I’d write a prescription,” he told me, “and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.”
When he decided to work in a hospital, he figured that there would be more freedom to practice his specialty.
“But managed care is like a magnet attached to you,” he said.
He continues to be frustrated by payment denials. “Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ”
Recently, he confessed, he has been thinking about quitting medicine altogether and opening a convenience store. “Ninety percent of doctors I know are fed up with medicine,” he said.
I am not working in a convenience store, but negotiating with Kenyan bureaucrats is not exactly clinical medicine either. If American doctors choose to work in convenience stores or the developing world rather than primary care practice, isn't it time to reform the American health care system?