Sunday, January 26, 2014


    I get some of the emails , that tells me the medical news and also new inventions , drugs , some studies and some opinion polls . I recently got one ,that was I think was from New York Times. Knowing well that the New York Times is a very 'liberal ' news (?) paper , I knew that the article will have liberal slant and will not address the real issue. I was partly right . It told a story of a history professor, who was seen by a 'physician extender' and was suspected to be a cancer and was further worked up and then the cost of the entire work up was $25000. The article stated the opinion that the consulting physicians make 'too much money'. The article never address the real problem with the health care cost . So I thought of writing about my opinion .
    One of the problems in medicine today is the physician extenders . I really have no problem with the physician extenders, namely the nurse practitioners or physician' assistants . They do a great job or may be even better job than originally they were suppose to do . But when I see them being used as physicians and not as physician's extenders , I feel that that is a  misuse. I often see that they are the only health care providers who are seeing patients in the hospitals ,  most of the time replacing the consulting physicians .This is not the best way to utilize the talent of these group of health care providers.
      The second problem is the way in which health care system works . In past the consulting physicians got more fees for " consulting ", as they had more training in a specialized field . For last few years , may 4 or so , the amount that is approved for a new medical graduate or a cardiologist or a brain surgeon is same , even though the training that a brain surgeon gets is several years more than new medical graduate . So in essence it is like saying that a high school graduate and a person with masters degree or doctorate should get same salary. But in medical field this how it is . So many doctors are trying to find a way to see more patients, to compensate for this lowering of the fees . There is a limit to how many patients can one physician see in a span of 8 hours or so . So then they stared having physician assistants see the patients . This may lead to more referral to other physicians. In turn it will cost more money .
      The issue that has cropped up is disparity between the reimbursement that physicians get and what hospitals make , sometimes for the same procedures . For example , the endoscopy , physicians may make $150 , while the hospital charges may be as high as $2500. Now a days many of these procedures are done with sedation , that is administered by anesthesiologist .This adds to he cost and since they are employed  by the hospitals, the money goes to the hospital. Doing a ultrasound test for heart for example will cost double if not more , if done in the hospital than done in doctor's office . If physician is employed by the hospital , the fee that he gets is much higher than if he was on his own . So when the hospitals ' employ '  physicians , the hospital makes more money and the physician makes more money and the cost of the health care goes up .
    There are many more reasons for the increasing cost of the health care , like new drugs , say for pulmonary hypertension , cost $50000 per year, new tests and treatments , ICD a defibrillator, price tag of $27000, just for the device and the hospital charges  probably same .
    One additional factor is the big gap between the 'charges' and the actual reimbursement The latter has gone down over period of time for certain procedures and if one looks only at charges , then it does not give real cost of health care . For example in past the colonoscopy was paid as much as $600 or even more with private insurance. Now a days it pays  less than half of that , but the charges have not been reduced . So the charge may be $1000, and physician will get $250..
    What I felt is that instead of trying to find a real cause for the increase cost the New York Times took a view as to criticize the consulting physicians .
     If they are interested in reducing the cost or helping the primary care M.D they should contact people like me not those who live in Ivory Towers .   

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