The country can’t have it both ways


Patients complain, "My doctors worry about money too much. What happened to the times when doctors practiced medicine because they actually cared about patients? In the old days, they would take care of you in exchange for a roast chicken."

And, yet, other patients complain, "We need better doctors, able to see me when I want to be seen, better trained, better studies, and better technology."

You can’t have it both ways. Patients and politicians have created the monster and now they want to put it back into its cage.  The easy scapegoat — the doctor.  It is easier to nail someone wearing a white lab coat and driving a nice car than an ambiguous group of lobbyists and unaccountable politicians.

Here is the reality: Physicians are over-regulated and underpaid. Many are in debt coming out of college and medical school.  Most patients are over-demanding and under-appreciative.

As soon as the government and third-party insurers told a physician how to practice, how to code a procedure, how to bill a procedure, how much a physician would be paid for a procedure, and then to pay for maintaining certifications, compliance, malpractice, HIPAA, electronic health records, PQRI, cancer logs, Quality assurance logs, Quality control logs, CLIA, and subjected physicians to audits and penalties, that is when all the rules went out the window. That is when all patient expectations and demands of a Marcus Welby, MD, perception dissipated.

Physicians are treated like a highly regulated business by government and third-party insurers.

Thus, physicians should conduct their practice and themselves like a business, and patients, who elected the politicians, have no right to complain.

I advocate to medical residents and other doctors all the time to approach their practice like a business. Doctors have no choice if they want to succeed in their practice and ultimately their life.

First and foremost, provide incredible patient care — in other words, customer service. Second, understand all the costs and the revenue opportunities in your business — in other words, act like a COO (chief operations officer). Create and stick to a budget. Watch the pennies. Doctors can no longer afford to waste dollars. Minimize the costs while maximizing the revenue opportunities. Every practice and every specialty should find, identify and add incremental revenue streams and create revenue to offset rising overhead costs.

You can be a savvy businessperson and a caring physician. They are not mutually exclusive. Lastly, do not listen to the noise of the critics as they really don't care about your livelihood.

Steven M. Hacker, MD, is a board-certified dermatologist practicing in Delray Beach, Fla. He is also the author of a top-selling practice management book, The Medical Entrepreneur: Pearls, Pitfalls and Practical Advice for Doctors, and the founder and course director of the Medical Entrepreneur Symposium.

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