Wednesday, December 23, 2009

Lemons From Spoiled Lemonade

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'.


  1. It is funny how people on the outside, working normal jobs, have little care or concern what happens to health care and physicians in general, assuming that things will just stay the same, and the same level of care from the same caring physicians will be there. I can promise you, they won't stay the same. Just like anyone else, physicians like to be rewarded, financially and by helping others. To better yourself is simply human nature. And when professionals who have spent nearly half their lives studying and practicing an art are treated with disdain and disregard, the medical care you get will reflect that, unless you are a Senator or Representative and have excluded yourself from the whole process. No tort reform. You have got to be fucking kidding. 2700 pages. I guess when your country has 1.2 million lawyers and 660,000 doctors, what can you expect.

  2. It is funny how people on the outside, working normal jobs, have little care or concern what happens to health care and physicians in general, assuming that things will just stay the same

    I think a significant number of us have enough brains and experience with life to understand the implications of socializing any business. Frankly, it scares the water out of me, and I'm tired of mopping already.

  3. Good grief. This country needs a massive enema STAT. I hate the idea of telling people I live in the United Socialist States of America.

  4. Hey 911 (and anyone else who might know),

    I won't be starting residency for a couple more years, but I'm already thinking forward. Do you think certain specialties stand to benefit more than others (at least in the short term) when and if this bill passes?

    For instance, I could see EM salaries going up significantly. I was talking with an EM doc who said his group gets payment from maybe 40% of their patients. So I could see where the new mandates could drastically increase their salaries. On the other hand I could see something like private primary care not increasing much since they generally don't have non-payers (unless you include Medicare and Medicaid) anyway. Thoughts?

  5. dear medical student,
    guessing what will be a good field right now would be no better than going to vegas, betting it all on 'red', and doubling down with every loss. i've tried it and it doesn't work.

    i remember in the mid nineties everyone said to stay away from anaesthesia... CRNAs were going to take it over, residency programs were not filling, etc... oh to be in anaesthesia today... in fact, a colleague of mine, after getting boarded in EM and working for a year, got so disgusted that he went back and did an anesthesia residency. very happy now, but did he make a good choice given the current circumstances? i'm not sure.

    the obvious choice would be primary care, but i'm not sure this is true. so much of primary care is already done by NPs and PAs that there may not be much money in it (but there will certainly be a three thousand page guide for you which you must follow so you will cease to be a physician as the term is now understood and become more of a social worker.

    if obama and co. have any sense and actually want to spread misery all around then they will outlaw private practice medicine that does not accept government reimbursement. then you have France, where a surgeon makes about ten dollars per surgery on top of their government provided salary.

    in fact, if the idiots have as much sense as i think they do they will make going to medical school 'free' but then decide what you will practice and where. you think i'm kidding but this WAS in the Hillary bill of 1993 or 1994. in that case i'd just go ahead and join the military... you will have more choices.


  6. Obamallama has already spoken about a Civilian Defense Force. Just wait, soon there will be a Civilian Health Corps and we'll all be drafted...

  7. Liberal Doctrine:
    "Government is the ideal director of medicine. Politicians are thoughtful, caring, and altruistic. They devote their lives to helping others.

    Contrast this to physicians, who spend half their lives learning diagnosis and complex, delicate procedures, with the intent of charging sick people for these services."

    - -
    ObamaCare intake protocol:
    Yes, our care is only $15. Fill out these forms, mail us two referrals, and we can see you two weeks after that. Apply pressure in the meantime; maybe the bleeding will stop.

  8. In spite of it all, I hope you all have a happy Christmas with your families and friends!

  9. Thanks PeggyU but some of us don't worship your False Christian God...

  10. dear frank,
    this club's restricted so don't tell them you're Jewish alright?... And Frank, what's with the pictures? It's a parking lot! Happy festivus to you sir.

  11. Let me rephrase that, then :). Those of you who want to, please have a Merry Christmas - or a Happy Hannukah, if that is your inclination!

    Those of you who don't, kindly disregard the greeting and have a good day off anyhow!

  12. We patients are so friggin hosed.

  13. 911- was caddyshack recently on guys seem to be quoting it a ton lately. Hehe. Might I suggest The Hangover.

    PS: took your advice, thank you, sir


  14. Have you ever putted with a Wedgie??
    Caddyshack is SO 1979...
    I'm quotin Caddyshack unappreciated classic...
    No Bill Murray or Ted Knight...Dan Akroyd is awful, and Jackie Mason in Rodney Dangerfield's role is just sort of annoying...but China Phillips and Randy Quaid are worth the price of admission...


  15. ...because before now there has been no rationing of health care in America.

  16. Dear CannedAm,

    I assume you meant that sarcastically. yes, there is rationing now, there is a shortage of organs for transplant for instance and some strict criteria about which patients may receive said transplant organs. the new legislation, however, makes rationing of transplant organs a bit more fair... if you can beat someone in an arm-wrestling match, you may have their liver.

    the only rationing in our system now is in transplant surgery and rationing based on bed availability.

    And congratulations... no one does 'crazee' like you. Keep it up.

  17. OH! OH! OH!

    I just thought of a really neat experiment so that we can maybe get on the same page with CannedAM.

    Dear CannedAM,

    I know you claim to live in Canada and if I remember correctly you do not live to far from the US. Here's all I ask... Get a large wooden mallet and hire a gang member for this... they know how to do it. Place your left ankle against a cement block and have the gang member break it into many pieces. Go immediately to one of your Canadian hospitals after the ambulance refuses to transport you... report on your experience and tell us when you get your surgery and tell us about your recovery.

    After you recover, come south of the border and repeat the experiment with a US hospital and US gang member.

    Think of it as doing your part to further the debate, or, not.