health care providers who know that we can offer affordable care to patients without a third-party payor
health care consumers who know that you can manage affordable care with providers without a third-party payor
My Personal Health Care Experience
Every day that I see patients, I think to myself there has to be a better way to make this system more cost effective, transparent, and efficient. And every day, I become disheartened by what I see. Our medical system is too complicated and chock full of conflicts of interest.
Personally, I lucked out with good genes and a momma that made me play and eat healthy meals. I am lucky that I have not had a major accident or been diagnosed with a random incurable illness. Yet even though I'm a physician, I worry about what will happen to me and my family when that luck runs out.
RETAIL SALES ASSOCIATE
I started working at age 16 at Eckerd Drugs. I assumed I was covered under my parents insurance, though my momma worked diligently to keep us from going to the doctor or the hospital. As a part-timer, I was not eligible for insurance or benefits, but luckily I was blessed not to need it.
In college, the cost of student insurance was not only high but didn't really cover anything. I was still working part time as a retail sales associate, and I made sure to only get sick while I was still covered under my daddy's policy. My copays seemed reasonable, and I was able to go to a private doctor in the community rather than the university health service, which had very limited hours. I was lucky.
NATIONALLY CERTIFIED PHARMACY TECHNICIAN
Going from retail sales associate to pharmacy tech, I had my first encounter with prior authorizations. Being on the pharmacy end of things, I served as intermediary between hard-to-reach doctors' offices and insurance companies. It fell to me to cajole the computer into accepting claim, and I would roll my eyes when patients had already filled a script at another location. In addition to doctor shopping, drug abusers would pharmacy shop. Without proof of this, it was hard to deny serving them because there was no universal controlled substances database in Texas. I became pretty skilled at returning meds to stock when people couldn't afford them and cringed when I saw some of the costs patients paid for "non-formulary" medications. I was lucky that I needed no help from medications because I had to pay my way through college and couldn't afford to get sick.
I began to notice that we are incredibly wasteful in the hospital ̶ equipment, food, space, paper charts ̶ and that the medical education system was designed to push altruistic beings into becoming jaded, reactive individuals. Deferring my med school loans in addition to my undergraduate loans allowed interest to compound and loom over me like an axe. But I was lucky to complete my degree at a state school while on an academic scholarship. When all was said and done, I was only $200,000 in debt, unlike one college friend who attended a private school and was almost $400,000 in debt when she finished.
I realized why we were wasteful in the hospital and clinic, and it was partly due to CYA (cover your ass). Time became a commodity that fought against itself. Patients wanted more of our time, but the system doesn't pay in time ̶ at least not to the training doctor. Working 80 hours a week for around 50K a year seemed like a dream, and I felt guilty complaining about my fatigue. But when the numbers are actually crunched, there were times I made less than minimum wage. I fell asleep one day at a stop light on my way home after being at the hospital for 30 hours, and I was lucky I didn't get into a car wreck.
I love well child checks; teaching new parents what to expect from their babies and catching problems before they start. Rescuing a child's airway in the PICU was a highlight of my training. But I began to loathe traditional outpatient sick visits due to constant fighting with parents about their child's viral illnesses that don't require antibiotics. I saw colleagues treating against standard of care for parental convenience ̶ and to protect themselves. I thought it would be sheer luck if I survive an antibiotic-resistant bug in the future. And it was strange to hear that my colleagues in private practice have to pay for vaccines; and if they expire, that's money lost by their practice.
CHILD PSYCHIATRIST IN COMMUNITY MENTAL HEALTH
At a federally qualified health center, my population was mainly Medicaid, and it was a joy to ignore billing codes so that I could treat the clinical situation to its fullest. Alongside an amazing child psychologist, we built plans to help the most fractured of children: those in the foster care system. But I began to notice an awful pattern. These kids would "act up," be slammed with medications, and then transferred from home to home. Medicaid didn't cover the actual standard of treatment ̶ long term therapy with a clinical specialist trained to treat reactive attachment disorder ̶̶ and despite my pleas for comprehensive care for these individuals, my voice went unheard. I was ashamed to think that at least I was lucky enough to have a family that loved me.
CHILD PSYCHIATRIST AT A CHILDREN'S HOSPITAL
When the health care system can't appopriately communicate within itself, it leads to defensive medicine, duplication of treatment, and unnecessary drama. Health care providers are human, and humans are protective of their territory. The race to become "the best" hospital system is a double-edged sword that promotes more and more spending ̶ even when it's not necessary. It was difficult to see altruistic donors gladly give to medical and surgical centers but overlook the mental health need. Insurance companies made it worse. Between the outrageous documentation requirements and hours spent on the phone begging them to cover care that was already paid for by premium-paying parents, I felt lucky to be able to change my career path and start a private practice.
CHILD PSYCHIATRIST IN PRIVATE PRACTICE
Almost everyday, I hear from health professionals who want to leave the field. Psychiatrists, pediatricians, pharmacists, therapists, nurse practitioners, psychologists, surgeons, obstetricians, internists ̶ no one is happy with their schedule, the insurance companies, documentation, patient expectations or their pay. When I designed my practice, I put into place very meaningful boundaries and rules. As a result, my patients are doing great, and my job satisfaction has improved. I am lucky to now have time to devote to this project ̶ and other nonmedical endeavors, such as singing and volleyball.