Two of the guys I admire in strictly entrepreneurial terms are the creators respectively, of "Girls Gone Wild" and "Spongebob Squarepants." To be sure ,the former is a sleazebag and I avoid children and their entertainments whenever possible. But both represent a vision of opportunity recognized and converted to cash, two variants of entertainment Botox if you like. And like my other primary care escapee brethren and sisteren, I wonder what the great unnoticed opportunity is. It is well documented that the Pri-Cares are beset on all sides by contracting, hostile forces that are squeezing them out of any lingering professional enjoyments, as well as their livelihoods:
Increasing burdens from quasi-government stooges like the AMA, AAFP, NIH, IOM, etc; sanctimonious politicians whipping a collapsing bureaucratic engine like a rented mule, fueling it with dollars so imaginary and foregone that Peter and Tink should be snorting them in lines in the backroom of the Never-Never Lounge; angry,scared, and sometimes vengeful patients whose unreasonable expectations of perfect and happy lives could only have sprung from the naivete of a developmentally-delayed society; and the lawyers, always the lawyers. These are bad days to ride the darkening roads as a Pri-Care, with a bandit, landslide, or hidden pit around every bend, and those that can are voting with their feet. Where is the big opportunity in this decline and fall?
A lot of pri-care docs need to get out, but do not have a way out. School debt, underwater mortgages, or that illegitimate child with the out-of-work drug rep whose product just went generic all add up.
But why should professionals who have invested years and six-figures allow themselves to be used up and thrown away like the standard American Idol contestant? I read that Lindsay Lohan was going into rehab one step ahead of the warden, and it seemed therein lay the answer.
For years now the Pri-Cares have been their own worst enemy, cheerfully lining up for every new Maintenance of Certification like it was Kool-Aid at Jonestown, while begging, pleading to keep their pittance payments for government patients (Medicare/Medicaid). Every once in awhile they all jump up and down and wave signs at some sad little "white coat rally", and are roundly laughed at by those holding the purse strings. Then their masters pat them on the head, promise them a whole 1% extra if they do 10% more work, then force them to buy electronic medical records. Now that the profession is being effectively disabled by the society that claims to value it, should not the victims be able to benefit? Now I know that the old joke about doctors approving each other for disability has been around for some time, and yes I do have several colleagues willing to enter into such a beneficial reciprocity when the time comes. But that is akin to solo practice - where are the extenders for physician disability?
Maybe the right physician can get other doctors to work for him, and in so doing advocate for the poor Pri-Cares everywhere. If LiLo can skip down the rehab trail in the footsteps of Mel Gibson, Rep. Paddy Kennedy, and the wannabes on "Celebrity Rehab", then we should be smart enough to know how to get in on the act while there is still some fat on the hog to cut.
Say one hires the right professionals, all for a piece of the action, to establish a caring and comprehensive clearing house to connect stressed, depressed, borderline-alcoholic, and plain angry doctors with the just compensations accessible to the rest of society? Every day we are marauded and badgered by all manner of patients and family members seeking disability or some other special consideration for this or that, otherwise able-bodied masters of pitiful who would just rather not make the effort any longer. How many times in med school were we exhorted to learn from our patients? If doctors knew that there was help and a place of legal and financial refuge, then they might feel more at ease, indeed liberated to come into work drunk, scream unhinged at just one more pseudo-myalgia narc seeker, or punch out the office manager,
because plainly they deserved it.
Said professional would immediately be charged with one or more transgressions fit to suspend their livelihood, at which point a trained support team of analysts, evaluators, character witnesses, and lawyers - always the lawyers - would swoop in to protect the rights of the put-upon provider. The hospital, multi-specialty practice, insurance company, patient, and any involved bystander could all be named in suit to recompense the now-disabled doctor who would be quickly whisked to rehab for further evaluation, understanding, and isolation from troublesome recording devices. Clearly the wealthy hospital was responsible for the onerous paperwork, bitchy staff, and undue stress caused by patient complaints that all contributed to the hostile work environment that drove Dr. Smith over the edge. Certainly the state medical board with its repeated insistence on yet five more hours of CME for the reproductive risks in crystal meth users drove Dr. Rebar whacko.
These well-funded, uncaring organizations should be made to pay for the damage they have inflicted upon caring, once stable physicians now no longer able to practice for fear of relapse, low-self-worth, or nagging pain out of proportion to any exam.
Of course the goal is not court, but just settlements that reflect not only the economic losses of the victim and the guilt of the causative party, but the reasonable financial aspirations of the caring team of professionals responsible for connecting the doctor-victims with the proper rehab facilities, evaluating physicians (themselves, future customers?), and in selected cases, book publishers. Compassion at this level does not come cheaply, and it cannot be overstressed - unlike our clients - that settlement awards reflect these costs.
Of course medical specialists could also call our toll-free number for a consultation, but the potential settlements would need to be large enough to justify leaving, say, cardiology or a rural "pain and nerves" practice. It is to be expected that the initial bulk of need would come from the forlorn Pri-Cares deciding whether their next paycheck will go toward the next family medicine board exam or an extra pack of baloney for little Timmy. (Nurses might also be included, but in a bulk package per workplace, in order to make up for the likely lower individual settlement rates).
This would be a time-limited, relatively narrow-window opportunity that might be limited in short order by state laws or new CMS regulations requiring states to forfeit all Medicaid funds if they do not pass laws that re-define all licensed physicians as "those immune to, and not subject to the disability protections in other law", or some such boilerplate. Emphasis should be place on a low overhead, with minimal physical plant, minimal staff (the redhead from "Mad Men" comes to mind), and maximum dividends for partners to encourage the most compassionate possible direction.
And with that in mind, we have to prevent VH1/Celebrity Rehab's Dr. Drew from getting wind of this for as long as possible.