians.  We are all tired of bearing the responsibility for change without sharing in its fruits.  Any new program that comes along is suspect.  Where's the catch?  How is this "great new idea" going to lower my bottom line?

Why can't we just get paid for doing a better job?

Let me make this clear:  I do whatever I can to maintain the best quality care for my patients as is possible.  I am proud of the quality I do.  Our practice has actually surpassed most reported quality numbers by far.  We do well despite this climate.  But the rank-and file physician is frustrated with having to choose between good care and good business.

I really see an attitude - especially among primary care physicians - of resignation.  I think a bunch of doctors are on the verge of either totally dropping insurance, or quitting medicine altogether.  This will make an already bad situation for patients disastrous.  Sometimes I even wonder why my practice keeps accepting insurance.  It certainly is not because it is a wise business move.

Note to politicians:  be careful what you do.  A bunch of physicians are hanging by a thread.  They are tired and cynical.  Make the wrong move and the whole house of cards will crash.

Some "insiders" have told me that the folks in Washington really get it, and primary care is about to get a really big boost.  Well, I hope so.  But I am not keeping my hopes too high.  I am planning for the worst.

And I am one of the more optimistic physicians.