While the debate rages on, we bring you a report from the very trenches of health care: the wards of hospitals. These comments come from residents, attending physicians, and doctors in private practice, and may serve to open some eyes…
Spend any amount of time in a hospital, and you will be astounded by the amount of time taken up with paperwork. Detailed reports, for every single patient encounter (largely for defensive purposes), are input into ever more sophisticated computer systems. The latest wrinkle allows medical billing experts to view these reports as they are being entered in real time, so that they can issue helpful pop-ups suggesting how additional billing items can be added.
But then, don’t blame the hospitals completely. They need the additional revenue since insurance limits reimbursements, and they are forced to treat many patients at no charge. Hospital poverty can also be used to justify the virtual slave labor conditions under which residents operate. Med students, facing $200,000 plus college loan debt, can look forward to around $40,000/year as a resident (with slight step increases for each year) and upwards of 80 hours per week on the job.
The lengths of residencies seem to make little sense, unless the goal is to keep the slave labor machine going for as long as possible. Then there are innumerable fellowships, that exist between the completion of residency and the move to private practice (or an assignment as an attending physician), that can tie up the poor docs for another two years at very low pay.
The slave labor concept could be somewhat justified in the past in light of the big bonanza at the end of the rainbow for the docs. However, with very few exceptions, that simply does not exist anymore. And, in the few specialties in which it still may exist, in certain cases it is only because of expensive procedures that are monopolized by specialists.
Many people are unaware that colonoscopies are performed by non-doctors in several other countries, and one might question the value added by having this be the exclusive province of gastroenterologists. Few specialties are despised within the profession as much as this one, since virtually no one likes the work, and if the remuneration were as low as it is for pediatricians, no one would go into it. Indeed, when the recommendation for frequency of colonoscopies was changed to every ten years, all other specialties cheered.
The length of medical education, along with the endless system of credentialism in just part of the medical cartel. The fact is that a vast number of mistakes are made, and most of these are committed by physicians with an armload of credentials—most of which are based on exams rather than actual clinical skills.
Finally, the notion of defensive medicine and all this implies, including “customer service” departments at hospitals, as well as the patient being able to challenge such things as his data of discharge help jack up costs. One resident related a story of a patient who wanted to stay past his discharge date, and argued passionately about it, until he found that he would be footing some of the bill. As it happened, this would have been a relatively small amount (under $1000) but since no one is supposed to pay for any of his health care—at least directly—he balked and checked out at the recommended time.
Anyone who expects the federal government to be able to clean up this mess would probably qualify for lengthy psychiatric care.