I have mentioned problems with the NHS here before.
That was about emergency care.
Last fall there was a concern about junior doctors emigrating to other countries.
Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.
According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.
Two-thirds of practices are now finding it ‘difficult’ or ‘very difficult’ to find locums — freelance medics — to cover the shortfall.
As our population gets steadily older, and sicker, frontline surgeries are becoming increasingly swamped.
‘We are in dire straits if we do not act to address the GP recruitment crisis immediately,’ the Royal College of GPs warned last week.
In standard government medicine fashion, the British Health Minister imposed a new employment contract that ignored doctors complaints.
The result ?
Junior doctors are threatening a mass exodus to Australia after Jeremy Hunt forced through his controversial new contract yesterday.
There has been a huge surge in the numbers seeking certificates to practise abroad and some have already lined up jobs.
Almost 760 doctors were issued with documents by the General Medical Council in the first four weeks of this year – nearly 200 a week and almost double the usual number. Although they include some older GPs and consultants, the vast majority were disillusioned younger doctors.
Becoming a doctor is a classic middle class occupational choice. Few doctors become rich and almost none do so from actual practice. There was a phase in the 1960s when doctors suddenly became much more prosperous as Medicare was introduced, providing payment for care that had been done for no charge mostly. With time, the US government has reduced compensation and imposed rules designed to reduce costs. With the imposition of Obamacare, many older doctors who do not have heavy student loan balances and whose own children are educated, are choosing to drop all insurance, including Medicare, and practice for cash.
Obamacare has resulted in many hospitals consolidating and buying up medical practices to develop a vertically integrated system of health care delivery that resembles old industrial models. The result for physicians is a trend to salary jobs and dissatisfaction with their careers.
I met a woman geriatrician, the only fellowship trained geriatric specialist in central Iowa. She had quit Medicare. That sounds a bit suicidal if all your patients are Medicare age. What had happened was she was being harassed by Medicare because she was seeing patients too often. Many of them were frail elderly living at home. She dropped out and began charging her patients cash for services. She was making a decent living after a year and was happy with her decision. I don’t know how many realize that geriatrics, as a specialty, is a university subsidized field. There is no private geriatric practice because the doctor can’t survive on what Medicare pays. She tried and had to quit. She is doing it on her own now.
That was about Medicare. The same is happening with Obamacare and the medical conglomerates that have been assembled in anticipation of the “Industrial Model” of medical care. How is that working out in Britain ?
Yesterday Health Secretary Mr Hunt announced he would be imposing the contract because further negotiations with the doctors’ union were not ‘realistically possible’.
His decision followed a 24-hour strike by junior doctors on Wednesday – the second in a month. The walkouts have led to a total of 7,000 cancelled operations.
Last night up to 300 junior doctors and other campaigners protested outside the Department of Health in Whitehall, calling on Mr Hunt to resign.
They chanted ‘Where are you Jeremy?’, ‘Jeremy Hunt has got to go’ and ‘We won’t give up the fight’.
Is this the future of American medical careers as well ?
I have also mentioned the hospital where I practiced for 25 years.
The commission that was assigned to inspect the applying hospitals was made up of big hospital trauma surgeons and they did not expect to see much in a small suburban hospital. There were five applicant hospitals in Orange County, one of which was the UC, Irvine hospital. When the survey was complete, we had scored the highest of the five, including the university hospital.
The trauma center got gradually busy over the next seven years. We added additional surgeons to the surgical group so we would have enough to take the necessary call.
At that point, I thought it was the best hospital in Orange County and many agreed. Since then, it has been sold to a group of nuns and they hired some of then worst people I have ever encountered to run it. Run it into the ground, I should add.
Now, the employee doctors practice at the bidding of the hospital administrators and risk severe consequences if they do not follow orders. For example, my former surgery group which has run the Trauma Center for 35 years since I designed it, has now been arbitrarily replaced by another surgical group from another part of the state. The new surgeons are strangers and the OR staff knows nothing of their training or experience. The staff finally met the new surgeons last week and they are all women. They begin to take trauma call next Tuesday, July 1.
Why was this radical change made ? There is speculation that the surgery group was made “an offer they couldn’t refuse” last year when the hospital wanted to buy their practice and put them all on salary. They declined and this may be the result.
More recently, a close friend who has been the Operating Room supervisor for 20 years was fired and is sueing the hospital. The “grounds” for firing her were, according to her and I believe her, fictional. The director has been harassing her for two years and they have been trying to get all the senior nurses to quit so they can be replaced by new graduates who makes less money and who do not recall how things were when quality was more important.
There were even more developments last fall.
The Orange County Register had the story.
All elective surgeries at Mission Hospital, the third-largest hospital in Orange County, are on hold after four patients who underwent orthopedic operations developed infections.
The hospital opted to close its 14 operating rooms in Mission Viejo and Laguna Beach last week after a major accrediting agency, The Joint Commission, intervened and found, among other problems, high temperatures and humidity in some of the rooms, according to Chief Medical Officer Dr. Linda Sieglen.
I understand the hospital was fined $5 million and the administrator, the one who had hired his chiropractor brother-in-law to run the operating rooms, was fired. One of my former surgical group partners has left the community and moved to northern California and things are slowly getting worse. The Newspaper had a followup story that concerned continued use of contaminated operating rooms.
Mission Hospital, which said Monday that it is resuming elective surgeries at its medical campuses in Laguna Beach and Mission Viejo, continued to allow surgeries in its operating rooms earlier this year even after an inspection found flaws in its heating and ventilation system.
At least four patients suffered serious infections in Mission Hospital operating rooms this year. Two weeks ago, the Joint Commission, an agency that oversees hospitals, issued a preliminary recommendation to deny accreditation to Mission Hospital based on conditions in its operating rooms.
Last week, Mission said it voluntarily suspended all elective surgeries and closed its 14 operating rooms. Mission is the county’s third-biggest hospital, accounting for about 7,000 surgeries a year.
On Monday, the hospital opened its five operating rooms in Laguna Beach, with the nine in Mission Viejo set to reopen as early as Wednesday.
The facility is back working but I would not choose to be hospitalized there. It is sad to see the high morale and esprit de corps we had dissipated by ignorant bean counters. I don’t expect a hospital to lose money but there are foolish ways to try to save money, like ending cleaning crews for operating rooms, and more efficient ways to maintain quality. Toyota showed how that could be done while the American auto industry showed how to fail.
It is frustrating and infuriating to see the great hospital we built up in the 1970s, reduced to a news story about poor care as the result of ignorant and corrupt administrators.
The trend toward stupid management of so many things in American life is a reason why we see the political revolution that is beginning.
Tags: economics, health care
The above account regarding Orange County medicine sounds very familiar to me. The same thing – to a degree – is happening in Omaha.
The people who provide the real value – the doctors – should be the persons most highly rewarded; not the hospital administrators. And most definitely not the health insurance people.
I wanted to puke when Obama had his Rose Garden press conference on Obamacare and some stooges in white coats were props standing behind me. Lefty academics, I guess, in the presence of the Sun King.
It is stunning to me that more people aren’t completely outraged as to what Obamacare has done to this county. Save $2,500 a year? How’s that working out?
We are headed to an NHS system if the Dems win in November. Complete ruination of one of the best parts of our economy. One doesn’t go to France or Saudi Arabia for medical care.
My wife and I moved from Colorado to South Carolina last year, and so had to find a new doctor. We opted to go with a “direct pay” doctor who does not accept insurance or Medicare (which I am on; she has a $5K deductible catastrophic coverage policy). There is a monthly payment that covers most things; office visits, annual physical, routine lab tests. Other procedures are steeply discounted. We get appointments quickly, often the same day and the Dr. and/or NP spend a lot of time with the patient. The level of attention and ease getting to see the doctor is well worth the small increase in costs. Great medical care, which we certainly had in Colorado, is worthless if you can’t utilize it. So far we are very pleased with the experience….reminds me of the old days.
I think the cash practice model will grow. You will know it is scaring the politicians when they try to make accepting Obamacare is a condition for a license. That was introduced in Massachusetts a couple of years ago.