County on brink of health-care crisis
Nevada County is experiencing a health-care crisis of mammoth proportions. Our population is steadily growing and many physicians are leaving. The remaining physicians are unable to assimilate any further patients into their already full practices. Several thousand patients will be seeking a health-care provider and tying up the phone lines of already overwhelmed medical offices. The lack of family physicians will have a profound impact on our emergency room, delaying services for those with true emergencies.
For various reasons Nevada County has recently lost numerous primary care physicians. Considerable blame lies both with the consumer and the health-care industry. It requires a tremendous personal and financial sacrifice to become a physician. Long work days, sleepless nights, educational requirements and financial expenditures never cease. The old stereotypical image of the wealthy doctor who works banker’s hours and plays golf excessively is purely fictitious.
Unless a physician caters to the wealthy, offers cosmetic procedures, works for a large health-care corporation or the federal prison, their annual income is probably less than the average hospital nurse or pharmaceutical representative. Many physicians can’t even afford health-care coverage for themselves and their families. Who can fault them for seeking higher-paying benefited positions?
It seems the consumer has little appreciation or respect for their family physicians. They often complain about office co-payments yet are not hesitant to pay outrageous costs for unnecessary luxury items. Many feel their time is too important to be spent in a doctor’s office.
Some patients show up once or twice annually presenting lists of accumulated medical complaints with the expectation that they all should be addressed in a single 15-minute appointment. It is common that after refusing or not showing for appointments patients will demand to be diagnosed and treated over the phone. This denies the physician needed revenues yet increases their liabilities and paperwork.
In such a litigious society, the physician is often liable for a patient’s noncompliance. Every conversation must be documented. Physicians must make numerous efforts to assure a patient has followed through once a problem has been presented to them.
Many individuals fail to take an active role in their own health care and feel the physician is solely responsible for their well-being. Reliance on expensive and toxic medication rather than making healthy lifestyle choices has raised the cost of health care. If these trends continue more physicians will be forced to make difficult career choices.
Equally to blame for our dwindling number of family physicians is the health-care industry. While health-care costs soar to record levels, physician reimbursement is diminishing. Physicians are inundated by mountains of paperwork in order to get their patients’ needs met.
A 15-minute appointment not uncommonly results in 15-30 minutes of paperwork and phone calls. All encounters, test requisitions and referrals must be accompanied by approved diagnostic codes and often require multiple submissions for improper coding. It takes a significant amount of time to look up these codes.
Insurance often refuses to pay for mental health care and affordable accessible services are virtually nonexistent in this county; therefore the responsibility falls on the family physicians. Counseling is extremely time-consuming and depression is not considered a reimbursable diagnosis in the eyes of insurance companies
. Insurance companies and governmental agencies are constantly creating more obstacles for physicians. Nonpaid paperwork consumes much of the workday yet patients are often irate if a fee or appointment is required when they request forms to be filled out. It takes many staff members to make a medical office function, which results in a tremendous amount of overhead.
I hope to enlighten the public as to many of the challenges family practice physicians are facing. The rewards are few and the sacrifices many. As consumers we need to work with our physicians and assume a greater amount of responsibility for our own health care. Be more proactive in confronting the insurance industry regarding the numerous obstacles they are creating for physicians.
The family physicians remaining in private practice deserve our cooperation, respect and support. The personal sacrifice is tremendous and their value to the community is immeasurable. Please find some patience and understanding for your physician and their staff when you have trouble getting through on the phone lines or have to wait a bit longer for an appointment. The thousands of people seeking a health-care provider in this county are going to have an effect on us all.
Mary Raymond is a nurse practitioner and a registered nurse at Sierra Nevada Memorial Hospital where she works in the emergency and recovery rooms. She has worked in the health-care field for 25 years.
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