Wednesday, June 26, 2013

Dinner at a Orthopedist Home

Dinner at a doctor friend’s house is always an interesting phenomenon. You learn the heartaches and the travails of another colleague and spend time commiserating the evening away. You also learn in the process of what has transpired in their field of medicine. Any and all new developments are bandied about and a roughly drafted thought of what helps and what doesn’t, seems to stick.

The other night, it was orthopedics. You know, my friends who use buzz saws and staples, as they set broken bones straight. Yes, those wonderful human beings who spend an inordinate time washing their hands in the sink before they enter the theater. Oh I recognize their superiority in their art and the unsaid aplomb admixed with the tension of time constraints, sometime insufficient supplies or inadequate trainees gives it an air of a theatrical performance. All said and done, most perform admirably in setting things straight.

So I learnt that the orthopedic surgeons have seen a drop in their income. But not to despair, I said, it is happening in all specialties across the board. No he says, the NYT states that we are making more money than last year. Ah yes, that determination is based on one’s billing or revenues and not based on the Net Income. Yes, he says, that’s probably true. You know, he wonders out aloud, what will become of medicine? I ponder on the subject, staring intently at the glass behind the elegantly furnished bar in the basement of his house. I look up to answer and find that he is gone, shaking hands with another. Ah yes the art of company and being a host.

What will become of medicine? I wonder. But the wall in front of me is bare except for this tiny framed English painting of a foxhound hunt. And for a brief moment this painting clears the foggy view but then it is gone.

The dinner call comes and slowly we all fall in line to climb the stairs to his dinning room. Nothing ostentatious here, a table for 10 with place settings and in one corner a Roomba ready and “green” with desire to clean every dirty speck that came crawling in underneath every guest shoe.

The dinner is quiet with the clinking of stainless steel ware and the china and from across the room a friend of his shatters the quiet reverie. Hey, he says, did you notice what these PAs and NPs are doing? Boy! He sniffs, are they raking it in. What do you mean, my friend asks. Well, the other guy says, I operated on a arthritic hip the other day and I received my usual $1500 for the total hip from our bountiful masters. Meanwhile this non-par NP receives $2900 for assisting me and also has the temerity to balance-bill another $500 to my patient. I mean, what the hell? Really? My friend asks with incredulity. Yeah, so we started looking at all the surgeries done with these “providers” and in a 100% of the cases they were paid double if not triple of what I got paid for the surgery. Incredible! He gulps down his class of water trying to force the chicken he has swallowed, down the gullet. Oh, he exclaims after swallowing, the podiatrist who assisted me the other day got three times of what I got. I complained to him, and he smiled back at me. Well, he said, those are the chinks!

My friend now slightly agitated asks his wife, Honey! Could you check our explanation of benefits and see what is going on. Yes, she says she will.

Needless to say that the desert tasted a little out of sweet, to my friend and maybe all of us assembled, that night. The night ended with pleasantries as all dinners do and as I got back in the car the only thought ringing in my head was, what the hell is going on under the guise of Healthcare?

While the overhead costs for these surgeons has reached 70-80% their struggle to continue serving patients is making them run like hamsters. And hamsters can run but not think, you see! The programming is well in its final phases and you can run but cannot hide. 

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