Friday, January 22, 2010
Facing the Future
This post by Rob Lamberts, ACP Member, originally appeared at Musings of a Distractible Mind.
The following is an actual fictional conversation that took place in the doctor's lounge at a local hospital.
Internist: Dang, these Medicare cuts are coming and I doubt that Congress has the wits to avoid them. I am not sure I can go on practicing if they cut them anymore.
Family Physician: Yeah, we already get paid so little by Medicaid and the private insurers, we have had to start to look for other sources of revenue.
Internist: Really? We have been looking into that as well. What are you thinking about doing?
Family Physician: We thought about doing cosmetic procedures, but we have an especially good-looking population, so we really can't make it work.
Internist: Bummer.
Family Physician: Yep. Instead, we have decided to open a kiosk for Krispy Kreme donuts. We figure we can make money off of the donuts, plus we can get more of our patients obese. Then we can treat worse diseases and code a higher level for each visit.
Internist: Genius. Plus, you can get all of the kids hyperactive on the sugar and treat their ADHD.
Family Physician: And the "Hot Donuts Now" sign along with the scent of fresh-baked donuts will really draw in new customers ... I mean patients.
[Click on the More link below to read the full post.)
Internist: One of the GI doctors in town is doing the same sort of thing, opening a Starbucks in his office. He figures he gets walk-ins, gets people with worse dyspepsia, and gets free WiFi to boot.
Family Physician: Brilliant. What have you been thinking of?
Internist: We have noticed the interest our patients have in holistic medicine, and thought we should capitalize on that.
Family Physician: So you are hiring a homeopath?
Internist: No, they wouldn't set foot in our office because of the "evil" immunizations we use. We tried to get all sorts of alternative providers, but they would always sneer at our practices. And so we finally opted for two things: First, we are doing aromatherapy, which has our staff so relaxed that they don't seem to have noticed that we cut their pay by 50%.
Family Physician: Great.
Internist: Second, we have a psychic who goes around in our lobby doing palm reading and tea leaves on our patients as they wait. There are two positive outcomes from this: the patients who get bad fortunes told are so anxious that their blood pressure is up and they are ripe for anxiety treatment; the ones with good fortunes are happy enough that we can order all sorts of tests on them and they don't seem to care. There is a downside, however.
Family Physician: What's that?
Internist: My partner now thinks that we should take our entire budget for next month and invest it in Power Ball lottery tickets. He says it is a "sure thing."
Hospitalist: Hey guys, what's up?
Family Physician: We're just discussing what we are going to do to offset the impending Medicare cuts. Do you have plans?
Hospitalist: Oh yes. I don't like the idea of increasing the load to 70 admissions per day. Fifty is plenty. Instead, we are capitalizing on the fact that our patients are a "captive audience."
Internist: This I've gotta hear.
Hospitalist: We figured that we have enough turnover that some sort of direct marketing scheme to our patients could be quite lucrative. We are now certified Amway sales representatives.
Family Physician: I love it!
Hospitalist: Yep. We have these patients in a position where they can't move, and we sell them cleaning solvents, vitamins, and skin care products. Instead of taking cash, we just add it on to their hospital bill, so they usually buy a bunch.
Internist: As an added bonus, the families of your patients will be so scared that you will try to sell them Amway products, that they steer completely clear of the hospital.
Hospitalist: Bingo! It works like a charm. We got this idea from the intensivists who were holding Tupperware parties in the ICU. The patients were sedated "just enough" so that they left the hospital with all sorts of cups, jugs, and bowls.
Family Physician: Any complaints?
Hospitalist: Not yet. You figure, what we charge for the solvents is 1/4 of what the hospital charges for an aspirin. The patients really don't notice a little more charge. We have even had some insurances mistakenly pay for some of our Amway products!
Internist: You know, maybe this Medicare cut may just be a good thing. Look at how it has pushed us to open new frontiers in medicine. Our children will look back on this time as being one of the real turning-points in American healthcare.
Family Physician: Yeah, today Amway ... tomorrow ...
Hospitalist: Healthcare reform? Higher reimbursement? A fair payment model?
Family Physician: Used cars.
Internist: I am so glad I went into medicine.
Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.
Labels: guest post, humor
posted by Ryan DuBosar at
8:00 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert
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Albert Fuchs, MD, FACP, graduated from the
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Berger
Zackary Berger, MD, ACP Member, is a primary care
doctor and general internist in the Division of General Internal
Medicine at Johns Hopkins. His research interests include
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CasesBlog
Ves
Dimov, MD, ACP Member, is an allergist/immunologist and Assistant
Professor of Medicine and Pediatrics at the University of Chicago,
where he evaluates and treats both pediatric and adult patients.
David
Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally
renowned authority on nutrition, weight management, and the
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Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid
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FutureDocs
Vineet
Arora, MD, FACP, is Associate Program Director for the Internal
Medicine Residency and Assistant Dean of Scholarship & Discovery
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Hospital
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Gut
Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist
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I'm
dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
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Just
Oncology
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clinical practice of hematology and medical oncology. His blog is a
joint publication with Gregg Masters, MPH.
KevinMD
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influential health commentary.
MD
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Elaine Schattner, MD, ACP Member, shares
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More
Musings
Rob Lamberts, MD, ACP Member, a med-peds and general
practice internist, returns with "volume 2" of his personal
musings about medicine, life, armadillos and Sasquatch at More
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Musing
of an Internist
Justin Penn, MD, ACP Associate Member,
attended medical school at the University of Washington School of
Medicine and trained in internal medicine at the University of
Rochester, where he is serving as Chief Resident.
Prescriptions
David
M. Sack, MD, FACP, practices general gastroenterology at a small
community hospital in Connecticut. His blog is a series of musings on
medicine, medical care, the health care system and medical ethics, in
no particular order.
Reflections
of a Grady Doctor
Kimberly Manning, MD, FACP,
reflects on the personal side of being a doctor in a community
hospital in Atlanta.
Technology
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Neil Mehta, MBBS, MS, FACP,
is interested in use of technology in education, social media and
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personal information and knowledge management.
White
Coat Underground
Peter A. Lipson, MD, ACP Member, is a
practicing internist and teaching physician in Southeast Michigan.
The blog, which has been around in various forms since 2007, offers
musings on the intersection of science, medicine, and culture.
Other blogs of note:
American
Journal of Medicine
Also known as the Green
Journal, the American Journal of Medicine publishes original clinical
articles of interest to physicians in internal medicine and its
subspecialities, both in academia and community-based practice.
Clinical
Correlations
A collaborative medical blog started
by Neil Shapiro, MD, ACP Member, associate program director at New
York University Medical Center's internal medicine residency program.
Faculty, residents and students contribute case studies, mystery
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Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept
industry money so he can create an independent, clinician-reviewed
space on the Internet for physicians to report and comment on the
medical news of the day.
PLoS
Blog
The Public Library of Science's open access
materials include a blog.
White
Coat Rants
One of the most popular anonymous blogs
written by an emergency room physician.
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