Sunday, August 30, 2009

What Ever Happened to Marcus Welby, MD

I wonder where and when Marcus Welby, MD disappeared from the scene? You might not remember Doctor Marcus Welby. He was a dedicated family practitioner who combined cool intellect with professional acumen and was a highly successful doctor. In fact he was so successful many others were encouraged likewise to become doctors. What Dr. Welby did for the medical profession is much like what the TV shows about CSI is doing for forensic science: motivate people to take on a challenging career.

Lest you think Marcus Welby, MD was a real doctor that he was not. He was a character played by Robert Young from 1969 to 1976 in the medical drama of the same name. The show was number one in its second year and stayed in the top 20 for most of its run. But what I find myself contemplating was how Dr. Welby seemed to focus on curing the sick, not fighting insurance companies and government regulation. Even more odd, was the show only had one nurse and the nurse also worked as the practices' secretary! Amazingly, there were never any shows about the ability of a patent's ability to pay the office visit or co-pay.

What happened between 1969 and 2009? Here are a few ideas:
** Malpractice Insurance went through the roof due to unrestrained lawsuit payouts. Thank you John 'medical trial lawyer' Edwards, et al.
** Employer paid insurance benefits to union workers - non-union companies forced to follow suit to acquire top workers. Also private policy insurance can't compete
** Demise of major medical policies replaced by full coverage policies. Increased risk equates to increased costs even if spread over millions of policy holders.
** HIPPA - Single biggest invasion of government in health care to date. How many privacy act statements have you signed? Each one has to be processed and recorded.
** US Food and Drug Agency - More governmental requirements and costs, some for safety to be sure, many inane rules that only increase costs.
** Doctor rationing by medical schools. Fewer doctors means greater pay for demand
** Insurance networks - Doctors either join the network or have no patients
** Demise of single owner - private hospitals and independent Doctors. Now all are part of big corporate operations and networks having huge overhead costs.
** Third Party Administrators - Part of overhead to control costs - Often the insurance company's gate keeper for coverage.
** 12+ million illegal immigrants going to emergency rooms for treatment.
** Over use of specialist - MRIs and Labs in every facility & if the ailment can't be fixed in the allotted 15 minutes with the PCP, its off to a specialist.
** Indulgent society I -Pills for everything - A no pain society.
** Indulgent society II - Triple Bacon Cheese Whoppers for lunch with a giant side of FF & gulp cup coke.
** Indulgent society III - we drive to the post box instead of walk.

Next time you go to the doctor, count the number of non-medically related folks you observe. Every one of them with the exception of the receptionist is there because of insurance claim processing, government documentation requirements, or financial accounting. Thirty years ago, Consuelo Lopez, Dr. Welby's loyal and able nurse had time to hand out candy to the children. Now she's too busy with meeting the increasing demands of the industrial-medical complex.

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