The Era of Marcus Welby MD is Over

By Jerry Kremer

I’ll bet very few readers remember television shows like “Dr. Kildare” and “Marcus Welby.” Those popular shows featured physicians who made house calls and performed miracles of all kinds. There may be a few of these doctors left, but it’s only a matter of time until such dedicated physicians are no longer in existence. Like it or not, the business of medicine is changing rapidly, and not for the benefit of the average patient.

I recently experienced this sea change in medicine, when two of my doctors announced their retirement. One was my internal medicine doctor, who served me faithfully for 32 years, and the other was a neurologist who had monitored me for about five years. It was obvious from our parting conversations that they were exhausted and tired of the day-to-day stresses of serving patients.

If you visit almost any doctor’s office, you’ll notice that there are walls and walls of files on display. They may signify how many patients your doctor serves, but they are also evidence of the amount of paperwork the average doctor must do to get paid by an insurance company. Once upon a time, insurance companies gave doctors an appropriate amount of money for the services they performed, but not anymore.

If you’re a doctor in New York City, you may get $1,000 for a medical procedure. But if you practice in, say, Smithtown, you may get paid $180, if you’re lucky. Geography makes a difference in reimbursement, and no rational observer of medicine will defend such an abominable system. These days, doctors need experienced staff members who have to deal with endless piles of documents, many of which are for small reimbursements.

The daily practice of medicine isn’t a 9-to-5 operation. Many doctors take their charts home, to review medical histories and also to protect themselves from malpractice litigation. The business of suing doctors is a major enterprise, and the volume of litigation forces doctors to pay outrageous fees for malpractice coverage. I’ve heard quite a few stories about doctors who quit the practice because they simply couldn’t afford the high premiums.

One way that a doctor can avoid some of these headaches is to become an employee of a hospital. That spares you the high insurance premiums, but life isn’t a bowl of cherries for the employed doctor, either. Large hospitals have rules upon rules, and they can mean plenty of paperwork, and having to handle a much larger caseload of patients than you ever had when you were on your own. One of my longtime, highly respected doctors has taken a leave of absence, because he’s now in his 80s and just can’t handle the caseload he’s been given. But hospitals are businesses, and they have every right to demand a high level of activity of their doctors.

There are many dedicated, newly minted doctors graduating from medical schools, but quite a few of them approach medicine much differently today than their forebears. Many young doctors would prefer to work five days a week, with no weekend duty. They are willing to take less compensation and have more time for family, golf and vacations. They may be brilliant practitioners, but they don’t want to be so many Marcus Welbys.

And when we talk about medicine, we can’t forget about nurses. The recent strike at some major city hospitals was no surprise. I was in an ER recently, and found out that my nurse had 15 patients assigned to her. She was on the verge of a physical breakdown, but soldiered on, handling all of them with grace and patience. No doubt, she will get a large pay increase and a smaller patient workload, but it’s only fair to give her those benefits.

Like it or not, medicine is changing dramatically. In the next 10 years, we will see changes that we never dreamt of. Some will be good, and others bad. Let’s hope there are more good than bad.

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