Many have commented on my laments at the difficulty of practicing primary care in the US.  One of the recurrent themes centers around whether or not physicians should just stop accepting insurance altogether.

One reader commented:

For me, the doctors I see most frequently simply don’t take insurance. Less office staff, more doctor time. I pay a 30% out of network copay, which often doesn’t work out to much different than what my office visit charge would have been anyway. those doctors take phone calls during the day, call back at night, etc. The minor difference in cost is worth it!! they are always booked and seem to be doing fine financially. In this area, in certain specialities, if a doctor is any good, they have opted out of insurance.

If you can’t get an incentive system with the insurance companies, I would consider the no insurance model to be a good one.

And another:

We sit and wait for someone else to fix the system do not become proactive, and wait each year for the bad news from the insurer, medicare, etc.

Patients….fire your classic insurance company, opt for a very high deductible or a major medical polilcy.
Doctors….stop taking insurance except for surgeries, hospitalizations and/or major workups.

You will see how fast the insurers belly up and change their tune…..Americans unite, we do not need them…

In his editorial in USA today, Kevin Pho points out that over 40% of Texas physicians don't accept new Medicare patients.  Truly, if the recent Medicare cuts had not been stopped, our practice would have lost money on many things we do and would be forced to strongly consider doing the same.

money_cash The business argument for quitting insurance is solid.  I would not need billing staff, could give upfront fees to patients, and could set my rates as I saw fit.  I would not have to do authorizations for procedures - passing any hassles off to other physicians.  In my market, I could even charge an annual fee for the many IT services we offer above and beyond what most practices offer.

Ironically, I could also start not charging patients if I choose.  Since I am a Medicare provider, to no-charge a non-Medicare patient would be considered fraudulent.  Why?  Because I am not also extending that discount to my Medicare patients.

So why don't I do it?  Why do I hang on to the arcane, complicated mess of medical insurance?

If you ask a patient who their doctor is, they will almost always refer to their primary care physician.  I am their doctor and they are my patients.  As a physician, I have taken on the task of helping my patients navigate through their sicknesses as well as working to prevent them.  This is the reason I chose primary care: I wanted to build long-term relationships with my patients.  I wanted them to see me as their doctor.

Specialists  deal either with a single body system (such as heart or lungs) or perform procedures the patient needs on the short-term.  They do build long-term relationships with some patients, but it is only the sicker, more complicated patients.  Even then, they (hopefully) send their notes back to the patient's PCP, so someone can know and understand the over-arching needs of the patient.

Dropping insurance would come at a cost: I would lose a large number of my patients.  I like a lot of them.  I have helped them through tough times and have enjoyed having many of them.  They aren't all demanding.  They aren't all frustrating.  They are just caught in the same mess I am in.  It is very hard to cut them loose in a time when the PCP market is shrinking.

obit_young This is a big reason as to why the trust between patients and doctors is going down.  Physicians are being forced to decide between money and patients.  They are being forced to look after themselves when their job is to look after others.  This contradiction is not lost on the patients and causes doctors to become suspect in their eyes.  The focus on the business of medicine has taken the focus off of the practice of medicine.  This is why many patient feel "like a number."

It amazes me that I would even consider dropping insurance.  The cost would be huge.  I would lose many long-term relationships.  They would feel jilted and betrayed.  It would appear that I am "all about the money."

Even though my income would go up if I did, I am not ready to do that to my patients.  It is emotional, not economic.

Let's just hope that things change before I am forced to stop being their doctor.

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