Q: Why can't doctors just leave?
This is a follow-up post to my review of The New York Times article today. In a nutshell, we can leave. But it's a painstaking process that most of the public doesn't know about.
Let's break it into two parts: quitting and on-boarding.
Quitting: for most states there is, at a minimum, a period of time required by the medical licensing board for us to give notice to our patients before we close our doors. That may take 30 days for those of us working in the outpatient (clinic) setting. For doctors working in a hospital system, we are typically under contracts that bind us into giving 30-90 days' notice. Worse, insurance companies such as Medicare can create periods where if we get off their panels, we might not be allowed back on for two years. In other words, if I said, "Yeah, I'm not going to take Medicare because I disagree with them," I won't be allowed to see patients who try to use Medicare as a payment source.
On-boarding: finding a job is easy, but coming on board is ridiculous. If you, as a provider, plan to accept insurance, you have to individually "credential" with the insurance company. This is a fancy was of saying that you submit every piece of every bit of personal information you've ever gotten to a random insurance company who will undoubtedly lose your personal material and make you submit it at least twice. Then they make you wait for three to six months, intermittently asking for other bits of data you have no way of providing. Then add in the "credentialing" required for the actual medical system (hospital, university, etc.) that you're working at. They request the same amount of ridiculous information plus peer references. Some medical systems will even charge you an application fee.
So why can't doctors just leave? Because you are guaranteed a minimum of three months to a year of absolute upheaval in your life, finances, and sanity. We have bills, debt, family obligations, and unfulfilled dreams just like everyone else. So doctors, being human beings, will often pick the path of least resistance and stay in a job that we can tolerate while we tolerate it.
How would P.S.Y.C.H. fix this?
Doctors won't have to credential because there will be nothing to credential to. Our state licensing boards are a beast when it comes to patient safety and making sure we're doing what we're supposed to do. That alone should be sufficient proof to patients and anyone else that we're working in the patient's best interest.
Doctors will have the same job mobility as anyone else. Since all patients will be in one medical record, there won't be the need to "release information" and delay patients when their provider moves away, quits practicing, or dies. Doctors won't have to stay in jobs for the health insurance benefits; they too can move towards opportunities that fit their goals and dreams.