Way back when I started in practice I joined another physician in a small office. An old-time doctor’s office. No computer. Everything was handled on paper, including the billing. People answered the phone. I’ve always been proud that I run on time, but there were doctors in the neighborhood who thought nothing of making their patients wait for two hours. There were few standards. Doctor A would treat his patients with diabetes with medicine B; doctor C would use regimen D; nobody complained. We muddled along. Health care was definitely more personalized, but quality was uneven and sometimes questionable.
You don’t see these situations any more in large cities. There are very few incompetent doctors. There are standards of treatment that are generally accepted. Computers have made vast amounts of information available. We’re just scratching the surface of what they’ll be able to accomplish. It’s relatively inexpensive to study genes. Within five years there will be a fairly good understanding of what diseases each and every human being on Earth is susceptible to; we can find out the minute they are born.
Large corporations have been in the thick of this progress. Pharmaceutical firms have come up with fantastic new drugs that treat fatal or crippling illnesses. Device manufacturers have made it possible for you to have an internal organ removed, or fixed, without the need for extensive surgery. Hospitals have gone from charitable endeavors who served a community to massive organizations that control a large percentage of health care delivery in any city. Health insurance companies generate huge amounts of information that is used to find otherwise unavailable clues about medicine side effects or inadequate care.
All of this change costs money. Because people value their health above all else, the new era has also generated massive profits. A profession whose guiding principle was to serve has turned into an industry where the key to survival is to generate enough income to please the head administrators and stockholders. Green is the color of progress.
More than twenty years ago I decided to give up my quest to be independent of these behemoths. I clearly saw that computers were going to be indispensable. I had no technical skill. It had become very difficult and time consuming to have employees. There were many regulations. Once a month I’d hear horror stories about doctors whose office managers had embezzled money from them. Insurance companies paid more, for the same services, to doctors who worked for hospitals.
I sold my practice to the Daughters of Charity, who owned De Paul Hospital. Soon after De Paul was sold to SSM. My practice was part of the deal. I became an SSM employee.
For the most part things went well. The employees had more benefits. The technology that I craved became available. Many lives have been saved because of it. Patients were satisfied. I did extremely well financially. SSM has done even better. De Paul was a failing institution when I joined its staff. It lost money; employee morale was low; patient satisfaction abysmal. Thanks to the hard work of many people who sacrificed some of their personal life things turned around. SSM’s leader, sister Mary Jean Ryan, became nationally acclaimed for going out of her way to provide quality and compassionate care to people who came through our doors. I was proud to follow her lead.
Unfortunately, my situation has changed. The people who recruited me to work for De Paul are gone, either fired or retired. The emphasis on quality remains, but the drive for profit clearly dominates the picture. Regulations have mushroomed to the point of distraction. Employees are tense and anxious. We don’t see many smiles from them.
I can’t have an open cup of coffee in the exam room any more. There are certain shoes that are outlawed. I can’t hand free medicine samples to people in need. Employees who are busy are not allowed to have a quick snack at their desk, even if their work place is far removed from any patient area. It goes on and on. I decided that I was old; too far along to complain. I wrote some letters to “the new guys.” The answer was always the same: we have to do this to comply with regulations. Bide your time; it will get better.
A few months ago I received an e mail. Jeans are no longer allowed in the office. No one can wear Cardinals gear. I later found out that clothing that showed a large logo, such as “The North Face,” was banned (inappropriate advertising).
If you’re not from St. Louis: we have two religions in this city. The zoo and the Cardinals. We may have Ferguson and racial strife and whole city blocks that are boarded up, but we will always be proud of the zoo and the Cardinals. We worship these institutions.
We had a meeting.
What’s with the dress code? This has nothing to do with federal regulations. It’s just one person trying to wield some power over me.
“It’s not professional.”
I was professional before you were born, I think to myself. I wrote a book on being a good professional. I even gave you a copy. I decide to try reason.
The patients love it. When we have a weekday noon game I wear jeans. I take some employees to the game. Good for morale.
Do you have any idea how complicated this gets? Who will be the police? Do we have employees who have nothing else to do but check on jeans and shoes every morning?
The last time anyone told me how to dress I was nine (I inadvertently lied here. I served in the US Navy for two years. They told me how to dress, and how long my hair could be, and many other things. For a good reason). What will happen to me if I wear jeans? Will you send me home?
An angry look. End of conversation.
A few weeks later my pay was cut. Nothing personal. Regulations, I was told.
“You will not like it on your own. You’ll have to buy malpractice, and get a computer system, and once again be responsible for the employees. You’ll make less money.”
Malpractice is easy to get. So are computers these days. I love my employees, and they worship the ground I walk on. I can live with less money. I’m leaving.
It has been a tough two months. SSM will not give me a list of all of my patients, so that I can inform them of my impending move. Regulations, they say. A letter was sent to my patients. It doesn’t say that I will remain in practice. It tells them that they can switch their care to a different SSM doctor. This is our policy, I was told. My colleagues; my friends who refer patients to me will be told that it will be in their best interest to stop doing this.
It’s all about establishing a brand. When you go to McDonald’s you don’t care who’s behind the counter. You want the fries. When you visit Disneyland it does not matter who dresses as Mickey Mouse. You just want someone, anyone, to wear the outfit so that you can take some pictures. Large corporations want to do the same with health care. They want you to go to their building; they don’t want you to prefer one doctor over another. Take a look: you won’t see anything in their offices that belongs to your doctor. They want all locations to be the same. Their brand.
October 23 will be my last day with the organization that I have devoted 21 years of my life to. On November 2nd my new practice at De Paul Drive, right across from the De Paul ER (the Quest diagnostics building) will open its doors. There will be pictures of my grandchildren on the wall. Of course I will wear jeans and a Cardinals cap on that day.
We are in the process of getting credentialed to all major insurance plans.
Please do not call the office with questions. Sick patients may not be able to get through. Best if you wait for us to contact you, which should happen in the next 4 weeks. If you have any immediate concerns you can e mail me at firstname.lastname@example.org.
New address: 3440 De Paul Lane, Bridgeton 63044
Web site drbaak.com