Thank you for the gift link!
I agree with almost all the points made in the article. The only area where I think the author was a bit off mark was when he attributed doctors’ dislike of the new management practices to resentment over loss of prestige (e.g. that weird quote about “platinum-level social status at high school reunions and Thanksgiving dinners.”)
I do not give a crap about prestige. My former high school classmates generally don’t know I’m a doctor, and anybody at my Thanksgiving table doesn’t care (they know that I put on my pants one leg at a time.) And I formerly worked in retail and food service so I don’t think I’m “better” than workers in those industries as the author seems to imply.
What I DO think is different about my job is how extremely close the relationship we doctors have with patients (i.e. the people that our management calls customers): I have heard their worst secrets. I have seen their crotches. I hand them kleenex when they cry. (I sometimes cry myself.) I tell them when they are dying. I hold their hand when they are dying. I hand their spouses kleenex after the fact, and attend their funerals if it happens to fall on one of my days off.
So when management (usually some 29 year old dude with a recent MS in “Healthcare Management” from the local evening class diploma mill) tells me I would be more “efficient” by double booking more of my slots, yeah it pisses me off.
100% agree about the weird comment about prestige.
Feels like the writer had a conclusion about how physicians feel but not any evidence to back that part up.
Physicians I know aren’t worried about being the “big dog” at their high school reunion. They are more concerned about doing a good job and having the time and resources to do so.
Very true. My brother retired last month after 35 years in the ER because of the exploding gov’t imposed paperwork demands accompanied by less staff support in the ER (in the name of efficiency?!) that causes insane wait times for patients (now averaging 52 hours across Montreal) that threaten patient health and actual survival. Nurses are unionized and are currently taking strike action for better working conditions (the government banned vacations for nurses for 2 years during COVID, and many left the profession due to burnout so those left are feeling the brunt). The government has tabled a bill to centralize the control of all hospitals, giving them the power to send nurses to any hospital or service they choose (total disrespect to specialization required in different services like NICU, OR, transplants etc.). It’s just a brutal time to be in medicine. My brother retired early because he is afraid that with his current level of exhaustion he will make a mistake that costs someone their life. He has enormous guilt leaving the ER even more short-staffed but he’s done his part.
For unionization of high-prestige professions, McGill law professors recently unionized, a pretty shocking development as professors here generally consider their work as too independent for unionization to apply. However, the law profs – who likely know more about this than the rest of us – see increasing demands and reduced benefits coming down the pipe so they are preparing themselves to be in the strongest possible negotiating position.
It will be interesting to see if doctor unionization ultimately helps and whether we’ll see it as well in other high-prestige professions.
A friend of mine who is an ob/gyn went completely fee for service. She doesn’t take Medicare anymore. It simply didn’t reimburse her enough to run her practice.
You are describing the situation in Quebec. It is another warning to Americans that “free” universal health care is not the utopia that many claim. And it leads to new problems such as government control and micromanagement of every aspect of health care.
I would rather have government control and micromanagement than private for-profit insurance company control and micromanagement.
You are not a health care provider in Canada I assume. Did you read @ProfandParent 's comment?
Yes I did. And I stand by my comment, via observation of others and my own personal experience with a for-profit health insurance company.
I can’t speak to the alternative of being micromanaged by private-for-profits in healthcare since we don’t have that. I have seen the transition of nursing homes from nonprofit to profit with drastic declines in care, so I would not be optimistic.
It used to be, in Quebec, that the government provided funding to local health boards that ran local English or French hospitals, walk-in clinics etc. and these boards were largely autonomous in how the money was allocated and were answerable to the community with local boards having community representation. Those were the good old days.
Then came government centralization which gave people who have no knowledge of healthcare the power to make decisions that started us down this miserable path. Most healthcare deliverers know centralization is a bad idea, but administrators love it because they can get fat off cheating the system, and with centralization it is harder to tell where the money went and no one is directly accountable to a constituency. With money allocated to bulging layers of bureaucracy, kickbacks, and funding priorities driven by special interests and lobbyists, the healthcare system is falling apart. And that is where we’re at.
@ProfandParent and @TomSrOfBoston and @oldmom4896, I’m not a health care specialist, but I have been an advisor to health care systems in the US, medical insurers in the US and UK, a drug distribution company, and pharma and biotech companies. I’ve also been on the board of a Canadian private health care company. And I’m married to a Canadian, we have a house in Quebec and my daughter is a PCP in the US. So, I have an idiosyncratic but not wholly uninformed perspective on the situation.
There are significant problems with both public and private funding of health care. In the US, we have what I think of as a three-tiered system. There is very good insurance supplemented by concierge docs for the fortunate (depends upon the area as well as some places have the best hospitals and some don’t). You can get the best surgical techniques and advanced care but preventative care is pretty weak. Then there is the middle of the road care, which often involves insurers who routinely deny coverage. And then there are the people with no or really barebones insurance. The cost of insurance is very high and as a percentage of GDP, the cost of health care in the US is a lot higher than any other country and US health outcomes are worse than many countries (I think the US ranked 37th (just behind Costa Rica).
In contrast, publicly funded health care is overstretched as the countries don’t have the political will to pay the cost of medical care as the population ages and lives longer than expected and expensive new tests, procedures and drugs come on the scene. My sense is that NHS is close to the breaking point. But, my sense is that NHS and Canada do a lot better on preventative care. Health outcomes are superior on average to the US at much lower cost.
I suspect that in both Canada and the UK, the health care systems will have to scale back their ambitions and focus on providing a basic level of relatively high quality care – full prevention and basic care – and that people will need to purchase private insurance to go beyond that. In both countries, that is going to require a shift of attitudes that won’t come easily.
It is worth noting that in the US system, as the article noted, a 25 year old kid with an MS in healthcare administration is making decisions about what is the appropriate care for you whereas in the Canada and the UK, it is someone in NHS or OHIP or RAMQ who is making those decisions. In neither case are doctors or NPs or PAs doing this on their own like the good old days. I don’t have a view as to which form of interference ends up being worse from a practitioner’s standpoint. However, people switch health insurers relatively frequently in the US (an employer gets a better deal from Aetna or the employee changes jobs). As such, US insurers don’t have any economic interest in your long-term health because some other insurer would be the one benefiting from investments in preventative care.
I think the top part of the income distribution can get great care under either system (NHS plus private insurance in UK. private in the US). I don’t think Canada’s private insurance is yet as evolved although it may be by now. But for the person who would have mediocre health insurance in the US, care in the UK and Canada will likely be better and for the lower tier, the UK and Canada will provide superior care.
I just don’t see how I’m going to be able to afford insurance when my husband retires soon. I have 3 1/2 years to go until I’m 65. $890/month in 2024 is literally the cheapest policy I can find. Maybe I’ll qualify for a subsidy once DH retires?
Retirees not eligible for Medicare is a hole in our system. I assume the subsidies are income related. Not sure how they work.
Are you maybe part of an architects’ association which may have a group health insurance policy? Also, some small business organizations have group policies too. Perhaps look into those/joining an org for access. Not sure those would be cheaper than what you have already found though.
That assumes that the patient can be seen by a doctor or other health care professional. Here is a recent article from a Montreal Gazette reporter describing two similar biking accidents he had, one in Montreal, the other in Vermont.
Josh Freed: I fell off my bike and into the reality of U.S. health care | Montreal Gazette
He is wrong on one point. Emergency care, like he received, must be provided in the US regardless of ability to pay. Also, the amount a hospital bills is drastically reduced to an insurer’s “contractual amount”. So even with mediocre insurance the amount the hospital receives is far less than billed, whether paid by the insurer or the patient.
Luckily he was in Vermont where there was a hospital with emergency room nearby. Not necessarily the case in other parts of the U.S. where hospitals are closing left and right.
You could probably get an idea here of retirement income (taxable) vs cost of various plans
Depending on what you learn, it could impact your plans for how/when to tap into taxable IRA withdrawals, investment income etc. I have heard about retirees who do this to optimize opportunity for ACA coverage. (It is an even bigger deal when both spouses are under 65)
My professional years saw such change, it was incredible. I actually left retail pharmacy in '77 for hospital, but in my later years, hospital pharmacy changed, too, as community hospitals got gobbled up by corporations, mine included. There was a time hospitals were managed by administrators with masters degrees in Hospital Administration. So long ago. Now it’s greedy businessmen. With no care whatsoever as to the real bottom line that we made professional oaths for…patient care.
I’ll never forget meeting with a “suit” at some point who supposedly was sent to show care for us. @@ What did we need? How were we doing? Etc. etc. We begged for more help as we were drowning. And the next week, four of our staff were laid off.
I was sooooo blessed to have my retirement age coincide with the debacle it all was becoming. I got out.
Thank you for the article.
I think we want just universal insurance. Not the total system control like Britain and Canada.
I used COBRA for one year after I retired and I thought $600 a month was brutal. I’m so sorry.