The Worst Mutant - Health Care

It seems fitting that I happen to be writing this blog on Halloween. Mutants are celebrated today. So let's celebrate the mutant, which happens to be dominating the news and national conversation, health care. And to be sure, we are witnessing another massive mutation of the already grotesque beast right before our eyes. Well intentioned, and not so well intentioned, congressional leaders and the President are in the process of grafting new appendages and organs to the beast. Make no mistake, this will be the most hideous of all beasts we know of today. If you think otherwise, with all due respect, you are completely out of touch with health care. I suggest you read this well written, very insightful piece by David Goldhill. It is simply the most comprehensive, succinct review of health care I have read to date. Forget about whose side you are on, Democrat or Republican. To my amazement, I have read positive remarks about Mr. Goldhill's article from individuals on all sides of this debate. He has done what no one else has been able to do, dispassionately dissect the mutant. His article should be required reading for the entire Congress, all their aids, those writing the bills, the President, pundits, "experts" and all who have commented, blogged or in any way chimed in on the debate. Basically, any American who can read, should read his article. In the meantime, as children and adults get ready to dress up as ghouls, goblins, zombies and the like, let's realize what a freakish creature we have and prepare ourselves for the even worse freak show to come!

Health Care Exodus?

I just missed getting vomited on this afternoon. It has happened before and much worse, to be sure. In fact, I have been bitten, spit on, bled on, pooped on and had all manner of bodily gunk on my person. There are pathogens of the worst sort in the blood and body fluids that I have been exposed to in my almost 25 year career. Some of the worst are hepatitis C, HIV, MRSA (methcillin resistant staphylococcus aureus) E. coli and C. diff. (Clostridium difficile). I routinely miss lunch or have to eat in 10 minutes or less. Sometimes when I need to go to the bathroom it is not possible. I am also routinely up in the middle of the night. My workday finishes when the last case is finished, which could be 5:00 p.m. or 9:00 p.m. BTW, my workday starts around 7:00 a.m. In addition to all of that, health care workers are routinely exposed to radiation, toxic chemicals, horribly non-ergonomic work spaces, noise pollution, extremes of temperature, psychologically stressful situations and the constant stress of knowing that our decisions have potentially deadly effects if incorrect. And lastly, there is the overarching threat of litigation that could result in serious emotional stress or economic disaster, or worse, for us. Whew! So what? You may ask. It is all just part of my job in health care, right? No one forced us to do what we do. And you are exactly right. But remember, no one is forcing us to stay in health care either. In fact, right now, I am plotting my escape. And if the environment of the health care workforce changes for the worse, it may well be that many others will follow suit. There are instances of great satisfaction in what we do. But there is also a tipping point at which some will leave (physically) and I am sure many others will leave emotionally, which could actually be worse for patients.

Workforce issues arising from the impact of reforms have not been adequately studied or addressed. Please read this recent New England Journal of Medicine article. And there is this study from the National Academies in 2008, which paints a sobering picture of current workforce issues before any fallout from the reforms being proposed. Reimbursement rates for providers are going to trend toward Medicare rates, possibly even Medicaid rates. Either of which will force many providers to make some difficult life or practice decisions. Chicago Tribune editorial writer, Steve Chapman, has written about some of the potential monetary impact of the now resurrected public option in this post.

There may be more patients to take care of and that, it could be argued, may sustain a provider’s income. My belief is that providers will make career or practice changes, which will further worsen the workforce issues that are known. If providers bail out altogether there will be even fewer providers for the “Baby Boomers” and all the newly insured patients. If providers decide on practice changes then you can be sure that few will work more than 8 hours a day. Lack of access will be the outcome of either scenario. No one is prepared for this. And did I mention how much I hate to be vomited on?