Uh Uh Tomorrow is Payday

Photograph Courtesy of Bob Cuthill

Tomorrow is payday and that is difficult in the life of a primary care physician (I’m not trying to get you to feel sorry for me, just trying to explain the realities of being a primary care doctor in 2010).  Can’t make payroll tomorrow.  This has become a frequent occurrence over the past two years as reimbursements have decreased and the number of patients that need to be seen daily has increased.  

The next time you get frustrated with your primary care doctor (not necessarily the case for some specialists, who are reimbursed at much higher rates) because you don’t have enough time with them, and you have had to wait for a long time in the Waiting Room, remember:  Primary Care doctors have to see more patients in a shorter period of time to keep the practice open. 

Medicare, Blue Cross and other companies audit doctors who routinely see (and therefore bill) for longer office visits.  United Healthcare used to routinely, unilaterally, downcode my office visits from higher to lower levels.  They underwent class action suit and had to stop that practice.  In the end, remember that insurance companies want profits (How else can the CEO make $25 million dollars?) and one method is less reimbursement for doctors. 

But doctors are really rich, don’t work hard and make a lot of money, right?  Put yourself in my place.  If you sacrificed your twenties and thirties hanging out 48 hrs at a time in hospitals taking care of incredibly sick patients, would you be willing to earn less than many nurses, podiatrists, dentists and nurse practitioners?  Ask yourself honestly.  Do you expect to be paid for your time?  Or do you work at Wal-Mart for free?  Do you get free food at the grocery store (Ok, food stamps don’t count–hopefully at least your kids get to eat with the food stamps).  How about free gasoline for your car? How about a free car because you are a nice person and don’t want to get paid for working as a waitress. Hmm…you mean you do want to get paid?  And you work harder than doctors?  And how about those hundreds of thousands of dollars in student loans you accumulated trying to become a waitress.  Probably don’t need to pay those back right? 

And when you go to the grocery store, you get free food, right (OK, food stamps for your kids don’t count.  It is important for your kids to eat).  And free gas for your BMW, right?  And your mortgage is free, too, right? 

Anyway, my point is that everyone deserves to be paid for working hard, and should be able to repay their hundreds of thousands of dollars of school loans (My family isn’t wealthy).  I don’t want to pay to be a doctor, which happens frequently. I have to “lend” my office money when I can’t make payroll.  Problem is, I “lent” the office $6000 last week to pay for the credit card bill with vaccines, medical supplies (know how much that table paper and gloves cost???) and my malpractice insurance.  So now I don’t have anything left to “lend” my practice.  And three people who work with me in the office also depend on me to feed their families.  Never thought this is what life as a doctor would be like. 

So the answer has to be see more patients, less time, not fair to patients or to me.  But the way it is in the primary care world.  Oh, and I have tried praying.  A LOT. 


Last updated April 25, 2010 by Dr. Vee

One Reply to “Uh Uh Tomorrow is Payday”

  1. Dr. Vee, I empathize with your dilemma. Does this then make it okay for my internists to delegate total responsibility for my care to specialists and fail to heed my complaints when the specialists couldn’t come to terms with which one was responsible for diagnosing and treating me? I became disabled at age 50 unnecessarily as a result. I lost all my savings, am facing home foreclosure and am in very bad health as a result.

    I’m not blaming you. But you could seek alternative career options like applying to the Cleveland Clinic whose physicians and surgeons work on salaried annual contracts. Why do so many doctors become victim to big money mandates?

    My primary care doctor now does not accept any insurance and he has a thriving business. He spends a great deal of time with his patients. He is doing marvelously and has even added two more doctors to his practice. His secret? He actually helps patients heal, and doesn’t just shuffle them from one test and doctor to the next. He is an alternative medical doctor who seeks to treat the root cause of illness and not just mask symptoms (the messengers of underlying disease) with expensive pharmaceuticals.

    From my window now that I am no longer able to work thanks to modern medicine, you are lucky that you can still work and turn your career around if it isn’t working out for you. Being pressured and stressed is not helping any of your patients receive the care their insurers told them they would receive when they signed up.

    Explore and you will find there are many options for your medical career that are not dependent upon insurance company dictates. We encourage what we permit. So by playing the insurance company game, you become one with them.

    My experiences with doctors during the time before becoming disabled are portrayed on my blog http://doctorblue.wordpress.com


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