Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Intelligent Healthcare Information Integration 5/27/09
Life in a Little Trench, or Supply Side HIT
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A “grunt in the trenches.” That’s a term I’ve used to describe who, what, and where I and thousands of healthcare providers like me are, occupationally speaking. It is probably a different perspective than many you’ll see on these pages. Please allow me a moment to offer a few descriptive moments to sketch out that picture a bit more.
- I’m a solo pediatrician in a small town (pop. ~9,500) in the rural flatlands of central Ohio.
- I’m on call for neonatal emergencies and C-sections 24/7/365.
- I love living in and serving my small community. I’m the medical director for the county health department, a member of the town planning commission, a local United Way board member, a Rotarian, a member of the local hospital Foundation Board, and have a spot on our town’s Bicentennial planning group.
- In the last three years, my true “vacations” have totaled 3 days.
- Our busy little practice serves a rural populace: about 65% of our families are Medicaid.
- I locally host our EHR on two servers. For IT for our office, I’m it.
- My three wonderful employees started off almost fully computer-illiterate. (OK, one knew how to turn a computer on, one didn’t, and one called the mouse a “duck.” Seriously.)
- I spent hours upon hours researching more than 200 EHRs, demoed scores of systems, and went into deep detail on the finalists before deciding upon an EHR for our office
- Life in my trench includes traffic “jams” of six cars and friends who know me before I’ve ever seen them. It allows for a trip to the post office, a bank deposit, picking up a prescription from the pharmacy, grabbing a forgotten paper from my home, and being back to the office, literally, in less than twenty minutes. There are Scout meetings, sports, school functions, and homework. I insist upon family time and some (admittedly brief) down time.
- I don’t miss big city life in the least.
I’m not offering this description to glorify myself nor anything I do. Rather, I am a very run-of-the-mill, small community, primary care physician. There are thousands more like me out there, working hard to care for our communities and families. We have wonderful, fulfilling lives and enjoy our labors.
There is, however, something missing from our great little lives. We need inclusion in this great big HIT discussion going on. With very few exceptions, nobody’s talking about us – even though we serve the majority of US healthcare needs. Systems and plans are almost completely focused upon the Mayos, the Clinics, the HIEs centered around giant centers, etc. Doesn’t anyone care about all us little grunts out in the frontline trenches?
It seems most everyone’s focused on the big guys and their bigger pools of money. Even the purported Keynesian liberals in political power now seem to be counting on the “Trickle Down Effect” (or its precursor, the “Horse and Sparrow Theory” from the 1890s) to spread HIT from the big centers to all us little guys. Last time it was the conservatives telling us grunts how well we’d all be served by supplying the big boys’ side and letting us little fellows feed off the crumbs that fell.
OK, so that was finance, not healthcare IT. I suppose it’ll work better this time.
Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.
C’mon, Dr. Alexander, as a pediatrician you are already screwed. Let me see if I get this right as it relates to the EHR stimulus scam:
– First, you’re only earmarked for 2/3s of the ~$65K that every other speciality is getting, right? Too bad kids don’t vote.
– Second, you *must* take 20-30% Medicaid (depending on what you read) in order to qualify. I realize that you already do, but for some practices, that 20-30% influx of Medicaid removes a multiple of the potential benefit.
– Third, the money isn’t guaranteed to come to you anyway. It will be handed to your local Medicaid program where they will distribute it as they fit. If you’re in a state whose Medicaid relationship with kids is bad (like, say, OK or NJ), har har har. In fact, I don’t know what state will do it right. Is there a state with wise Medicaid spending? VT? RI?
– Finally, and this is true for every speciality and every practice: I don’t know what economic background everyone else has, but in MY microeconomics courses, I learned that when there is a known subsidy in place, what happens to the prices? They stay artificially inflated. If anyone thinks that the “big boys” above aren’t acutely aware of the additional budget possibilities for each and every doctor, they’re insane. You think they won’t figure out a way to extract every cent, or more, of the mythical $65K? Can anyone here name a time when subsidy money was pushed into an industry and it actually drove prices DOWN?
I would have voted for Obama three times if I’d had the chance, but if anyone thinks that this HIT stimulus bill is anything more than a way to move taxpayer $$ to the VPs of the top systems (’cause it sure ain’t going to improve healthcare), they’re dreaming.
Les,
I’m glad my cynicism only goes so far. (Otherwise, I probably wouldn’t be happy as a small town pediatrician.) My take on the value of trickle down Obama HIT Bucks for us grunts, sarcastic thought it may be, is tempered by the fact that, despite how the big boys may continue to undervalue the small community primary care docs, we’re still a pretty happy bunch who aren’t all in it just for the profit margin. (Again, if not so, I definitely wouldn’t be happy as a kid doc.)
Still, I believe a smart cookie could wean huge advantage with a smart, small community focus. Health- and dollar-wise.
Please don’t misinterpret my cynicism, Dr. Alexander. I really appreciate all the medicine that happens below the radar of CMS, the Feds, etc. I can’t imagine there is a much more rewarding career than being a small town pediatrician (I’m quite close to the concept, personally). Knowing a few hundred of them as I do, I can’t actually think of _any_ who are in it for the money.
C’mon, small town primary care is not about $$/hour! 🙂
That said, it isn’t a ticket to the poor house, either. You are very right – done well, it’s a very comfortable living with an amazing career return. Keep it up.