I have practiced medicine long enough to remember when a doctors’ lounge was filled with, well, doctors. In the late 90s and the earlier part of this last decade, the hospital was still populated by a diverse lot of physicians who made the lounge a very vibrant place indeed. Not quite a speakeasy perhaps, but still a haven for free hot meals, plentiful cookies and Shrimp Friday by divine right.
Oh, how that has changed! With the influx of hospital medicine and the out flux of everyone else who didn’t have to be in the hospital as part of the cost of doing business, these lounges are now the kind of tumbleweed wastelands found in old Westerns.
While the doctors’ lounge has died, doctors still occasionally socialize with each other. These chance encounters may have a “strangers passing in the night” feel to them, but the tenor of the conversation remains the same. What we communicate–after the cursory, “How’s the family?”–is that the “good old days” of medicine are long gone.
What constituted the good old days? Probably an equal mix of less hassle and more money. Being a hospitalist has always meant being at the lower end of the compensation food chain, at least relative to other physicians, so I would often take these conversations with a grain of salt. Listening to people complain about how the mortgage on their beach house is killing them just left me thinking, “Are you kidding me?”
But what strikes me as interesting is that these conversations now may have much validity. In most areas of the country, primary care physicians have an extremely difficult time running a private practice in the black, short of working 24/7 on patient care and then finding still more time to run a business.
And for the first time in my career, the specialists are really starting to hurt. Sure, they have been complaining like the rest of us for a long time, but this time I actually believe them. Cardiologists are seeing a 37% decrease in reimbursement for stress tests and are facing further proposed cutbacks in the reading of ECHOs. One cardiologist told me his margin on ECHOs next year will be $2 net positive. As widely discussed, the consult code is quickly becoming a distant memory. And perhaps most telling, no one in subspecialty private practice is hiring any more, at least not in most urban settings.
Physicians as a whole dread the idea of “socialized” medicine and most have fought tooth and nail against any reform that meant increased government influence. But almost all of them believe that given health care’s current trajectory, soon they will no longer be able to survive in private practice. Likely, decreasing reimbursement to the point that most doctors seek hospital employment is Plan B to control health care cost a la the Mayo clinic, especially true now that Plan A–true reform–is looking too ill to resuscitate.
But please don’t misread this as an anti-government screed because it is not. Quite simply, this is just what happens when the well finally starts to run dry. Call it the “Peak Medicare Theory.” Medicare is broke in seven years or fewer if the status quo continues. No politician will raise taxes or cut entitlement programs any time soon, especially with the current level of unemployment. And rational rationing of health care is a four-letter word.
At the same time, physicians fees are half a trillion dollars a year, so you do the math. Where else do you think some of the money is going to come from?
At the end of the day, I have never doubted that I made the right choice in my career. I get paid to help people. But I am starting to think that choosing to be a hospitalist was an even better decision than becoming a doctor in the first place. I work for a good company, I make a fair living and I don’t deal with the hassle of a business. Life could be much worse–and no doubt for many doctors, it will be soon, especially when compared to the days of yore.
That’s another reason why it’s too bad the doctors’ lounge has died off: Misery always needs a place to keep company.