Ten Things Your Physician Won't Tell You

When we think of doctors, we patients respect the fact that they spent many, many years in school learning about medicine, they work long hours, they hold the health of many in their hands -- and we think about the fact that they make mega-bucks.

What we don't think about is the hierarchy that exists among doctors -- an order based on income. But exist it does, and it affects our care. That hierarchy puts specialists at the top of the income ladder -- and primary physicians at the bottom.

How does that affect us patients? An article in Smart Money Magazine called Ten Things Your Primary Care Physician Won't Tell You spells out many of the outcomes, all money related:

1. Primary care physicians (PCPs) are becoming more difficult to find, and even when you find one, it's tough to get an appointment. First, PCPs make about half of what some specialists make. And because of the way insurance and Medicare reimbursements are structured, it's almost impossible for them to move that bar higher. As a result, not many med students choose primary care, especially geriatrics (primary care for seniors).

   Further, even when we do get an appointment to see our PCP, we have limited time to spend with him or her -- again -- based on the money they are paid by our insurance or Medicare.

   The bottom line is that our care is being determined by our insurance, and not by what's wrong with our bodies, or the doctor we find to fix it. Even if we get an accurate diagnosis, even if we find a doctor to care for us, all decisions for our care are based on how the insurance company deems it will handle our situations.

2. If they can't make money through the current system, doctors will look for other ways to supplement their income:

   According to Smart Money, the amount of money spent by the pharmaceutical industry on the 900,000 doctors practicing in the US today is $7.2 billiion to encourage them to prescribe those pharma drugs. That boils down to $8,000 per doctor. And that does not include drug rep salaries, much of the advertising done in journals, and other promotions. In many cases, that is money paid to doctors directly to get them to convince other doctors to prescribe those drugs.

   Some doctors are developing a new practice model so they don't have to deal with insurance at all. Concierge medicine is a growing trend -- and may be just the ticket for patients who can afford it. The patient pays a retainer fee of thousands of dollars, but it provides the patient with the doctor's cell phone number, and 24/7 response. That's something we haven't seen in the US in, oh, say, 25 years? But remember -- it leaves insurance out of the loop. That may be why it works so well.

3. When patients can't get the service they need, they will seek alternatives. Included are easy and quick care when that will suffice through the use of quick clinics, now found in many drug stores and big box stores across the country. For $50 or $60, the patient can drop in, see a doctor or nurse practitioner, pick up his prescription, and get back on with life. When contrasted with having to wait for an appointment, filing out the insurance forms, then having to find a second location to pick up the prescription, it's easy to see why patients are drawn to this new model.

There's more. The article is quite comprehensive in its description of how a doctor's income concerns affect our care. Give it a read, and then share your thoughts with us. I'm eager to hear what you have to say!

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