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I worked in the US for a brief time as a general internist. Here is what for-profit privatised health care had to offer:
First note that our medical group saw patients covered by private insurance and the government medicaid. Our company prioritised private patients = more $
First note that our medical group saw patients covered by private insurance and the government medicaid. Our company prioritised private patients = more $
I had a beautiful clinic. Two rooms that only I used! WOW! My own nurse who did all my phone calls and accompanied me on rounds in nursing homes! WOW what service! My office had the best examining tables and equipment, my personal space was luxe - better than any I've seen
The first wake up call was intentional misrepresentation of our working arrangement. We were led to believe we were joining a group of 6 docs - so we'd be doing 1/8 call. We were actually 3 doing 1/3 call. Our home was on-call 2 out of 3 nights. Not a life for a young couple.
Then came the expectation that Iexamine children and read pediatric ECGs. Children in school in the US can't participate in sports without a certificate of good health provided by a doctor.=$$$maker doing needless quick exams. It mattered not that I lacked pediatric expertise
I'd never read pediatric ECGs before and this also did not matter - when I consulted with a cardiologist for help he advised me to refuse as these are complex. As a young physician I realised I had to start standing up for patients and my rights.
I was so impressed with my clinic set up - not only nice rooms and offices, but we had our own radiology department with MRI, CT, ultrasound and X-ray. I could get ANY imaging I wanted same day, usually same hour! WOW! I began to see the problems however when the radiologists
Would send me in circles - in each interpretation recommending a different imaging modality until I finally realised they were just making $. And to boot the interpretations were deliberately vague to promote that. In Canada you can often rely on the interpretation to help.
I also had a lab attached to my clinic. WOW! I was encouraged to do as many lab tests as possible. Anyone who has ever written a grant will know that lab testing is the most costly thing of all. More $$$$ making.
Patients also suffered. One patient with bladder cancer needed radiation and chemo concurrently. Unfortunately she could only have radiation on one ward and chemo on a different ward so she had to pay for two beds in order to have her cancer treatment. Insurance covered 1.
Another patient with brain trauma from a motorcycle accident - who would never recover - was caught in a rehabilitative hospital - the insurance refused to acknowledge a long-term brain injury. The family was required to provide weekly updates and beg for another week of $
A former CEO of an IT company who had undergone renal Transplant lost his job and insurance. He could not afford his anti-rejection drugs. My partners response: well different classes of people deserve different classes of coverage....
We were rewarded for efficiency. Our senior colleague had mastered the 5 second physical exam. Greet - listen to the chest and abdomen simultaneously over the xiphoid process. Write script, send home.
The practice I inherited was full of patients hooked on narcotics - prompting lots of phone calls to me to refill. Once I figured this out, I realised that it was the way my predecessor made $ - quick scripts. I refused to do this much to the dismay of my CEO
Patients in hospital received nonsensical ($$$) therapy designed to max out cash. I saw doctors treating cellulitis treated with a bizarre cocktail of antibiotics that made no sense, ignoring cardinal symptoms of sarcoidosis to prolong admissions. It was bizarre.
Other than my nice office / well appointed clinic, I did not see any advantage to privatisation. The doctors seemed less well trained; focussed on money not good care and this was encouraged. It was not how I wanted to practice and I could not stay there even for more $$$.
