Why I quit being a "Primary Care Provider"

Over at FreeRepublic, they're discussing this week's New York Times guest editorial, "The Doctor Will See You for Seven Minutes," by Peter Salgo, MD. I highly recommend that your read the op-ed at the NYT in full, and then the thread at FR.


3 years ago, I closed my office and went to work part time and back to school for a Bioethics Masters. I was already trying to change the system, and knew I needed more initials to get attention.

These are not in order of importance. (The immediate cause was number 7, the most compelling was number 8, and the ones that made me begin to look at the rest are all the ones that mention the government, which is supposed to work for the citizens).

But, I got burned out and fed up with:

1. The assumption that I was only in it for the money. After all, I just looked at them and wrote a prescription, right?

2. The assumption that I was committing "fraudandabuse" - guilty until proven innocent - with Federal felonies and audits I would have to pay for if ever I got above the radar. That's without even considering that I was hearing about armed raids on hospital records departments and docs being harassed for refusing to allow government officials to video tape and copy records -

3. Trying to learn and follow E&M codes, ICD-9/10 codes, and the latest documentation requirements for each.

4. The government mandates for technology and "certificates" in order to practice medicine (look under the microscope, dip a urinalysis, run a flu test that medicare wouldn't pay for anyway).

5. The "patient satisfaction surveys" and the insurance company black box quality assurance reports (I don't know what they're measuring and half the patient names on their lists were either on-call patients or people I hadn't seen in years) and the bundling of charges.

6. Stable or decreasing fees, while my own health insurance, malpractice fees, licensing and certification fees, rent, utilities and all the other overhead went up.


7. Employees who would quit for a new job paying $3 an hour without health insurance, when I had been - in effect - taking money from my take home pay to make sure they had insurance.

8. Hearing about Dr. Chiropractor, Dr. Nurse practitioner, the school medical clinic nurse practitioner and the ER doc from Saturday morning and what a great or what a bad job they were doing. (They might have been great people and practitioners, but the care was not appropriate for that particular patient who needed a primary care physician for their medical care. )

9. The way my professional organizations were practicing social eugenics with my dues and in my name.

10. Frank embarassment (see my post on this blog from last week for more) about what some of my professional colleagues were doing - refusing to see Medicaid patients they were assigned on call from the hospital, lack of follow up and more and more money making procedures (admittedly due to third party pressure) with less and less patient care. The games with consults vs. E&M, insisting that the FP admit and do the non-paying scut work, but the consultant gets paid for high-dollar procedures, hearing that "you need to follow-up with your Primary Care Provider" on discharge.

11.The docs "supervising" clinics with unsupervised NP and PA's.

12. Medicaid patients whose official PCP, according to the State of Texas - printed on their card, for pity's sake - was a clinic, not even one of the "providers" listed in no, 11.