Still Breathing…

Word of my demise, widespread and nefarious as it has been, is most assuredly premature. I must put these scurrilous rumors to rest…

But life has been, well, most interesting

The past year or so has been one of the most challenging in many a season, on a number of fronts. Professionally, the passage of Obamacare has made it abundantly clear that the independent private practitioner is a dying breed, and likely will disappear — with the exception of cash-only, concierge-style arrangements — within the next few years. The administrative burden is crushing — unfunded mandates, such as pay-for-performance, compliance programs, HIPAA, mandated “government certified” EMRs (even though existing, non-certified ones are fully functional), and intrusive, abusive audits by the Feds and third party carriers. Such mandates and regulatory excesses place, or will soon place, such an overwhelming burden on the solo physician or small group as to make their continued existence unsustainable, even in the near term — and the full implementation of Obamacare will put roses on their grave. Reimbursements are dropping precipitously (my income dropped about 25% last year), as expenses spiral upward (employee health insurance rates are up 25%; malpractice rates up 15%, etc., etc.). The small business model of solo practice or small medical group is rapidly becoming extinct: its executioner, Big Government and Big Insurance.

The medical-legal environment remains as hostile and capricious as ever — I have endured two lawsuits in the past three years, both resolved with decidedly mixed outcomes while taking an enormous toll both in time wasted and emotional sobriety. I hope to share some insights thus gleaned on this horrendously dysfunctional system in the not-too-distant future.

Personally, although my health remains good, the exhaustion borne of these and other struggles had taken much of the joy and energy from life. The time for renewal was long overdue.

And so, big changes are in store: my practice will be sold in the next few months to a large medical group affiliated with a nearby hospital, and I will have as a primary responsibility inpatient hospital care, with a much diminished office practice focusing primarily on my specialty of male infertility and vasectomy reversal. I have decidedly mixed feelings about this change — I anticipated going to my deathbed as a private, solo practitioner, loving the independence and rich patient relationships which this brings.

But I am weary. After nearly 30 years in private practice, I am not sure which straw broke the camel’s back, but it is most surely broken. It is a weariness born of 14 hour days; of dictating charts and finishing paperwork until 8 or 9 pm each night, after starting the day at 7 am; of endless audits by the insurance industry and Medicare; of the constant threat of litigation; of the crushing burden of one more federal requirement mandated but never recompensed; of a host of ever-expanding administrative burdens having nothing to do with patient care, and everything to do with bureaucratic micromanagement of the profession. And this before we have even begun to see the nightmare which Obamacare will inflict. Camels weren’t designed to carry such a load.

But the change is nevertheless much anticipated in a host of other ways, with its reduced administrative and regulatory burdens, and substantial increase in free time. For me, the war is over: I have fought the good fight, and no longer see it as profitable to battle the inexorable forces which threaten to crush a beloved profession. My spirit is in many ways free now, as though a great burden has been lifted. God is good, and has been gracious and kind to me in so many ways.

I have needed an extended break from blogging to process these many life changes, but in its absence have heard the siren call of the muse quietly whispering to my soul.

So I am back — bitterly clinging to God, guns and guitars — and hope to speak of each in their turn, among others, as the spirit moves. For those who have checked back regularly, only find a petrifying post from the past, you have my great gratitude for your loyalty. I hope to reward that loyalty with something of worth in the coming days.

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11 thoughts on “Still Breathing…

  1. Welcome back! I was just clearing all the neglected or no-longer-interesting blogs out of my feeds a few days ago. I left you in there on the off chance you might make a comeback. Wouldn’t want to miss that. :-)

  2. Glad you are back. Sad to hear of the demise of yet another good solo practitioner. I worry that my trusted doctor who takes time to talk books, laugh and *know* me will soon join the ranks of impersonal assembly line medicine. Will I still get care? Sure, but will it be as rewarding? Pretty sure it won’t be. I totally understand your decision though and hope that you put that freed up time to the best use possible… and I am most excited that the inner muse might just be rereleased.

  3. I’ll be discussing some of the rather earth-shaking changes going on in healthcare shortly. Even before Obamacare kicks in, the changes are rather tectonic.

    Thanks for the kind words.

  4. I too am pleased to see you back, and look forward to your insights on the state of “Medicine”and “Current Events”. Let’s hear some more about “Guitars” :)

  5. Welcome back! I have been watching the surrender of private practices to the hospitals for about 4 years. The first Docs who signed on have done very well. I believe that once all Docs are safely controlled the compensation will change dramatically.

    I am surrendering to the idea that my freedom does not come from the systems of men.

  6. I’m glad you haven’t given up the blog -I’ve enjoyed your writings after being directed this way by Anchoress. I will print your article and give it to my daughter who thinks that government-run health care will be just great.

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