This article makes many good points, and this is an area where our humanitarian physicians who take care of us, have swallowed many bullets, not due to ignorance in many areas, but simply due to the fact they are taking care of patients, like they were trained to do in medical school. There have been various articles written on the same subject that medical school does not help get the doctor ready to negotiate insurance contracts, etc., but the day the practice opens the door, it's all there and waiting...BD
Few American physicians -- young or old -- understand that in the last 15 years healthcare economics have been radically changed. Physicians have largely abandoned the pure fee-for-service model that has been the economic cornerstone of Western medicine since Roman times. In its place doctors now contract with health plans for rates negotiated in bulk under so-called "managed care" plans. Economically, there can be no greater change in a personal services industry than changing how people get paid; yet medical students, residents, and fellows are provided virtually no education on the nature or implications of this profound change. The need for such practical education has never been greater.
Almost all of a physician's private patient flow depends on his or her contractual relationships: Private patients are provided either under an employment contract with an employer or they come into the practice through a contract between the physician and a health maintenance organization (HMO) or preferred provider organization (PPO).
The foregoing are but a few examples of the practical areas not addressed by medical training. More insidiously, however, medical training is inculcating a culture among physicians that may be deepening their woes and contributing to the decline of the profession.
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