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Financial worries leave doctors feeling blue, wearing blue jeans
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It’s Halloween. The doorbell is ringing incessantly. Each time I open the door, there is another child or group of children eagerly standing before me. The youngest, thus far, was 3 years old, the oldest was 10. Some were dressed as scary monsters, others as kings and princesses. Each assumed the role of their chosen characters as they held out their bags for goodies.
All of this activity has made me think of how we adults dress and the roles which we play as we hold out our bags for “goodies.” Could it be true that you are what you wear?
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Take the white shirt, for example.
My interest in white shirts began last year when a pilot friend of mine flew a huge FedEx cargo plane into Phoenix. As a FedEx pilot, he was flying cargo all over the world “hauling trash,” as they say in the business. On the day he was leaving, I was with him in his hotel room as he ironed and carefully put the final touches on his white shirt. It was part of his uniform. Before walking into FedEx Ops, he made sure that his tie was straight and that his shirt was properly tucked in. He wore his uniform very proudly and with distinction. In turn, he was shown respect.
Lately, in the hospital making rounds, I’ve noticed that more doctors are wearing white shirts. No, not the white dress shirts that one would wear with a blazer or suit, but rather white T-shirts. They are often worn with blue jeans, not designer jeans, not even new jeans, but rather old beat-up jeans. Some top off their sartorial splendor by wearing flip-flops.
It wasn’t always like this. Not too long ago, the doctors were well dressed when they rounded in the hospitals. They exuded a certain pride and confidence mixed with enthusiasm and excitement. But now all of that has changed, and so has their attire. Their attitude and demeanor are much more somber and downbeat, perhaps as a result of the impending Medicare reimbursement cuts. They find themselves in the financial crosshairs.
The congressional “super committee” was tasked with trimming more than $1 trillion from the federal budget. Although their meetings were held in secret, there were indications that the Democrats wanted to cut Medicare by $400 billion, with half of that coming from cuts to health care professionals. Republicans wanted to cut $500 billion. It is unclear if these cuts will occur, but already on the books is the Medicare sustainable growth rate (SGR), which will lower Medicare reimbursements by 27.4% in January. The Medicare Payment Advisory Commission (MedPAC) has recommended replacing the SGR with a freeze on payments to primary care physicians for the next 10 years and cutting [payments to] specialists 17% over 3 years, starting in 2012. They would then be frozen at that level for the subsequent 7 years. In the past, the SGR was the only bullet and was usually dodged by congressional interventions. But now, can multiple bullets be dodged at once? Not too much in the way of “treats” here for physicians holding out their “bags.”
As the financial pressures have increased, the professionalism, camaraderie and collegiality previously prevalent in medicine have decreased. Once viewed as a profession or calling, many who practice medicine today are taking on the mentality of a factory shift worker and dress accordingly with “white shirts” and blue jeans. Working set hours, they are unreachable when their shifts are completed. The difficult patients are no longer viewed as therapeutic challenges, but rather as “hot potatoes” to be passed on to the next shift and possibly never seen again.
What is happening? Have we been tricked or are we being treated?
Richard Dolinar, MD, is a senior fellow in health care policy at Heartland Institute in Chicago and a clinical endocrinologist in private practice in Phoenix. He is also an Endocrine Today Editorial Board member.
Disclosure: Dr. Dolinar reports no relevant financial disclosures.