By skyforbes 
I am in an abusive relationship. The funny thing is, I don’t know quite how it started but know that what is keeping me to it involves one of my greatest passions. The seeds of this passion first sprouted when I was a little girl. My brother, an infant at the time, became ill with a serious infection and had to be rushed to the hospital. I don’t know what it was, but my heavy-lidded eyes were introduced to an aura of wonder and delight that I had never dared imagine- a hospital. I loved that there was a place for my tiny sibling to go that offered to comfort and heal him. To make him whole again. I loved that there were medical personnel who surrounded him, took his vitals, and knew what was wrong with him without him having to say anything.
I remember that I told my father that I wanted to be a nurse one night as he tucked me into bed. He politely inquired at what I wanted to do with my life again. I told him that I wanted to be a woman who worked in the hospital and helped heal people. Because I had only seen male doctors at the time, I believed that no woman could hold this role. Maybe my father intuited this naivety and advised me that being a physician could also be a possibility for me. From then on, I wanted to be a doctor.
Little did I know what a treacherous road becoming would be. After years of trying, studying, praying, I was finally able to add two letters to the end of my name. But this had been no less easy than what I imagine climbing Mt. Everest must be. It was a solitary trial by fire, one that challenged me to rise from the depths of despair and hopelessness to finally fly. At the end of my training, I was still blessed with a sense of justice and equity. No racist, sexist, tropes that my fellow attendings threw at me phased me anymore. I was finally in the world as a physician; chiseled, molded, fired in the kiln and present.
But this is where the story begins. Here I was a person fully equipped to help and heal. The decision surrounded me about what direction I wanted to go. I knew that I was and had always been a pediatrician. Children delighted me. I knew that I could offer purpose and direction. But the finances of my decision were also weighing on me as well.
As a medical student, I had incurred a great deal of student loans which caused me to live so meticulously that AARP had flagged me as a retired person based on my intermittent purchasing habits. I stayed inside my small dark, apartment for days on end, fearing the temptations that could easily pull money out of my wallet. Every minute was spent studying and focusing on budgeting -managing fun with dollars incessantly to live out my dream.
I was notified at the end of my medical school career that the school loan repayment delay that had initially been offered to residents every year before mine, was now becoming null and void, meaning that new medical graduates had to start paying (with interest) as soon as we graduated, while working long hours for little pay. This meant that residency brought with it its own struggles and challenges, but it especially heightened my financial anxieties; the loans seemingly ballooned as did the financial stress. Most people would believe this to be a justified practice; glitzy doctors leading lives on a mediocre stipend, but what they don’t realize is that the myth of the lifestyle is what pervades everything.
I wear a mask that reflects financial success, as do most. The issue is that people believe that doctor’s make upwards of a half a million dollars per year with the average being $335,000 as noted in past newspaper articles… but what about the physician who makes much less than that? They are likely practicing in primary care. It is no wonder that physicians are fleeing primary care and contemplating other avenues of revenue after decades of study and experience. For some, it is a long and arduous path. For others, It is a jagged black hole that sucks you in with its demand, it is a grating line of work at times with little bursts of joy tenured by a steady drum of regret.
I did not sign up to do this for money, nor power. I did this to help people. What a bitter malady I sing in my head as I realize that there are so many others like me, all with the same purpose who have been thrown into a never-ending spiral of a cruel Insurance company game-show life. Most people do not know what doctors go through with insurance… so let me illuminate it for you.
Imagine being a waiter working in a five-star restaurant. You wait on the tables, make efforts to please the customers, and serve the food with perfection based on what is ordered. In this metaphor, the insurance companies are the owners of the restaurant, and they determine the prices. This means that everything on the menu is TBD (To Be Determined). Now let’s say that a doctor can wait 30 + tables a night. They get no tip for service and must wait 40 days plus to actually see what they were paid for this one night of service.
Here’s the kicker. Even though the waiter sees 30+ tables per night, does everything that he or she is asked, the owners (insurance companies) choose what to pay the doctors. In some cases, the waiter may find out that some of their tables were VIP meaning that they were gratis, some customers who were only allowed to order meat, ordered fish (unbeknownst to the waiter at the time) and now eat for free. There are also deductions to the waiter on how they carried the tray to the table, whether they smiled at customer A first, even though customers C and D needed the smiles first, deductions on which side of the table the plate was placed on last…. deductions, deductions, and more deductions.
Now, let’s say that after all of the calculations are done, the waiter has a total of about 30% of the revenue that they may have thought were guaranteed for this one night of service. And this goes on night after night. The waiter may read up on the constantly changing “serving guidelines” that state that the plate must now be placed on the right side of the table first and begins to do that… however, the owners soon change it to the right side of the table every other day and the waiter loses revenue. To add insult to injury, should the waiter complain to the owners, he or she must do it in mime, as the owners only understand this method of communication.
Each time that the waiter complains, he or she must do so before or after their shift. Mime takes some time, and the owners may understand it, or they may not. Either way, it is up to the waiter to keep track of the number of customers seen, be omniscient and somewhat psychic in knowing their customers’ needs while continuing in their industry.
What should be a straight-forward work for wages ends up being a stranglehold-hog tied mess. Every person deserves to have a living wage. Every person should know the clear value of their work. In this day and age, I am given pay that does not have a definite value. There is a pay schedule, but, the insurance companies don’t necessarily have to abide by this. They can pay me what they deem appropriate.
Some may argue that there are laws in place to protect me and they would be right. The issue comes when there is an onus on me to prove that there is a problem- submitting supporting documents, dates, times, wages, etc. Even when the insurance companies review this, they can still deny payment, just because. It adds further insult to injury when I am so overworked and know that there is a problem, then report it time and again through channels lined with so much red-tape and bureaucracy that my initial complaint ends up being typed up and thrown into a black hole, only for it to keep continuing with no resolution in sight. What is there to do then?
On top of the exhaustion of the rigmarole is the shame. Shame that my role in the community may carry weight, but, that I am not even respected by those who I work for- sometimes my patients, but most times insurance companies. Shame that I am lumped in with a large group of my peers who live exorbitant lives because they chose not to go into primary care. Frustration with the system of “agencies” and “associations” who have allowed their members to be hen-pecked and sun-scorched to submission. Apoplectic about looming student loans while trying to maintain a small business, providing for patients, paying my employees, other business expenses, and hoping for the best.
This is the weight and the burden of the physician with no voice. But I hope that someone hears me today. In this looming mess of a system, insurance companies must be held accountable. We need clear price schedules that show us what each visit is truly worth and insurance companies need accountability to make certain that we are paid for the patients that we see and the work that we do. We need transparency, so that it is easier to identify errors in the system and unobstructed channels in place so that those errors can be reported and modified accordingly. We need loan reform to create a pathway for other physicians to enter primary care so that they may one day be able to fill their souls with the weight and joy of service. But, if we keep down this path, it is only the people who will suffer. I guarantee you that the insurance companies will be fine, however.