I use to have Kaiser as my healthcare provider.  While in their system I was allowed to have
a pick of their litter of doctors but each time I found one I liked, they would leave and then I would
ultimately be forced to select another.  I went through several doctors and each time, I was left
with a pool to select another, then another, and yet another.  It was tough but I suppose that shows
what type of disposition I have with people.  

One afternoon during a scheduled appointment, I was told that my doctor was no longer with
Kaiser and during this visit I was assigned to see Dr. Joe.  Okay, what other choice did I have?  I
needed to see the doctor.  During the visit, Dr. Joe - not his real name - was not only pleasant and
kind, but his bedside manner was impeccable.  I liked him, but was certain he wouldn’t be in their
clinic for long.  (That always seemed to happen to me: I find a doctor who is both professional and
knowledgeable, and then they leave.)  When it was time for me to schedule another visit at Kaiser,
I asked to see Dr. Joe and low and behold, I was right.  He was gone!  Yep, I was batting a

When the year was up and I was allowed to select another insurance healthcare provider through
my employer, I switched to one that I thought would better serve me.  And while I didn’t have a
primary physician, I searched through a list of doctors and was surprised to see that Dr. Joe’s
office accepted my new insurance.  I was happy.  I made an appointment and from that day
forward, both Dr. Joe and I had a great doctor-patient relationship for many years.  I trusted Dr.
Joe.  He was not only my trustworthy healthcare physician, but also someone I relied on during
some very difficult times.  

Years later to This Week

    The other day when I came back from picking up the mail out of
    the cluster box, I sifted through it and sorted in piles.  I stated,
    this is junk, this is a bill, and this, I can read later and then my
    hands touched an over-packed #10-sized envelope.  I recognized
    the lettering on the envelope and so I sat down at the kitchen
    counter to open it and examine the contents inside.
    As I sat and read, I began to realize two things:
    1) Dr. Joe was threatening me, and
    2) I had been dumped.

    Dr. Joe was threatening me to either be with him in his new
    venture and if I wasn’t, he would send my 13 years of medical
    reports to another doctor.  What?!?!?!
Economic Blues Trickle Down to Physicians
Robert Lowes
December 28, 2008 — Although most physicians are not losing their jobs or homes, they're nonetheless feeling the repercussions of the recession
that began in December 2007 and deepened during the financial crisis in the fall of 2008. Symptoms large and small abound of a financial slump in
 Fifty-six percent of hospitals told the American Hospital Association in November that physicians were seeking more financial support, ranging
from reimbursement for on-call duty to outright employment.
 Roughly 1 in 2 physicians plan to attend fewer continuing medical education conferences in 2009 that require overnight travel, according to a
September survey by the publication Medical Meetings.
 Some physicians may be receiving fewer holiday gifts, a sure sign of belt tightening among patients. Internist Sheree Lipkis, MD, in Glenview,
Illinois, has noticed a decline in such gifts from previous years from her patients. "Some of them have lost their jobs," Dr. Lipkis told Medscape
Medical News.
Physicians like Dr. Lipkis might expect that rising unemployment and curtailed consumer spending would reduce patient volume, but that's not a
universal pattern. To be sure, elective surgery has tailed off. Six in 10 plastic surgeons, for example, report a decrease in cosmetic procedures during
the first 8 months of 2008, according to the American Society of Plastic Surgeons. Yet most primary-care physicians interviewed by Medscape
Medical News say they haven't slowed down. "Patient numbers are stable," said internist C. B. Dehlin, DO, in Lansing, Michigan. "Maybe we're
just caring for the 90% of Michiganders that have jobs."
Patients Postponing Care, Skipping Tests and Treatments
Full schedules for primary-care physicians may be misleading, though. Thirty-six percent of Americans are postponing needed care, while another
30% are skipping tests and treatments outright, according to a survey in October 2008 by the Henry J. Kaiser Family Foundation, and both
categories are up 7 percentage points since April 2008. However, with many primary-care physicians ordinarily drowning in patients, reduced
demand may simply translate into a shorter waiting time for an appointment slot as opposed to an open slot.
Also, the payment cycles of commercial insurers may have temporarily softened the effect of the recession for physicians who enjoyed crowded
waiting rooms in late 2008. By that time, many if not most insured patients had met their annual deductible, motivating them to load up on needed
care before year's end while it was less expensive. Dr. Lipkis said that's the reason why the last few months of 2008 were busier than usual for her.
Come January 2009, the prospect of shouldering the entire cost of an office visit or procedure may discourage insured patients from making an
If patients — insured or not — do book an appointment, there's also the possibility that they may not pay up afterward. The Kaiser Family
Foundation found that one third of Americans were struggling to pay their medical bills in fall 2008, up from one quarter in 2006. Not surprisingly, a
St. Louis collection agency called Account Resolution has seen the dollar volume of delinquent accounts received from physicians increase by
roughly 25% in the last half of 2008, says company president James Hill, Jr. "These trends are happening all across the country," Mr. Hill said. And
they only stand to worsen with unemployment expected to hit 8.3% by the end of 2009, according to financial research firm Standard & Poor's.
One component of the current recession — the credit crunch — has made it harder for some physicians to borrow money to start a practice or
expand an existing one. "Automatic loans for anyone with a medical degree are a thing of the past," practice management consultant Michael LaPenna
in Kentwood, Michigan, told Medscape Medical News. Besides requiring physicians to put up security for term loans, cautious banks are asking
physicians with an existing line of credit to prove that they have enough accounts receivable to justify the amount of money made available.
Bolstered Medicaid, Medicare Spending May Help
Prognosticators such as Standard and Poor's expect the recession to last well into 2009. How physicians fare will depend partly on the success of
federal bailout efforts enacted under the Bush administration — bankrolling banks to loosen up credit, for example — as well as the economic
stimulants that President-elect Barack Obama has said he will administer. Mr. Obama has contemplated pouring billions of dollars into state
Medicaid programs that have experienced budget cuts in the face of higher demand (the Kaiser Family Foundation estimates that every 1% increase
in unemployment adds 1 million people to Medicaid and the State Children's Health Insurance Program). For many physicians, bolstered Medicaid
spending could mean the difference between poor compensation versus none at all.
The American College of Physicians (ACP) is asking the federal government to be just as generous with Medicare. It is recommending
that for 18 months, Congress fund a 10% bonus for all Medicare services performed by primary-care physicians. "Without funding to
stabilize primary-care practices, many will go under and have to close" in light of the credit crunch, investment losses, slower
collections, and uncompensated care, the ACP states in a letter to the incoming Obama administration.
While everybody, it seems, is waiting for federal largesse, physicians can act on their own to cope with the forlorn economy. For starters, tune up
your billing and collection operation. With patients losing insurance coverage or switching to a spouse's policy after a job loss, it's imperative to
verify insurance eligibility and benefits at the front desk so you know whom to bill, said practice management consultant Mr. LaPenna. Collecting
copays and patient balances at the front desk is another must for the sake of maximizing revenue. If patients are short on money, offer them an
installment plan. It can be as simple as keeping their credit card number on file — with the patient's authorization — and automatically charging it
over a set number of months.
Improve Marketing to Current and New Patients
Practices with openings in their schedules should try to make it easier for patients to make appointments, suggested Hobie Collins, a practice
management consultant with the Medical Group Management Association in Louisville, Kentucky. Extended weekday hours, for example, cater to
employed patients who might find it hard to come in otherwise. "Eliminate as many barriers as you can," said Mr. Collins.
Stepped up marketing can also help fill up the waiting room. Target your existing patients first, advises practice management consultant Jeff
Denning in La Jolla, California. "Go through your charts and see who's overdue for preventive or follow-up care, and give them a call," Mr. Denning
said. A practice Web site may help a surgical specialist attract new cases.
Cost control is an indispensable virtue during a recession. "Remember the motto from the Great Depression," Mr. LaPenna said. "Use it up, wear it
out, make it do, or do without." To achieve the right economy of scale, Mr. LaPenna said, physicians may have to go beyond mere downsizing and
consider merging with another practice.
How drastic the solution needs to be, of course, depends on the length and severity of the recession. Dr. Lipkis, for one, will be watching how many
tins of popcorn and bottles of wine she receives from patients when the winter holidays come around in 2009. In the meantime, she's giving thanks.
Dr. Lipkis said: "We remind our staff during stressful days how lucky we are to have jobs and be financially afloat."
Keeba’s Commentary
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Dr. Joe was the same doctor who bent the rules for me when I was forced to change medical insurance Companies.  Dr.
Joe was the same doctor who helped me sift through dozens of neurologists until I found one that I liked.  (He helped me
through that process more than 3 times.)  Dr. Joe was the same doctor who helped me through weight loss and other bad
habits.  Dr. Joe was there through the midnight hour when I couldn’t sleep because of severe coughing.  Dr. Joe was
productive when he made threats to my employer.  Dr. Joe made the correct notes in my medical file when I was
financially forced to cut down on my medication.  Dr. Joe has seen me through the good, the bad and the ugly, but now,
but now this???  He's dumping me?  What?

At fist, I was upset that he was threatening me to either pay into his new plan of $2,500 a year to receive his health care
or get kicked to the curb, but then I thought about it.  Dr. Joe was married with children.  Yes, his office was always busy
and humming with patients, but one thing was certain, he had bills and I know for sure that my medical insurance
Company did not pay his office right away.  He just like everyone else was hurting financially.  

    Dr. Joe’s “Business” healthcare plan is a simple one.  Each patient is not
    required to have health insurance.  Wow, what patient wouldn’t want
    that, right?  But there’s a catch.  To be Dr. Joe’s patient, you must sign a
    contract that says you will pay $2,500 per year for his services.  This new
    plan allows the patient to have more than 10 minutes during each visit
    with the doctor and ultimately, the doctor promises the ability to provide
    more hands-on healthcare.  (With his new plan, he will be able to spend
    30 minutes or more with each patient.)  In addition, the doctor will be at
    the patient’s disposal 24 hours a day, 7 days a week.  His plan allows the
    patient to receive flexible scheduling and easier prescription refills.  Not
    bad when you think about it, but who can afford it?  Dr. Joe’s plan will
    most likely cut down on the number of patients he sees, but then if he’s
    able to provide everything he proposes, he’s guaranteed to receive a
    descent salary.  

Dr. Joe is suffering with the rest of us.  I can’t afford Dr. Joe’s new health plan, so I will be moving on.
His letter says that I can visit his website and to forward any questions I might have via email, but I don’t have any.  I
can’t ask him to keep me just because we have a long-term relationship.  No, not for the sake of our relationship because
I know it’s not personal; business is business.

Honestly and truly, I’ll miss Dr. Joe.  I’ll miss his goofy smile, unchanging arrogance, strict health advice and caring
bedside manner.  Dr. Joe is one in a million and I know that those who are allowed to be his patient will receive the best
healthcare possible.  I’m not mad at Dr. Joe nor am I envious that his patients will receive exquisite care, but instead, I’m
happy for them.  I’m happy that they are able to survive.

It is my hope that some day, before I have a new kinship with another doc, that Dr. Joe will reconsider and allow us poor
folk back in his care.  (I know I’m not the only one who is seeking a new primary care medical doctor.)

I want to email Dr. Joe, but what can I say?  As my dear Dad used to say, “That’s just how it is.”
Severed Relationship
               Severed Relationship
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January 8, 2009
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This entry was posted on Thursday, January 8, 2009 and is filed under Keeba’s Commentary  and Political Notes.
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Keeba Smith is a published writer and desired screenplay artist.  She is the author of “Shades of Bright Pale,” and many other
unacquainted writings. Please visit  
www.Keeba.org to find out more about Keeba Smith, read additional critiques and her
unpublished autobiography,
“Spirit in the Dark.”
© 2009