Coronavirus Outbreak

[Ken]

If they’re on Medicaid, why should they care? They aren’t paying for it and they don’t have to pay missed appointment fees either.

Of course, whenever I go to a doctor’s office I often have my time wasted for an hour or more - even if it’s the first appointment of the day. Perhaps some patients are simply returning the same disrespect they’ve been shown.

It's not medicaid, it's mostly employer-based HMO coverage.

Just saying. From the point of view of doctors, a lot of telemedicine is just wasted time. They get paid either way. But then have to end up seeing the patient in person anyway.

And no, it probably isn't going away because the doctors and nurses and other professionals who actually practice medicine in this country aren't in charge of anything.

[Josh]

And no, it probably isn't going away because the doctors and nurses and other professionals who actually practice medicine in this country aren't in charge of anything.

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

[RZehr]

And no, it probably isn't going away because the doctors and nurses and other professionals who actually practice medicine in this country aren't in charge of anything.

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

About how old is your doctor? Are their younger doctors doing this, or is it just old soon to be retired doctors doing this?

[Ken]

And no, it probably isn't going away because the doctors and nurses and other professionals who actually practice medicine in this country aren't in charge of anything.

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

I guess it depends on if you want to practice medicine or run a business. I have two cousins who have or had their own independent practices. And at least half their time is consumed with the business end rather than medicine. One finally gave it up and now does urgent care because she couldn't stand the endless 24/7 hassles of running a business rather than practicing medicine. And lost a lot of money in the process. The other is basically stuck and can't retire because he can't find anyone who wants to take over his business and buy him out.

[RZehr]

And no, it probably isn't going away because the doctors and nurses and other professionals who actually practice medicine in this country aren't in charge of anything.

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

I guess it depends on if you want to practice medicine or run a business. I have two cousins who have or had their own independent practices. And at least half their time is consumed with the business end rather than medicine. One finally gave it up and now does urgent care because she couldn't stand the endless 24/7 hassles of running a business rather than practicing medicine. And lost a lot of money in the process. The other is basically stuck and can't retire because he can't find anyone who wants to take over his business and buy him out.

This morning I asked an attorney here if he would encourage a young person to become a rural small town general practice attorney as he is. He said no. 30 - 40 years ago when he came to town there was about 16-17 attorneys. Now, he is the only one left in the county that does general practice. Just him and his assistant.
His old partner left the business to do contract work for the state as a public defender. The state pays this guy $14,700 per month, and the work is very simple, and there is no assistant to pay, very little overhead. The next county over is down to only about 3 attorneys.

So sounds like these professions, doctor and lawyer, are not immune to the problems that other small businesses have.

[Ken]

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

I guess it depends on if you want to practice medicine or run a business. I have two cousins who have or had their own independent practices. And at least half their time is consumed with the business end rather than medicine. One finally gave it up and now does urgent care because she couldn't stand the endless 24/7 hassles of running a business rather than practicing medicine. And lost a lot of money in the process. The other is basically stuck and can't retire because he can't find anyone who wants to take over his business and buy him out.

This morning I asked an attorney here if he would encourage a young person to become a rural small town general practice attorney as he is. He said no. 30 - 40 years ago when he came to town there was about 16-17 attorneys. Now, he is the only one left in the county that does general practice. Just him and his assistant.
His old partner left the business to do contract work for the state as a public defender. The state pays this guy $14,700 per month, and the work is very simple, and there is no assistant to pay, very little overhead. The next county over is down to only about 3 attorneys.

So sounds like these professions, doctor and lawyer, are not immune to the problems that other small businesses have.

The difference is that a lot of small businessmen want to actually run a business and that is where their skillset lies. They thrive in doing business, the wheeling and dealing, managing people, etc. Whereas a lot of medical professionals go into medicine and spend their youth training in medicine because that is where their interest and skills lie. And then they find that running a small private practice is as much business as medicine and and they are neither equipped for nor enjoy the constant demands of the business side.

My wife stays in touch with the other doctors that she went through residency with. Neither the doctors in small private practice, nor the doctors in big groups are particularly happy. Both have their frustrations and burnouts. Her only colleague who seems to be thriving is the one who went into concierge medicine in Houston and works for some sort of fancy boutique practice that only sees rich people for cash and is basically at their beck and call. That is kind of a sell out too. But at least they have rosewater and a soothing indoor fountain in their plush waiting room that has a view of the Houston skyline. And she doesn't have to stay late doing dozens of charts every night.

[Josh]

And no, it probably isn't going away because the doctors and nurses and other professionals who actually practice medicine in this country aren't in charge of anything.

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

About how old is your doctor? Are their younger doctors doing this, or is it just old soon to be retired doctors doing this?

I suspect it’s an Amish country thing. He’s not that old. His dad was a doctor too.

[Josh]

And no, it probably isn't going away because the doctors and nurses and other professionals who actually practice medicine in this country aren't in charge of anything.

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

I guess it depends on if you want to practice medicine or run a business. I have two cousins who have or had their own independent practices. And at least half their time is consumed with the business end rather than medicine. One finally gave it up and now does urgent care because she couldn't stand the endless 24/7 hassles of running a business rather than practicing medicine. And lost a lot of money in the process. The other is basically stuck and can't retire because he can't find anyone who wants to take over his business and buy him out.

That’s because dealing with insurance, Medicaid, and Medicare is a gigantic waste of time.

The business of medicine in primary care is pretty simple. Charge $80 for a doctor visit. The end.

[Ken]

Which is their own fault; they decided to take easy employment jobs.

I see a doctor who owns his own practice. He doesn’t take Medicaid, insurance, and doesn’t carry malpractice insurance either. Cash is accepted for payment.

There’s no telemedicine although I’ve heard sometimes he FaceTimes with an already established patient. (My dentist did the same thing to check on a crown that fell out.) He doesn’t have an electronic system at all. The bill is written out by hand on a triplicate form.

Sometimes my church aid plan needs a little help to reimburse them… they’re so used to seeing fancy insurance company style bills.

I guess it depends on if you want to practice medicine or run a business. I have two cousins who have or had their own independent practices. And at least half their time is consumed with the business end rather than medicine. One finally gave it up and now does urgent care because she couldn't stand the endless 24/7 hassles of running a business rather than practicing medicine. And lost a lot of money in the process. The other is basically stuck and can't retire because he can't find anyone who wants to take over his business and buy him out.

That’s because dealing with insurance, Medicaid, and Medicare is a gigantic waste of time.

The business of medicine in primary care is pretty simple. Charge $80 for a doctor visit. The end.

So no labs? No X-rays? No MRI? No endoscopes or angiograms? No echocardiograms?

Just a doctor and a stethoscope like in the 1850s?

[RZehr]

I guess it depends on if you want to practice medicine or run a business. I have two cousins who have or had their own independent practices. And at least half their time is consumed with the business end rather than medicine. One finally gave it up and now does urgent care because she couldn't stand the endless 24/7 hassles of running a business rather than practicing medicine. And lost a lot of money in the process. The other is basically stuck and can't retire because he can't find anyone who wants to take over his business and buy him out.

This morning I asked an attorney here if he would encourage a young person to become a rural small town general practice attorney as he is. He said no. 30 - 40 years ago when he came to town there was about 16-17 attorneys. Now, he is the only one left in the county that does general practice. Just him and his assistant.
His old partner left the business to do contract work for the state as a public defender. The state pays this guy $14,700 per month, and the work is very simple, and there is no assistant to pay, very little overhead. The next county over is down to only about 3 attorneys.

So sounds like these professions, doctor and lawyer, are not immune to the problems that other small businesses have.

The difference is that a lot of small businessmen want to actually run a business and that is where their skillset lies. They thrive in doing business, the wheeling and dealing, managing people, etc. Whereas a lot of medical professionals go into medicine and spend their youth training in medicine because that is where their interest and skills lie. And then they find that running a small private practice is as much business as medicine and and they are neither equipped for nor enjoy the constant demands of the business side.

My wife stays in touch with the other doctors that she went through residency with. Neither the doctors in small private practice, nor the doctors in big groups are particularly happy. Both have their frustrations and burnouts. Her only colleague who seems to be thriving is the one who went into concierge medicine in Houston and works for some sort of fancy boutique practice that only sees rich people for cash and is basically at their beck and call. That is kind of a sell out too. But at least they have rosewater and a soothing indoor fountain in their plush waiting room that has a view of the Houston skyline. And she doesn't have to stay late doing dozens of charts every night.

I’m not at all convinced that it is all that different. A ton of sole proprietor’s start businesses because they like doing the work. In fact, I believe that the reason there are so many small businesses that plateau after some years, are ones that are started by men who are primarily craftsmen, and not businessmen.
Of course there are some who like business, and wouldn’t care if they were building/selling/servicing any particular thing. These just like business and the specific industry they are in is secondary.
But the craftsman, is the sort who loves what he does. A man who loves making furniture; a chef who loves to cook. They types often end up with a successful business, but they don’t like the “business” side of it.

What I specifically had in mind in my previous post, is the trend that has been happening toward squeezing out the really small business. It’s told that it is easier to make money with no employees than with 2, for example. I’m told that in the past, where a 2-8 employee company was viable, it now is forced to be about 15 people.
This is just due to regulatory compliance, low margins, higher labor costs, etc. And I suspect that the small town lawyer and doctor suffer from the same.

This is just what I’m told, but I do think there is truth to this trend.