× Women Physicians

Disillusioned with medicaid mills

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7 years 10 months ago #83143 by MoreThanMD
Ha!

I just met with the "big boss" for the clinics, who said "we don't encourage seeing more patients at the price of the quality of care."

oh really? Then why are patients being told to come back every month for refills of their stable BP meds, or being scheduled for a separate exam for every problem as opposed to being able to address several at once? I miss the days when you could sit down with a patient and address their diabetes AND their hypertension AND their allergies all in one 30 minute visit.

Are non-medicaid clinics mills also?

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7 years 10 months ago #83158 by sahmd
I don't work in a clinic, but since nobody else is answering, I will give my two cents. :) From what I hear and see, there are lots of ways to run a clinic. If the payor mix is good enough to pay bills and everyone's salaries, then it is possible to spend a lot of time with patients. Some people still do that (hooray!), and some people will still turn it into a mill situation to make more money. If the payor mix is really bad (and if there is no outside funding, such as from a hospital), then it seems impossible to stay in business without turning it into a mill.

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7 years 10 months ago #83159 by MoreThanMD
In some large areas (like Las Vegas) there are "boutique medicine" clinics where the patients pay a premium to the clinic in return for guaranteed quick access to THEIR doc and also for a guarantee that the patient panel will remain small to allow longer patient visits.

Nice if the area's economics can support it, but what about indigent areas? Don't these patients also deserve good/complete care?

I never went into health care thinking that I would spend the majority of my time dealing with the business rather than the art of medicine.

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7 years 10 months ago #83168 by sahmd

MoreThanMD wrote: Nice if the area's economics can support it, but what about indigent areas? Don't these patients also deserve good/complete care?


Very difficult question! It would be good to answer yes, but good/complete care does not occur in a vacuum. Someone actually has to provide that care. You or I might be willing to earn less in order to spend adequate time with indigent people, and that would be our free choice. But there are not enough people willing/able to do that. So however deserving the patients may be, the reality is that there is limited access to that kind of care. And people cannot agree upon the solution to that problem.

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7 years 10 months ago #83170 by MoreThanMD
My parents used to try to encourage me to go abroad to donate medical care to 3rd world countries through programs such as Doctors Without Borders or Peace Corps or similar. Back in my "wise" 20's I would tell them that I thought there was just as much need here in the USA. Little did I know just how true that was!

In med school there was a program where underserved areas would pay for school in return for 3-4 years of medical service past residency.

I do agree with you that there ARE doctors out there who would freely choose to provide care in indigent clinics for less pay, but there aren't enough established opportunities from which to choose. And it is too daunting and expensive and difficult (from a business point of view) to establish such a clinic on a small scale.

Anyone know Bill Gates? Maybe we could convince him to do something like this. :)

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7 years 10 months ago #83214 by AmmaMD
I know a physician who is currently running a "boutique" clinic (ie, you pay a yearly subscription cost, not covered by insurance, and it covers everything the office can provide - including 1 hour, same day appointments for pretty much anything). He tries to set the cost at ~the cost of basic cable (although it may be more than that, really? I don't have cable to know...), and a significant fraction of his clientel is made of people who don't have insurance through work and have some chronic medical condition that would make private insurance prohibitive on their not-particularly-high salary. So, they pay for this service and, if they can afford it, some catastrophic insurance on top. There are a number of wealthy people who just want the convenience and personalized attention as well. And he does some pro bono work on top of it all. It's an AMAZING practice. He doesn't make a lot of income compared to what I'm sure he could in another setting, but it's flexible and he loves it. And, for what it's worth, this is not in a particularly well-to-do part of the country. Just to say... it's possible!

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