Sunday, May 04, 2008

A Sad Commentary

An anonymous reader from a small town in the west sent this comment:

I am a radiologist in a western community of 50k, with both a hospital and outpatient practice.

The cardiologists have a CT

The family practice group has a CT

The neurosurgeons have a CT

The oncologist has a CT, soon to be a PET CT

The neurosurgeons have a MRI

The neurologist has a MRI

The orthopedists have a MR

The family practice group has a MR

This is in addition to the imaging center 50% owned by the rads and hospital with 1 CT and 2 MRs. There are also 2 CTs in the hospital. So, a town of 50k has 7 CTs and 6 MRs. There never was an issue with waits for imaging in our community. If a doctor asked for a study today, we made sure that it got done, today. We call results when asked, and have turn around time for written reports measured in hours. There was not a quality issue, as we have great equipment. Pure and simple, it is about money, and outside consultants promising the moon.

And people complain about insurance getting more expensive.

I suspect that our imaging center will be out of business soon, as they take the cream and we get the indigent (and the mammograms). Legitimate competition I can take, but there is no way to compete against self-referral. I have my hands tied behind my back, and a heavy indigent care "ball and chain" around my feet.

What patient will look their self-referring doctor in the eye, and say "I am going across town" ? They do not want to compromise their relationship with the doctor, after waiting 6 weeks for an appointment.

Many of my partners have left town, and those remaing are burning out, taking care of the indigent population.

I'm still hoping for federal legislation with some teeth, or else, I'm out of here after the next election.

Very sad, indeed. The government is really the only option to fight this. Maybe the loopholes will be closed, eventually. Too bad the government doesn't have the cojones to actually punish the perpetrators of this scam. Can't you just see the explosion of finger-pointing? "It wasn't the docs idea, it was the business manager's idea! Put him in jail, not us!"

1 comment:

Ron A. Dawson, MD said...

I agree. Greed trumps good medicine every time.

I see this as the next bubble our country will have to face. Million and half million dollar machines in every doctors office will have to be paid for. All this purchased on credit and the promise of riches. I wonder how these doctors are going to parcel the patients? Will the family doc request that all of "his" patients be scanned on his machine? Will each doctor scan their respective organs? Will the doctors accept the results of studies done at some other MRI or will the insist a repeat exam be performed on their machine.

The example is a great example of needless duplication of services and extremely costly for society.

I feel for the doctor in the example. I am sure this is not the worst of the stories. It seems incomprehensible that the most highly trained specialist is left to babysit a hospital to read simple x-rays and do barium studies. What a waste of a good resource. It is bad for the radiologist, but so much worse for the patients in his community.

The only thing I take issue with is attributing self referral to service issues. This should be about medicine, period! It should not be about speed, unless it is a true emergency and we all know how rare these are. We find that Radiologist cow towed themselves over the years thinking that these so called quality issues (nothing to do with the practice of radiology) were what was going to keep their profession afloat. When you start acting like a business, you will be treated like one and there is always a faster cheaper guy. In fact their better faster quest had done nothing but led them to running themselves silly into the ground. When it comes down to it, it was always about the money, not the timeliness of your reports, and this is proof. The only thing these self referrers understand is the stick. Radiologist should have seen this before it got out of hand. Radiologists competed against each other for business rather than doing their jobs as doctors and with beneficial "competition" with other radiologists based on skill. Maybe had they stood on principle from day one things may be different. But one cannot blame the Radiologist for what is happening now as the radiologist has become only a convenient scape goat in the rationalization of the corrupt behavior of the self referrer.