Yesterday I went to the post office to mail something. I was 23d in line, so I thought about blogging and how long it has been (again). There were four windows open, so it seemed that the line would move. But then Window #4 went on her ten-minute break (she was still gone thirty minutes later). What’s that got to do with you, or me? Let me make the connection.
I’ve been busy since my last post, working almost every day until this month. Half the time I was posted at a rural clinic upstate, a “federally-qualified” facility with osteopathic students in attendance, run as efficiently as possible with dedicated doctors and mid-level practitioners. The level of traffic was at times unreasonable, but no one could be turned away. If the patient showed up an hour late, he or she could simply declare that he/she was a “walk-in”. Only the high no-show rate kept the doctors from staying until midnight. The clinic was open until 9 p.m. evenings and all day Saturday, even providing van service for patients from nearby towns (thank you, taxpayers!)
The last few months were spent mostly in the Valley, not far from my old base of operations at Valley Presbyterian. However, that clinic was run like the post office or the DMV. The owner, who also operated several other clinics, paid himself about $700,000 a year, having appointed himself CEO, CFO and COO and collecting three salaries, plus a bonus. Employee morale was dismal, partly because they had to bring their own equipment (e.g. pens, paper clips, etc.) but mostly because 80 people were crowded into a crumbling building meant for 20. Efficiency was unheard of. Every patient, no matter how trivial the complaint, had to undergo financial screening, insurance verification, and then eye tests, blood pressure and other vital signs. Each doctor had one medical assistant; it took 2-3 hours before patients could even arrive at the exam room. I was grateful when my six-month assignment was ended early. I then covered a private practice in the High Desert for two weeks and the contrast was striking. Patients are the same in most places; these days they are mainly on government programs, for which most are grateful but some have a sense of entitlement that is offensive, to put it mildly. But the surroundings were cheerful and clean, the employees sharp and friendly (and there were enough of them), and it was gratifying to help the local pediatrician get a well-earned rest.
The point of all this is that medicine is headed over a cliff and will probably never be the same. Obamacare having been validated by a quirky Supreme Court decision, millions more folks are to be added to the welfare rolls (Oh, they won’t call it that) but doctors cannot be created by government fiat, so there will be fewer of us taking care of more of you. California has already announced its response; more care will be given by less-qualified practitioners: mid-levels, optometrists (!), pharmacists (!). Despite all the political promises, health insurance costs will go up, emergency room visits will rise, appointments will be hard to come by and brief, practitioners will burn out more quickly and will make more mistakes working under greater pressure. So when you’re standing in line, bring a book. Might as well make it “War and Peace!”