“Thank You” read the title of the message. As gratitude tends to make me happy, I opened the message with the expectation of good news. It wasn’t. A family that has been under my care for over 20 years, whose children I delivered, was leaving my practice for good. Their company insurance options had changed and staying with me would cost them over $2000 a year. With sadness and reluctance they signed up with Kaiser and send me the email thanking me for the care I.
A few days later a patient came in with a similar story. She was changing to a different HMO. Although I am affiliated with the hospital to which she was going to be assigned, the hospital contract with the insurance blocks her from seeing me. If she wants coverage, she has to enroll with them and see a new doctor.
This is the health system our society has chosen. Large hospital systems are committed to capturing every dollar they can and to do that they are affiliating as much as possible with medical groups they own or subsidize. These groups employ doctors who are contractually obligated to send every patient they see to that one hospital for any needed test or x-ray, maximizing revenue. These hospitals then sign exclusive contracts (at discounted rates) with large employers, contracts that give patients no choice but to sign up with them. The end result is that long term physician-patient relationships are cast aside.
Complaining is futile. Under the current system, patients have almost no say when it comes to choosing their coverage. These decisions are made by VP’s of Human Resources who negotiate with providers for the lowest possible price. No consideration is given to the savings associated with long-term relationships, of the value that comes from a doctor who knows his patients well.
This seems terrible at first, but the reality is that many doctors don’t know their patients well. Some hardly at all. This because when physicians rush through annual visits and refer all sick visits to urgent care there is not much of a chance for relationships to develop. When after hours calls are handled by call centers, emails are answered by other providers, and it can take weeks to schedule routine visits, strong relationships seldom develop. In such a world the value of a personal physician is minimized.
I wish I could change the system, but past system-changing efforts have proven to be disastrous failures. In conversation after conversation I have learned that the majority of Primary Care Providers are more interested in going home on time than they are in building relationships. When given the choice of staying a few minutes late or punting care to someone else, most choose the minutes and go home. My exhortations that there is joy in relationships are routinely ignored and met with disbelief.
Electronic records have made things worse by limiting the amount of time physicians can spend talking with their patients. It seems that doctors spending more time clicking the mouse than they do listening to their patients. In addition, many doctors don’t type well, and most struggle to use electronic records efficiently. I know many doctors who routinely spend 2-3 hours at home each night finishing up their work for the day. Such overworked physicians cannot see a reasonable way to invest more time in getting to know the patients they serve. Most have given up on ever having the time to build relationships.
I can’t control them, but I have decided to not give up. I cannot control what happens in the future but I can control how I spend my time today. I haven’t given up on loving and serving the patients God brings to me. Every day brings the joy of relationship, the knowledge that I have made a difference in someone’s life.
Even if that means shedding a few tears when we say goodbye.
PS- If your insurance had changed, there may still be a way to continue seeing your doctor. If you have changed to a high deductible PPO, you will likely be paying cash for office visits anyway. Your doctor might be willing to see you at a discounted cash price, and your out of pocket costs may be the same as if you saw an in-network provider!