Wednesday, December 23, 2009
If the health care bill passes, which everyone says it will, let's imagine the best possible outcome. The bill just might make it the best time in history to go into medicine.
You see, if you read this, you will see that the health care bill will give teeth to rationing. For me, a boarded ER doc, my job just got a lot easier.
Today, as it stands, you can be from Timbuktu (or Canada), walk in the door of my ER, and receive a coronary stent, a coronary bypass graft, or whatever is medically indicated. This is a result of the pre-Obama monstrosity of EMTALA detailed ad nauseum in other portions of this blog. It has nearly broken our system... NEARLY.
So EMTALA removed the onus from the patient to be responsible for himself both financially and health-wise, and put it on doctors and nurses. What better idea could there be then to remove the onus completely from the patient and place it on, well, people who pay taxes. Health care is now a 'right', but it will be like a 'right' to as much fool's gold as you want.
The dirty little secret for all you ER abusers is that your gravy train just went right through the station.
I now, along with my triage nurses, have teeth. You can now be turned away at the triage area if you haven't complied with the desires of the author's of the bill. Rather than ten hours of hell, my shifts now become quite regulated and predictable. EMS crews, guess what? Pretty soon you CAN actually tell people to fuck off. I imagine, that for a short time, it will be quite satisfying.
Initially, doctors should make a lot more money because the free care mandated by EMTALA will be reimbursed, theoretically, by you. The narcotic refill patients, the patients who can not see their primary care physicians and need reassurance regarding their chronic illnesses or perhaps a liter of saline for their gastroenteritis, will be sent home from triage. I won't see them anymore. They will be scheduled for the 'next available' appointment with someone, somewhere at some time in the future, probably three weeks or so.
So all you aspiring docs, you just got banker's hours. All you aspiring nephrologists, pick something else, dialysis as it is known today, will cease to exist for those with chronic disease. No doubt we will be very caring and provide comfort to those who will die, and when we can not provide a service or a procedure which is needed STAT, we can say, with sincerity, 'they won't let me'.
Posted by 911DOC at Wednesday, December 23, 2009