Physician Work-Life Balance and Financial Realities

March 26, 2013

How the Sequester and SGR issues illuminate the need to find some type of balance in healthcare spending.

You’d have to try pretty hard to mess up your personal finances as badly as the Federal government has messed up our government’s finances. Plus, you probably don’t have the (legal) ability to print more money if you run out. This most recent sequestration has united everyone around the idea that regardless of whether we need cuts, higher taxes or some combination of the two, the sequestration is the most inane idea of all.

One aspect that affects many physicians is the 2 percent Medicare payment cut. In the background, of course, is the ever-looming SGR issue. Two percent isn’t a lot unless you’re already a medical practice or hospital system living on the brink of collapse due to current healthcare financing.  I don’t expect a lot of sympathy from the public. After all, 2 percent cut or not, most physicians enjoy an excellent income. However, there is a balance to how cuts are made that can either promote moving our healthcare system in the right direction or heap chaos on top of disaster. 

I have my own healthcare litmus test. It is this. Let’s take a typical patient - 64 years old (Medicare’s not even involved) with uncontrolled diabetes, borderline hypertension, and elevated cholesterol.  He also is a smoker and reports a chronic cough which is a new problem and requires an in-depth evaluation. At the end of this 30-minute visit, I’ve generated a certain amount of RVUs and the payment that accompanies it.

My next patient is 21 and in great health. Her only concern is a single plantar wart which has failed at-home treatment. I apply liquid nitrogren and five minutes later she leaves my office. When I sit down to document these visits and submit the E&M code and procedure code, I realize that they are pretty similar in terms of the amount our system charges. I basically, in the roughest sense of convoluted payment, get paid the same for these two visits. I’m not arguing that I should be paid more money, but rather that I should be paid less for the wart removal. 

If you’re reading this blog, you already embrace the idea of work-life balance. It may or may not be attainable for you, but the pursuit of it is a worthy one. Similarly, as an increasingly larger part of our country’s expenditures, we must find some type of balance in healthcare spending. We need to balance what we pay for prevention with what we pay for disease treatment. We need to balance the cognitive work of medicine with the procedural work. We need to balance payment so that the highest cost is not born by the people with the least ability to pay for it, the uninsured.  We also need some type of balance in what we pay for. For critics this is called rationing, for advocates common sense. 

 Just like all of the choices you will make today - soccer game or medical executive committee meeting, address the crying patient in your office and run behind or be callous and keep to the schedule, put a smile or a frown on your face when you walk through the front door at the end of today – our government needs to make choices. Choosing everything is a vanishing option - it is disappearing as quickly as our country’s good credit rating.  Just like in your personal budget, you can’t afford everything, no matter how much you make; neither can our country.