I accidentally broke my streak of posting here every day :(
this post was submitted on 06 Sep 2023
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I get that it's just a shitpost, but the doctor who gets paid $200k a year has a much better chance of giving a shit about the financial hardship a medical emergency can bring to a patient than the capitalist executives at the top of hospital administrations and insurance companies who get multi-million dollar bonuses each year. Your doctor is just another cog in a machine. I'd argue most doctors do not take joy in knowing how pricey these things are, but they don't set the prices, unless they are also part of the group running the show.
Speaking as a former ER Tech and medical student, doctors are the most likely to just "forget" to bill for the random bullshit that admin wants tracked to an obscene degree. There are some ERs (mostly HCA run ones) that have to scan your patient barcode and the cabinet to track giving you an ice pack. I've really only worked in community hospitals and intend to keep it that way, and doctors are the most likely member of a care team to just do whatever is necessary and fail to document it. I've also seen doctors down-code visits and procedures to make it easier to get insurance to pay for things.
PS: I'm intending to go into emergency medicine and/or critical care at community safety net hospitals or critical access hospitals and I will raise hell to increase the number of social workers in the department to help patients get the resources they need.
When I was a unit clerk for an ICU unit, I was taught an "optional" part of the job which was basically me billing patients for "missed" (doctor forgot to bill for, intentionally) services and procedures.
Suffice to say I intentionally didn't do that part of my job. Glad I'm off to x-ray where we've got 2 steps of detachment from that crap.
I was on a different side of that equation when I was a clinic assistant in a surgery practice. A decent chunk of my job was fighting with insurance companies to get them to cover medically necessary procedures. It was a plastic surgery practice that was part of an oncology group, so one of the surgeons mostly did melanoma surgery and the other mostly did breast reconstruction after mastectomy, and they both did some cosmetic and general plastic surgeries here and there. The insurance companies would do idiotic things like not need a formal prior authorization for a melanoma excision, but because the skin graft needed to repair the excision site technically counted as a "plastic surgery" by its CPT code, they would require a prior authorization for that.
One of my favorite things is when I got the insurance companies to cough up for medically necessary panniculectomies following drastic weight loss which heavily subsidized the "upgrade" to a tummy tuck/full abdominoplasty. The patient basically just had to pay the difference instead of paying for the whole thing. Our surgeons were really good at planning and coding procedures like that to help patients as much as possible.
Thank you! I thought this was likely the case but now I'm certain. Your career choice sounds deeply noble. And meaningful, fun.
Yeap, I am a provider specializing in orthotics and rehabilitation at a children's hospital. I've been practicing for a little over a decade, i would say about 1/3rd to a 1/2 of all the co-workers I've seen "burn out" have done so because insurance is just too much to deal with.
By the time you finish your residency, you have a pretty good idea of the hardships and rewards of practicing medicine. The only thing you really aren't prepped to deal with is how much of your work is undermined or dictated to you by a faceless corporation.
About a third of my day is signing or writing paperwork, not paperwork that insures the safety and health of my patient. It's all to make sure that we get paid, and to protecting our patients from catching a mystery bill from the hospital or insurance company.
The insurance companies dictate who we can treat, how we treat, how we take our notes, and even how we archive those notes. You ever wonder why we ask the same questions over and over, like we never looked at your chart? Well it's because insurance companies make us! If I don't record the notes in a way that the insurance companies deem acceptable, it can get audited years later.
This alone would be awful, but guess what? Now that we've established medicine is officially a business we need........ managers! How are we ever going to run a business if you're spending 30 min with each patient? We' let's cut that back to 15 minutes, but don't forget to jump through hoops for the first 10 min for the insurance company...... 5 min is totally enough time to diagnose and come up with a treatment plan for systemic disease, right?
And that's not even the worst part. The absolutely worse part is knowing that if you were allowed, you could significantly improve the total outcome of a child's entire life, and then be told that no, you aren't allowed to do your job. Their parents worked too hard to qualify their child for Medicaid, and their private insurance doesn't have coverage. So now Billy doesn't get to run anymore, all because his dad did a little too much overtime this year.
It's criminal, and we are forced to be knowingly complicit in these crimes to help those we can.
When I was a clinic assistant at a surgery practice, a solid half of my job was obtaining prior authorizations for every procedure our surgeons performed. That experience is one of many reasons I want to go into Emergency Medicine. I hate appointment schedules, I hate prior authorizations, and I hate being told how to do my job. I know that I'll have to play the game and do the stupid metrics for all my lower acuity patients, but at least for the codes and stuff they won't really be able to give me a hard time about it.
Prior auths, Letters of medical necessity, itemized prescriptions, ICD-10 codes, CPT-codes, L-codes, so much ancillary nonsense that takes up patient time.
Lots of people hate on emergency medicine, and for some valid reasons. They tend to be overworked and the hours plus the on call schedule can be awful. But you're right about them not usually being hassled about billing, or have managers breathing down their necks.
It's actually one of the only specialties without on-call time unless you're on-call to cover another physician calling in sick. As for the schedule, I'm naturally nocturnal, so straight nights would be awesome.
Unfortunately it's pretty dependent on your location and their ability to retain providers. Our Emergency medicine providers have been on a pretty brutal on call schedule since COVID hit us.That being said, I live in a severely underserved state that had staffing issues pre pandemic, and we're the states only trauma 1 ward.
So we're probably an outlier, however it wouldn't surprise me if other rural states have their EM guys doing a lot more on-call scheduling. Hell, during the worst weeks of the pandemic our state was allowing support staff to practice medicine under the guidance of a PA-C or higher.
We need all the young blood we can get, but if you think you might be susceptible to burn-out, I'd probably avoid doing your residency in a rural state. It's been crazier than normal down here for the last few years.
I'm hoping to do my residency in a pretty urban area and move out towards the rural part of the state further down the road. When I was working as an ER tech before starting medical school, I was on straight nights and picking up a ton of overtime. I was averaging about 50 to 60 hours a week, and doing that as 12's and 16's actually worked out pretty well for me. I'm more susceptible to burn out on a normal M-F 8-5 schedule, honestly.
That's really good, you'll have an edge in your residency. We're a teaching hospital, so I typically will have at least two residents in my department at any given time. The biggest predetermining factor I've seen over they years for those who do really during residency is prior working experience.
You would be surprised how many young providers struggle with dealing with the general public. Lots of the residents we've had in the past went to private highschools and then private colleges, never having to deal with the underserved community.
Good luck with your schooling, and try not to worry yourself too much. The process can be daunting, but it's completely doable. Persistence is more important than raw intellect, I've met and taught plenty of idiots with MDs after their names.
Ps don't let them freak you out about neuroanatomy, it's not as bad as they say.
I'm in DO school, and in my first year, the neuroanatomy course was my highest grade for some reason. As in, the only in-class exam I got an 'A' on was the one that covered all the basics that one would need to know for neurosurgery. I'm still a little confused about that one.
For the overly sheltered K-MD kids, my belief is that working for a year as an EMT/CNA/RA/etc. should be a pre-requisite to application. The fact that people are allowed to apply to medical school without a history of hands-on professional patient care experience is actually quite galling. You can always tell which doctors have never had to clean up human poop (not counting infants).
Yep, I have no problem with doctors making what they make. Medical insurance companies are fundamentally incompatible with the mission of providing better health care. Some things are best left to the free market. Health care ain't one of them.
yeah I know, i just like to shit on the abomination that is the american healthcare system even if i dont live in america myself. in reality I have tremendous respect for doctors
Maybe edit the meme to be about hospital administrators and health insurance companies. They're the real problem.