The New America - Second Rate and Falling

There seems to be a general sense of dissatisfaction that pervades our lives today.  It touches us not only when we evaluate our own sense of self worth, but also reaches into our professional lives and grabs the satisfaction that work should bring.

Perhaps the current economic state of our country is to blame.  Or maybe our inherent sense of fear about the safety and security of our homeland.  Before the towers fell, we would awake and think about what tomorrow would bring.  Now, some parts of our minds worry that we may not make it through another day.  On September 11th, 2001, I remember driving home from work and being overcome by the pervasive silence that marked my journey.  People seemed to drive in a trance-like state, their hands at ten and two, knuckles white without awareness that they gripped the wheel a bit harder than usual.   I was overcome by the feeling that after this event we would live our futures being kinder and gentler to each other.  We would see the worth in each of our fellow citizens and treat each other with a new sense of respect and consideration.  But that didn't happen.

First the towers fell and then the economy tumbled to the ground as well.  We witnessed yet another war where our young men and women died in the sand fighting against weapons of mass destruction that were a fantasy of another group of men that would profit from bullets, tanks and oil.  We found out that it was not a kinder, gentler nation.  Bernie Madoff, the Wall Street tycoons and the banks that we supported with our hard earned dollars bilked us of billions of dollars.  The Dow took a downward spiral along with the savings of those who had worked a lifetime to put away a few dollars.  Jobs were lost and we now lived in a country where we produce nothing but lives that are designed to be wasted at war.

We fool ourselves into a sense of complacency by concentrating our attention on the cultural media.  Reality shows that highlight fools more lulled than ourselves.  The Kardashian marriage, rich Housewives fist fighting in public arenas, the zero IQ's of the Jersey Shore, posting our meaningless nonsense on Facebook and Twitter, never commenting on just how drastically our lives have changed. Sometimes, I think what emerged from the ashes of the Towers was a new sense of greed and self loathing and an attitude that life has become cheaper, instead of more valuable.  Many of us lucky enough to have jobs clock in strictly for the check and our sense of caring for our fellow man has gone the way of our country's greatness. Instead of engaging in meaningful dialogue, we drug ourselves with media hype, until we believe that there is something worthwhile about everything we do and say.

We used to have the greatest healthcare system in the world.  Now, doctors caution patients to avoid hospital stays as much as possible, for truly your very life is now in the hands of those whose apathy is palpable.  Amazingly, we discuss ways to avoid treatment for our patients, and actually have a plan to reward ourselves for doing so.  It is all too much like "The Emperors New Clothes," to remain comfortable for anyone who is rational and righteous.

Wake Up America and take stock of how you are being manipulated before your ashes join those of the innocents who perished for a nation that is on it's way to becoming second rate.  

Greed- and Your Reputation in the Medical Community

Those of us involved in the healthcare industry love to share the tidbits and gossip of what's going on in the practices in our community.  While there may be hundreds of practices in our particular demographic area, word spreads like wildfire when a physician practice does not work or play well with others.  A practice may find itself literally blackballed when it comes to referrals from colleagues when business models are based on the Gordon Geko philosophy of "greed is good."

There is a world of difference between a healthy attitude of ambition and a toxic desire for money that allows certain physicians to ignore the rules of healthy partnerships and collaborations.

In our current climate of reimbursement reductions, physicians are using their imagination and resources to create marketing programs and lease space arrangements that should benefit all parties involved.  Many practices have enjoyed great success as a result of these collaborations, however, certain parties cannot find satisfaction unless they take much more than their mutual agreement called for, or worse, find a way to constantly renegotiate their business deals to their own advantage.  It may take a while for the manhandled party to realize they are on the short end of the deal, but sooner or later the deal falls apart and the reputation of the physician who did not keep his promises often cannot be repaired.  

We have seen a societal change in our country where fair play and hard work is downplayed in favor of winning at any price.  Pride in a job well done has been replaced by the sole desire for material reward.  Indeed, it becomes increasingly difficult to find employees or even professional staff who operate with kindness and consideration both for patients and colleagues alike.   All of us have born witness to those barracuda physicians who operate as if they were the only game in town.  Partnerships are broken, employees become disgruntled and burn out, and fellow physicians stay as far away from the practice as possible.

Often, these "bad press" practices initially enjoyed moderate success and were well respected in their communities.  Over time, however, they failed to acknowledge some basic truths.  The first and most important rule that is disregarded is that every business eventually reaches the "glass ceiling of cash."
There are only so many patients that can be effectively treated in a business day.  You may have taken your practice into the millions of dollars range, but eventually you will reach a level of reimbursement that is appropriate for your specialty and the number of physicians that you employ.  The expectation of a "no limit" cash flow year after year, is unrealistic and the physicians who deny this basic tenant will go over and above the rules of fair business practices.  

A second and perhaps more grievous error is the hiring of multi-specialty physicians outside of your specialty before due diligence is performed.   Practices who deal in this behavior are constantly in a revolving door situation where physicians come and go, often at great expense and legal consequences.  These physicians do not make an adequate study of whether or not the incoming physician will be a good fit for their patient demographics and they may not realize that they are now paying for a physician in the same specialty as those doctors in their community who provided them with referrals.  They ignore the warning signs for the sake of "empire building" and may lose the possibility of future practice growth.  Many of these business deals end up in disaster, especially when the physicians who join the group do not meet their expected financial goals.  The comings and goings of these doctors have serious implications for the hiring practice and the unhappy physician who ends up leaving the practice will eventually voice his complaints loud and clearly in the community at large.

A medical practice cannot exist in a vacuum.  Those in our community will not experience our level of skill or caring attitude in the exam room.  We will be judged by our fair and equitable business practices and once our reputation is damaged, repair may not be possible.

Finding Your Fit

For those of us who have worked hard and successfully in the health care industry, opportunity often allows us to move forward up the chain of command.   Some navigate these changes and find a home in their new position, while others may end up feeling adrift and realize that their new job is just not the right fit.  Sometimes, we are motivated by the money, sometimes just the flattery that accompanies advancement is enough to induce us to move forward in our careers.  What should motivate us, make us stay in our new jobs, or admit that moving on was a mistake? 

The biggest falsehood in any career move is believing the adage that what one man can do - another can do just as well.  The fact that we have been noticed and appreciated for our work ethic does not necessarily mean that we can make a smooth and happy transition to any job description.  In order to assess our chances for satisfaction, it is necessary to make an honest appraisal of our skills and to understand where our motivation lies when it comes to career choices.

Many individuals report to work each and every day for no other reason than their weekly paycheck.  There is noting wrong with having the sole motivation to satisfy our financial obligations, and indeed how many of us would continue the grind of the work week if we suddenly won Lotto?  If you find that this describes your attitude toward work, then as long as you do your best each day, you should accept that climbing the ladder of success may not be for you. 

First and foremost, all of us should take an honest appraisal of our skills.  If paperwork drives you absolutely mad and sitting behind a desk for eight hours is akin to water torture, you probably should not think about taking an administrative position.  The money may be great and initially your ego may be flattered, but eventually you will find yourself bogged down by your responsibilities and your job satisfaction will continue to decline.  This is especially true if you have spent a large portion of your career at the bedside or engaging in some form of direct patient care.  Although difficult, many health care professionals who have moved into administration find that they pine for the days of one to one contact with patients.

Secondly, you should always consider your training before you accept any position.  What skills have you honed in your career?  Are your skills transferable to a new role in health care?  What is the learning curve?  

Most of us expect that we will have a mentor to aid us in our new roles, but without essential skills in place we may still flounder.  Our mentors may also be struggling, especially since health care is ever changing the way we process information and patients, so daily access to those who can make our transitions smoother may not be readily available.  Successful transitions involve the ability to customize our new positions so that they reflect our strengths.  Trying to make an exact fit into the existing job description will not allow for growth and positive change.   Claim the playing field as your own and use your essential skills to individualize your position, so that you and your new opportunity will be seen and appreciated as one entity. 

 

Help in the USA ? Not Anymore

There was a recent news story about the construction of a house made strictly from materials made in the USA.  Every single product from nails to bathroom fixtures was a product produced here.   The builder compiled a list of each product and their associated costs to forward to construction companies throughout this country.  His best estimate showed that new construction comprised of only American produced products would result in the creation of over 200,000 new jobs.

I couldn't help but wonder when we decided that American labor, which once led the world in innovation, was suddenly no longer a desirable work force.  One need to merely go online and search for something as arbitrary as American made sweaters to find how few goods are available with the Made in the USA label.

We have become a nation where the rewards of our consumption are reaped overseas and many of our citizens are barely making it from paycheck to paycheck.

It's difficult to understand why our nation allows corporations the luxury of selling their goods in this country while denying its citizens the opportunity to produce them for a livable wage.  The American public has been duped into believing that the demands of organized labor are just too extreme to keep our jobs at home, but in order to live at home, in this country, we cannot afford to work for the wages paid in China or Indonesia or wherever else the production of our goods and services have gone. Indeed, for most American families the cost of living is what may no longer be the greatest nation in the world is now a hardship rather than a privilege.

We have paid and continue to pay the incredible high cost of premiums for our homes and cars and to provide health care for our families.  The insurance companies who provide this protection consistently show staggering profits while Americans are struggling to put food on the table week to week.  Our out of pocket co-payment and prescription costs are rising, while our government makes an effort to keep testing and services farther from the reaches of those that support it.  To add insult to injury, the same companies that we continue to make richer are farming their customer support bases away from the United States, further denying us the opportunity to profit from the billions of dollars they make year to year.

Anyone who has worked in a medical office and has had to call customer service for claims or insurance verification knows what it is like to speak to someone who is virtually impossible to understand.  My billing department used to pray each time that they dialed United Health Care, hoping to be connected to an American representative rather than someone in India who could neither be heard or understood.  Does United Health Care insure citizens in Bombay?  Highly doubtful!  Why then should jobs for an American company be done on foreign soil?    What incentives are we giving these giant profit making machines to keep jobs here?   Further, what penalties are we imposing for those who take jobs out of the hands of our citizens while collecting their money?  It's truly pathetic and even worse when the money that they claim to save by using foreign labor never seems to translate into lower costs for their goods and services!

In order for us to solve our current financial dilemma, we had better stop pandering to multi-billion dollar companies who take jobs from American hands.  Who do they think they are fooling?

Treating Our Patients To Addiction

Like many Americans and indeed people throughout the world, I have been following the trial of Dr. Conrad Murray, the physician who treated Michael Jackson and is now charged with involuntary manslaughter in his death.   Jackson died from Propofol intoxication, Propofol being a drug administered in hospitals or ambulatory surgical centers as an anesthetic.  In the case of Dr. Murray, propofol was used in order to assist Michael Jackson get a good nights sleep- administered in his bedroom, through an IV, which is amazing in and of itself.  Why he agreed to use this anesthetic in the first place is even more amazing.

Having first hand experience with Propofol, during a colonoscopy/ endoscopy, I can tell you that waking up from this drug is akin to spending a week in the Bahamas, without the tan.  You feel as if you have taken the best nap of your life and your mood is one of sheer elation.  This feeling is common to almost everyone who has had an experience with Propofol and I must admit that you do have a quickly fleeting desire to purchase a six pack of the drug to take home.   The fact is that drugs are addictive, aside from the physical component, simply because they make you feel good long before they make you feel awful.

Now the case of Dr. Murray certainly seems bizarre, but physicians all over the world can become enchanted with their patients, even though they may not be "The King of Pop."  Doctors want to alleviate not only pain, but also an entire host of other patient complaints that give their patients less than an optimum lifestyle.  Insomnia, headache, menstrual cramps, muscle aches - treated with a swipe of pen on script pad.  Creating in many instances a whole garden of future addicts.

Put quite simply, the drugs exist, so why not use them?

There are, of course, those drug seeking patients who travel from physician to physician to obtain the medications that they now need for their daily survival.  Many patients, however, present to their patients with acute and chronic pain, unaware that abuse of medication to treat this pain will eventually become a way of life.  In many cases, physicians simply do not take the time to adequately explain how the medications that they prescribe can lead to overuse or addiction.  They treat the symptoms with drugs to alleviate pain, without realizing that the majority of patients are not aware of the implications of these drugs.  Pain relief equals pills and pills lead to more pills and so on and so on.  In addition the courting of physicians by the pharmaceutical companies tend to minimize the side effects of their products and gear their efforts to make their medications as appealing as possible.  You merely need to watch the commercials for some of the new drugs brought to market and if you are not shaking your head at the list of side-effects, you are certainly in the minority.

Perhaps patients and doctors alike need to realize that not every physical pain needs immediate treatment.    Physicians need to make sure that they take the time to assess the patient's lifestyle, diet and exercise regime before writing a script to deal with a symptom that could be addressed with simple lifestyle changes.  There needs to be a larger learning curve where physicians are better informed in the use of natural and herbal supplements that may work just as well as prescription medications.  Acupuncture and chiropractic treatments may also provide relief for acute and chronic pain as well as physical therapy.
We need to begin to align ourselves with modalities and lose the fear of having our patients seek alternative therapies.

As our largest population group continues to age, we must be mindful of using drugs that are often rushed to market with catastrophic consequences.   Continuing education in our various specialties should always include embracing less invasive techniques. 

Medicine in the Age of Carelessness

Talk to anyone who has worked in the medical arena for a significant period of time and inevitably you will hear the same complaint: "Nobody Cares Anymore!"   This is not endemic to only medicine, but in our dealings with each other as well as with patients, there is a new attitude that is best described as self-serving and unfeeling.  This applies to the largest hospital systems and the smallest medical office, where physicians are trying to eek out their existence on a day to day basis.

We have become a rude society indulged in a say anything and feel justified attitude that leaves most patients feeling as if they have entered a twilight zone, far removed from the past, where they are no more than a name and number.  I have been serving the needs of medicine for the past twenty years, and I am shocked at the lack of professionalism I find both as an administrator, and as a patient in the offices I work for and make use of as a patient.

Front office staffs are short and unmannerly and the patient is no longer the number one priority.  Physicians and other health care practitioners who are now forced to see larger volumes of patients are prone to more mistakes than they were in the past and I fear that those patients unfortunate enough that they cannot act as they own advocate will fall victim to an increase in sub-standard care.

Nurses are overwhelmed with the number of patients they are expected to care for on their particular units and the paperwork has become an overwhelming catastrophe that does not insure the patient's well being but rather puts it into greater jeopardy.  Nurse no longer appear at the bedside at the first bell ring and patient's without a family member to assist them during their stay often express serious complaints regarding their hospital stays.   The days where nursing is a profession for the most caring and dedicated of individuals has gone the same direction as flight attendants and indeed we are forced to feel as if we are traveling in steerage when we are forced to seek hospital care.

What are we doing as a nation and as a society to deal with these issues?  Perhaps payment for patient satisfaction scores is one answer, but right now all we are doing is giving our physicians and staffs greater obstacles to billing and coding.  So we become more overwhelmed that we were in the past, and the likelihood that this is going to positively affect our patient care is quite slim.

Carelessness in dealing with our patients is now standard fare even as we listen to physicians and staff complain about cuts in reimbursements.   Perhaps we are getting exactly the payments we deserve for the standards of courtesy and professional care that we are rendering today.  Perhaps, we will go the way of the airlines - no meals, no pillows and blankets - smaller seats - and zero advocates.  What can we expect when we have allowed ourselves to practice as a level that is strictly coach rather than first class!

It's time for us to wake up and promote the complete package of professionalism that existed in days gone by.  We need to take the time and promote an arena of excellence before we price ourselves right out of the market and health care becomes little more than a series of walk in clinics that provide only the most basic of care.  It's time to change our attitudes and realize that we are only as good as the patients think we are..... Nothing more !

An Alternative to Hospital Takeover

Many smaller practices have a good patient base, often by serving their immediate communities.  Despite committed patients and active days, some physicians still find that the overhead costs of running their own shop overwhelming.  Often, these physicians turn to hospital employ to solve their cash flow problems, but this situation often has problems of its own.

Hospital employ always means a loss of control.   Staff may be supplied by the hospital and it is often difficult to obtain the goods and services that are a part of your normal routine.  Large hospital corporations are not especially suited to a personal relationship with each physician and you may find yourself somewhat invisible in a large crowd.

One alternative is to seek a partnership with a large established private practice in your area, even if this practice is not aligned with your particular specialty.  These partnerships have proved very successful for a large number of physicians and can be tailored so that you keep more of your independence, while profiting from the protection of a larger revenue source.

The physician may find that in most cases, he or she will be able to maintain their practice address and even the majority of their employees.  Instead of outsourcing for billing, many of the larger private practices have enjoyed great success in revenue collection and this will ultimately save the physician from the monthly costs associated with a billing company.

Parent corporations will often also make an investment in the look of your practice, completing necessary  updates to hardware and software as well as office decor and furniture.  Bills from the physicians practice will be paid by the parent corporation as well and deducted from a bonus structure as overhead.
Suddenly, the physician who joins a large group will find themselves able to dedicated more of their time to patient care and less to the stresses of running and paying for their practice costs.

Prior to any commitment, the physician must take a realistic look at their annual salary expectations.  Contracts for these types of arrangements usually mean that you will be paid a salary for your services and a quarterly or annual bonus minus overhead for your contributions to the parent company.  You can expect both your salary and bonus structure to grow since you will now enjoy the benefits of a new referral source and any marketing efforts the parent company makes on your behalf.

You will be dedicated not only to your own practice but to the success of the parent company as well and will enjoy an easier one on one for meetings and negotiations than you would find in a hospital setting.  Private practice management is at your disposal and less distracted by hospital expectations.   In addition, you will have staff coverage for vacations and personal time.

Make sure that your agreement allows you access to statistics regarding your billing reimbursements.  You may need to reassign your Medicare and private insurance benefits, so you will need to prepare for the changes well in advance to any agreed upon start date in order to assure that your personal revenue remains on track.

Joining a private practice can afford you a new support group for your goals and future ambitions.  Growing your practice is beneficial to the parent corporation so you should gain a new sense of encouragement and a team behind you to assist you in moving ever forward.