The profession is feeling hard done by according to Leslie Kane in her (frightfully cleverly named) column The Kane Scrutiny on Medscape, who asks “Why Aren’t Doctors Allowed to Care About the Bottom Line?”

It doesn’t take much to provoke bleats from doctors about being hard done by and overworked.

“My plumber with no student loans, no education, and accepting only cash payments has an easier and more profitable career. Yes, medicine is a very altruistic career, but altruism doesn’t pay for college, graduate schools, mortgages, food, etc. The CEO of United Healthcare with $23,000,000 in earnings last year couldn’t give a hoot about the altruism in medicine.” Says one respondent.

And, “Our salaries are because we work our butts off, give up time with our families to take calls and work weekends, deal with stress most business people could never imagine (telling someone their mom has died or is dying, etc.), studied hard AND LONG (anyone get a chance to really enjoy their 20s or even early 30s? Didn’t think so), and we should never have to apologize for being successful through diligence and sacrifice.”

The Other Side

The other side to this is being in a group that owns it’s own imaging department and having mandatory meetings every month or two where the Chief Medical Officer and administration tells us what codes to use to assure the study doesn’t get denied by the insurance company, and cajoles us into ordering as many studies as possible.

Or the coders come and tell you how to “buff” the chart i.e. maneuver the documentation to allow one to charge the highest possible code - even if it’s something totally trivial like a sore throat. So the charge is absurdly overpriced - but it’s OK, you’ve put in enough (unhelpful) documentation to justify a 99214 charge.

Or why does the Institute of Medicine find it necessary to recommend in its guidelines, no “consultant fees”? Could they be thinking of us poor dumb schmuck, grunts being willing to pretend to be  “thought leaders” and regurgitate the Daiichi-Sankyo advertising garbage the reps give us to present at a “Physician Opinion and Discussion” (P.O.D.) lunch meeting. Where we shoot the breeze, eat the lunch they provide, and get paid $600 - which I see as a thinly disguised coercion to steer us away from the opposition’s products (Norvatis’s Diovan and Exforge), and to their products, Benicar and Azor.

So which is the true picture? The downtrodden, over-worked victim? Or the avaricious conniving manipulator?

Probably a bit of both!   ”Order the damn MRI” 

 In this world of copycats - as in teenage suicides and mass shootings to pick two lighthearted examples - my question is, who’s going to lead in the dietary coercion stakes?

Will it be Chelsea Clinton, with her vegan faire and gluten free wedding cake at her very overpriced wedding?

Or will it be the “depravity” of competitive eating - in which competitors have increased their ability to scarf down hot dogs from 25 in ten minutes, ten years ago, to 68 in a recent record breaking bortz out at Coney Island according to Slate.com.

 Gloria Silver intrigues me. Fibromyalgia and on Oxycontin - so back like clockwork to get her script each month.

Then there’s strife in the homestead and the husband walks out - or is thrown out, I never quite gathered which. She’s in spitting bullets. “He only wants the Cialis for his girl friend”.