Theoretically, doctors in the US are reimbursed for the amount of time and effort they put into a patient visit. Theoretically. The truth is far different, a frustration for many of us. Unlike many other professions, we must temper our economic decisions with compassion. If, say, a man has a 15 minute appointment scheduled but it turns out that his daughter has been killed in a traffic accident and he has chest pain, the rest of my day is shot. There is only so much I can bill for the time I will spend with him, and those scheduled after him will suffer. They will wait, become frustrated, and several will probably leave and hopefully reschedule. There is no way I can make up economically for the time I spend with the grieving father except by seeing more and more patients, exacerbating the problem.
But most doctors, I hope, will still take the time, and because of our lack of business savvy and political organization, we will never get it together to lobby for rational reforms in the ways we are reimbursed. There are all sorts of changes that are supposed to help, but it’s not at all clear to me that they do. I can get paid extra (read: not penalized) by entering quality data on my patients with certain insurance plans. The work is too complex for the front desk or a medical assistant, so that’s more time spent away from the patient. Some of this can be improved by electronic health records but there is no real standardization in the industry, across practices, or between hospitals.
Over the years, much of this may or may not sort itself out, but the upside is I still get to take care of patients every day. I just hope the economics never becomes so unfavorable that I work myself into the ground. My daughter picks up on that sort of thing.
Since my wife’s illness (documented a few times on this blog between April and now; see the archives), PalKid has been rather clingy, understandably. She prefers to stay up until I get home, to have me tuck her in, and then to have her mother finish getting her to sleep. And for the last couple of weeks, when she wakes up in the night, she does not end up back in bed. Last night I woke up to find her cuddled tightly to Mommy. Mommy, though, likes a little space and retreated to the guest room. We’re not sure what happened next, but when I woke up for work, PalKid was sprawled sideways across the bed, Mom was still gone, and Kiddo had no idea how she got where she was.
Pulling her off of me so that she could run back to the guest room to leech onto mom was hard, but at least I can look forward to my work. I usually stop at the same cafe for an espresso, and walk into the office to a full desk, a full schedule, and hopefully a smiling staff. And I get to take care of people. Even though the economics are insane (and later I’ll tell you the insanity of board re-certification), it’s still a privilege. I’m sorry if I’m running late, but the person before you may not be feeling well, and if you aren’t, you’ll get the same treatment.
At the end of the day, despite working in a broken system, I’ve helped a few people, and I get to go back home to play musical beds. I can live with that.