I watched a feel-good piece on television a few weeks back about an 87-year-old family doctor from Rushville, IL (pop. 4,300) who knows his patients by their first names because he was the attending physician when most of them were born.
He charges $5 for office visits and works seven days a week.
Inside the storefront office where Russell R. Dohner, MD, has practiced family medicine since 1955, a television journalist assures us that the good doctor "still does things the old fashioned way." No appointments are necessary. After-hours emergency patients use the back door. Medical records are kept on paper and stuffed in filing cabinets. Calls are taken on a rotary telephone. And prescriptions are sent to the pharmacy down the street.
As for a computer, Dohner says, "I never had one."
Dr. Dohner comes across as a remarkably selfless and saintly man who has dedicated his life to the health and well being of his community. He is a Norman Rockwell painting incarnate. But the story also makes clear that Dr. Dohner is a noble anachronism. There are thousands of older country docs across the nation like Dr. Dohner, but we all know that they don't make them like that anymore.
That's not a slap against younger physicians, many of whom still make significant sacrifices of time, resources and money to provide uncompensated care. We cannot expect physicians to work seven days a week and charge $5 for office visits. It is also unrealistic and unfair to expect that physicians will practice medicine until they're nearing the age of 90.
I was reminded of Dr. Dohner and the dizzying pace of change in the delivery of medicine in this country after writing this story—1 in 3 Physicians Plans to Quit Within 10 Years—about an online survey by healthcare staffing recruiters Jackson Healthcare which found that 34% of physicians say they plan to leave the practice of medicine over the next decade.
Sheri Sorrell, market research manager for Jackson Healthcare, says that many physicians are upset by the sweeping changes in medicine being brought on by healthcare reform and market demands.
"A lot of them are very concerned about the depersonalization and corporatization of medicine," Sorrell says. "It used to be [that] the family doctor treated your family for years, basing the decisions on what [was] best for you and your family. Whereas an employed doctor not only has to take into account not only what is best for you and your family, but also what the organization will allow him to do, and what the organization's guidelines for treating you are."
No one should doubt the sincerity of the doctors' concerns. However, the "used to be" method of practicing medicine that Sorrell refers to relied on a fee-for-service model that has been a key driver in rising healthcare costs.
Donald Berwick, MD, the former and controversial administrator of the Centers for Medicare and Medicaid Services, noted in a study this spring that waste, fraud, and abuse exceed 20% of total healthcare expenditures in the United States. Medicine can no longer afford to simply "do what is best for you and your family" in an uncoordinated manner that doesn't attempt to streamline processes and identify wasteful redundancies.
While many of us can remember a simpler time for healthcare delivery, those days are gone for good.
The driver here is not ideology or politics. The driver is money. Healthcare is becoming increasingly unaffordable for many of Americans with annual cost growth that is two- to three-times higher than the rate of inflation in the overall economy. (That may be about to change in Massachusetts, where a cost containment bill is on the way to being signed by Governor Deval Patrick (D).)
Even with the gradual implementation of the Patient Protection and Affordable Care Act healthcare costs will continue to stress family budgets. To keep the lid on costs, a growing number of people are joining, or have been dumped into, high-deductible health insurance plans that are designed to reduce utilization by making a trip to the doctor's office or an elective procedure too expensive.
That certainly is one way to ration care.
And speaking of money, it is also important to remember that most patients have annual incomes that are only a fraction of what their doctors earn. No one should begrudge physicians for being among the highest paid class of workers in the United States. Their profession is difficult and demanding and often requires long hours. Physicians have spent more than a decade in school and residency and often accrue huge debts to earn their MD.
That said, a physician complaining about compensation when he earns $200,000 or considerably more each year should take a look around at how others in his community are faring in this sputtering economy.
Perhaps the doctors who told the Jackson survey they wanted to quit were acting out of anger, frustration, and fear about the pace of change in healthcare and how it will impact the profession they love. Their concerns are understandable. Everyone fears change, especially when we perceive we have little control over it.
Similar concerns and anxieties have been raised by millions of displaced workers in the United States, most of whom don't have anywhere near the job prospects of physicians. Of course, most of these displaced workers can't afford to contemplate retirement either.
It will be interesting to see how many of these physicians who now say they want out of the profession actually make good on their vow.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.