Losing our skilled providers

Aug. 1, 1998
To talk with many health-care providers, you would think that the only problem facing physicians, dentists, and hospitals was the restrictive practices of managed-care organizations and their influence over both the marketplace and the delivery of care. While this is a definite problem, a more subtle difficulty related to insurance and managed care waits in the wings.

Carol Tekavec, RDH

To talk with many health-care providers, you would think that the only problem facing physicians, dentists, and hospitals was the restrictive practices of managed-care organizations and their influence over both the marketplace and the delivery of care. While this is a definite problem, a more subtle difficulty related to insurance and managed care waits in the wings.

Losing skilled providers

What is this problem? Attrition of providers! We are set to lose an entire generation of the most skilled and mature physicians, dentists, nurses, and hygienists to early retirement. Many health-care providers, at the height of their abilities and in the prime of their careers, are anxious to leave practice.

If you speak with any group of dentists, you find that most target their early to mid-50s as the age they plan to leave practice. Physicians follow suit, with nurses and hygienists planning to abandon patient care even earlier.

Why is this happening? With all of their long years of training, physicians and dentists traditionally have stayed in practice into their late 60s and beyond. Who of us who that have had to undergo a hospital stay cannot remember the experienced RN on our ward who was able to trouble-shoot problems and anticipate complications. Many dental patients can tell you of hygienists who have taken care of their children and their children`s children.

Three major factors are influencing health-care providers to quit, and they all are related directly to managed care and insurance.

Factor 1: money

The first factor is money. Physicians and dentists in their 40s are at the peak of their careers, yet they see their incomes being eroded while they watch colleagues in business, law, and on Wall Street make more money than ever. Delicate procedures performed on human beings take years to learn, yet may command a payment of less per hour than a plumber would make!

Nurses, who have been "downsized" over and over by hospitals pressured by managed care to cut costs, have become disillusioned. Some never return to patient care following the loss of a job. Positions in managed-care management and supervision pay better, have more consistent longevity, and don`t require working shifts on understaffed wards with an increasing number of sicker patients. Hygienists also are wooed by managed-care organizations and dental-product companies. Instead of seeing more and more patients during less and less time, they can work comfortably in an office or travel to cities around the nation representing a company.

Factor 2: independence

Senior physicians and dentists dislike being questioned on treatment recommendations and procedures by third-party administrators and claims personnel. They take exception to untrained personnel dictating treatment decisions based on actuarial tables. Many find it frustrating to go to bat for patient after patient so that they can receive the care they need.

Practitioners also dislike the third-party interference applied by insurance plans. Dental patients read the statement, "Fees exceed the usual and customary amount for the procedures" on their insurance forms and make the deduction that their dentist is overcharging them. The energy and effort required to help patients understand their insurance is too much for some dentists to continue.

Factor 3: escalating overhead

Physicians have experienced skyrocketing increases in malpractice insurance. Some obstetrician-gynecologists pay as much as $100,000/year for insurance. While malpractice insurance is costly for dentists, simple office overhead is what typically eats away at their incomes. In most parts of the country, dental-office overhead costs are 65 percent or more of collected income.

Controlling the cost of health care has affected all of us. While most consumers agree that some of the compromises necessary to keep prices down are inevitable, many would be startled if they knew of the planned exodus of experienced practitioners. Rationed, rushed care may be a problem, but inexperienced care may be far worse.

Carol Tekavec, RDH, is the author of two insurance-coding manuals, co-designer of a dental chart, and a national lecturer. Contact her at (800) 548-2164 or at www.steppingstonetosuccess.com.

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