Viewpoint: Doctor adapts and loves the job

January 25, 2013

Medical Economics readers discuss the need to adapt on the job, AMA guidelines, leaving practice, maintenance of certification, and finding the right electronic health record.

I was captivated by the “Talk Back” section in the December 10 issue.

My father practiced medicine for about 50 years. I am grateful that I saw him in action. The way I spent time with my father as a child was to go with him on house calls. As early as 5 years old, I answered the phone in his office. I was the only one of five children who did this and the only one to become a physician.

I pursued medicine because I wanted to help people (as cliché as that may sound). I love and respect my patients, and many feel the same toward me. Both my children have rejected the idea of becoming a physician. They want balanced lives.

My father’s life took a turn when he purchased a fax machine for his office. He muttered to me about how it forced him to work faster. He had to hire another staff member just to handle all the faxing to insurance companies, which no longer wanted to speak on the phone. The day of the little black bag was gone, and so was his ability to adapt. The new way of doing business was stressful for him.

I am a dreamer, like my father. I dream of a time when I can be the physician I want to be, instead of dictated to give more attention to productivity, coding, and co-pays than to the wholeness of my patients. I want to provide excellent care for all of my patients, effectively coordinate care, speak to their specialists, and walk them through sickness, loss, and death.

I have never carried a little black bag, but I carry the same tools, along with my smartphone and tablet. Most importantly, my virtual black bag still contains compassion, a love for the labor, and a meaningful, “There, there let’s see what we can do to make things better.”

I still love being a physician, and I will continue to adapt to the future. I will never give up on giving my input to make things better. Physician, it’s time to heal thyself. It is not the time to give up. We are made of stronger stuff than that. Speak up. Whatever little ripple you make is a significant one.

Now get some rest, eat a hot meal, regain a love for the labor, and give generously in your labor of love.

L. J. Bookhardt-Murray, MD

New York, New York

AMA ON THE WRONG PATH

It was hard not to smirk when reading your article, “[American Medical Association] AMA crafts principles to guide  doctor-employer relationship (December 10 issue). The article points to the growing trend of doctors leaving their practices to become employees. What the AMA fails to realize is that one of the major reasons for this trend is its failure to economically protect the independent physician.

I was a solo family physician for 25 years before I joined a large multi-specialty group in my area that the insurance companies were paying 75% more for a 99213 than they paid me.

If the AMA understood how such medical groups function (which in part is why they are successful), they would realize how naïve their principles were. These groups bring in new graduates and indoctrinate them into their system.

The group I joined had its own labs and diagnostic equipment, patients were never referred to outside facilities, and income from them went to the doctors. Having practiced in the community, I knew where to obtain tests for less, but when I referred patients to these facilities, I was accused of not being a team player.

The end result of this shift toward employment is that the doctor’s primary focus is his or her relationship with the employer, not the AMA or other medical organization. The survival of the AMA and other medical organizations depends on their ability to once again become relevant to the physicians they claim to represent, and so far they have failed to find that path.

Steven Howard, MD

Belmont, California

SKIPPING EXAM IS GOOD ADVICE

When I read the letters about maintenance of certification (MOC) in the December 25 issue, I noted they were overwhelmingly against the program.

I am a senior pediatrician in a medium-size pediatric practice. My younger partners are in a constant state of stress over having to meet the MOC requirements (which seem to get more onerous every year) and take an exam-at great expense-every so many years.

They have told me not to voluntarily participate in MOC (fortunately, I was in the last group of physicians that holds permanent certification). I am following their advice, which is that it is an expensive, irrelevant program, so I will never take the exam.

Although I don’t “prove” my expertise as a pediatrician through the MOC program, I am the first person my younger partners turn to when they are unsure of a diagnosis or treatment. I am almost always able to answer their questions with good, sound advice despite not passing an exam. Until someone can tell me how another exam will make me a better pediatrician, I will not take one. It’s one less stress I will add to my life.

I regularly take part in continuing medical education (CME), have spent my time learning to diagnose and treat depression in teens, and am able to perform osteopathic manipulation therapy. These CME activities have greatly added to my scope of practice, and I may not have had the time to devote to them if I was studying for a test.

Patricia M. Edwards, MD

Concord, New Hampshire

A SUITABLE EHR IS WORTH THE SEARCH

Almost every issue of Medical Economics has an article with numerous put-downs and complaints about electronic health records (EHRs).

I am a solo allergy physician who has used eClinicalWorks since December 2009. Our training was superb, and support is thorough and complete. The system is very flexible and appropriate for primary care physicians and most other specialties.

If a physician and his or her staff members want to fight EHRs tooth and nail and refuse to adapt and change as required by the times, then there will be problems with implementation and adoption. The first week of implementation was difficult and slow, but I would never return to paper records. As a solo, control-freak specialty physician, I have access to the system anytime and anyplace, including on my iPad when in remote Alaska or while hiking in Sicily.

Physicians need to find a system and a vendor suitable for their practice, style of medicine, and specialty.

Robert L. Freinkel, MD

Vallejo, California

GET INVOLVED TO HELP END MOC

As a member of Change Board Recertification, I read the article “Maintenance of certification [MOC] has value for physicians and their patients,” (Viewpoint, October 25 issue) with interest.

In light of the medical boards’ unchecked power to regulate physicians, what Change Board Recertification proposes is fair and in the best interests of our patients and our profession. Our goals remain clear.

MOC should not be associated with hospital privileges.

MOC should not be associated with insurance reimbursements or network participation.

MOC should not be required for maintenance of licensure.

MOC should not be mandatory.

All board certificates must be converted to lifetime status; only then will MOC be voluntary.

If this cannot be achieved, then mass MOC noncompliance is the only rational and logical means to reclaiming control of our practices.

During these changing times of healthcare reform, our medical boards sit on nearly a half-billion dollars in assets while hard-working physicians get less and less in reimbursements and many Americans remain without healthcare coverage. Beyond restrictive rules for doctors and their own enormous salaries and fees, what do our “nonprofit” boards actually provide? They do not represent us successfully in government matters and certainly have no understanding of practicing physicians’ interests.

It’s time for all of us to get involved and for MOC to end.

Ron Benbassat, MD

Beverly Hills, California

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