My wife went to her obgyn, a family friend with an established 30+ year practice in the area this afternoon. She was telling us something rather shocking.

According to her, her business has been trending down substantially in the last few months, which was worse than 2008 when she also had a slight setback. She always gets a constant flow of referrals from hospitals and fellow doctors, but she is now seeing dwindling referrals. What she sees is not an isolated phenomenon, her fellow doctors in private practice are seeing the same thing, and mind you, we are in the Silicon Valley with a mini-bubble (well, just popped) in social media. At the same time, her cost is going through the roof, particularly with medical insurance she provides to her employees. She has one 30-yo female employee perfectly healthy and she is paying $650 for her Kaiser HMO a month, and she has the cheapest rate among her staff, she is paying close to $1K for others.

She is also talking to some new med school graduates and they seem to be having problem getting matched as well. Many don't want to work for hospitals because most patients there are on welfare (Medi-CAL or Medicare) and it is hard to build patient base for private practice once they start seeing nobody but welfare patients. As a result, some new doctors are underemployed - working a couple of days each week for some HMO medical groups while looking for other private positions on the side.

It seems to me that the patients disappear because they are losing their workplace insurance. Is anybody else seeing this?

Declining birthrate due to economic pressures? Only people having lots of babies are members of the FSA?

The hospitals made a lot of money previously from elective surgery. With increases in co-pays, people are thinking harder about it.

Higher deductibles and copays keep the doctor away. Great business for the corrupt insurance companies.

When you have third party payment with relatively equal co-pays.. Guess you can't compete on price.

Doh!

My brother is a doctor and I got three things from from a talk on Sunday.

1) Medicare is paying less and less (no news there)
2) Insurance companies are pre-denying tests/services. You have to convince them the patient needs the test.
3) There is no visible cut back on paying for drugs and medical equipment

So doctors are getting squeezed and equipment makers and pharma are cashing in.

Ya know... I haven't had pre paid medical for oh a bit over a yr. I've been to the doc twice.

It is a different conversation when you pay out of pocket for everything vs just going un huh and nodding yes to everything they want to do for a 25 buck copay

Seems to me you learn more, however slight, and you get more options on a cost scale, pro/con, if ur not just a bobble head muppet.

Waiting times are much lower. A couple of the specialists my family sees used to have a 4-6 week wait. Now it is about a week.

Also, out of network specialists (such as cosmetic) are dropping their prices. For one procedure, the price I was quoted dropped from $5K to $3K over a 6 month period. Still too pricey for something completely elective, but a decent discount nonetheless.

{QUOTE] her business has been trending down substantially in the last few months, [/QUOTE]

Who wants to open a new practice in CA, IL and other similar states? People are leaving those tax and spend states. All that CA and IL will be left with are the FSA people.

I know a high ranking IL cop who is retiring. He said he's leaving Illinois because all he sees are continued tax increases to pay for state obligations.

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I know a high ranking IL cop who is retiring. He said he's leaving Illinois because all he sees are continued tax increases to pay for state obligations.

Irony?

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Irony?

I know of a Chicago public works retiree that moved to Florida for the same reason.

They want the pay and benefits but don't want to pay for them. They will stampede the state capitals if they had to pay more for their pensions and benefits. They feel they deserve it. Talk with the state legislature people and their rubber stamps for the public unions. Guess where this ends up.

Co-insurance is also a big concern. Our insurance has a 20% co-insurance, on top of the co-pays. Deductibles are rising every year too. So now we have a situation where even those who have insurance are paying through the nose to see a doctor. Our plan doesn't even cover specialists at all until after you meet a $2,000 deductible.

The only folks who are seeing doctors without any cares about the cost are those who have kids on Medicaid. They waltz in and get totally free care, while I pay $70 just to get my kids some antibiotics.

My town has a huge percent of older folks. Every business plaza is some kind of outpatient facility: retina center; imaging center; cancer center, and so on.

My parents are on Medicare now and ALL they seem to do is go to doctor appointments!

On another note, dentists seem to be doing a lot of advertising for patients now. $100 special for new patients: exam, x-ray, and cleaning. $50 for just exam and x-ray. The same ads have been running for a year now.

We're putting off a lot of dental care because of (a) no insurance and (b) high costs. Kids haven't seen the dentist either. I'm over due for my gyn exam, but I'm not worried about that, and I'm certainly not getting a mammogram either.

I also see a lot of jobs posted now that are "temp" (3-6 months) or contract (1099). No insurance offered with these new jobs.

So when will we hear the fate of "Obamacare"? Is healthcare going to "save the economy" and grow to the moon or are we starting to see the bubble pop?

I'm in dental and I saw a big drop (25-30%) in '07-'08 but it's been pretty stable at that level since. This year is actually slightly better than last. But I'm in Vegas and we went down pretty fast and early here.

And yes, most health business is insurance driven so as people lose their insurance they stop coming.

And if you start taking Medicaid you instantly turn off your cash paying and private insurance patients, since they know they are getting overcharged to compensate for your losses with Medicaid. Then you're really stuck.

The two-tiered system is coming. Just pray you aren't on the bottom tier cause it's gonna royally suck.

Oh yea, and at some point ALL doctors will be forced to accept Medicaid in order to renew their licenses. States like IL and CA will implement it first but it will shortly go national after.

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My town has a huge percent of older folks. Every business plaza is some kind of outpatient facility: retina center; imaging center; cancer center, and so on.

My parents are on Medicare now and ALL they seem to do is go to doctor appointments!

Unsustainable spending destroys lives and the longer it goes on the more people get sucked into it. What happens to all those gov- er health care workers when the free money stops? What happens to the economy when the 'stimulus' stops? I suspect a majority of the people benefiting from the government aren't preparing for the loss of those benefits.

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States like IL and CA will implement it first but it will shortly go national after.

When that happens you should see an exit of doctors from those states. They better do it all at one time.

How can the .gov force a private doctor, who has a private business, to accept medicare or medicaid?

How did the Government enact EMTALA?

Simple -- you didn't resist.

But doesn't EMTALA only apply to hospitals that accept some form of .gov funding? Theoretically, couldn't a hospital be solely run w/o .gov funding?

I have a friend on Medicare, basically healthy with some issues. She was telling me about something she did for herself at home, a little dangerous, that had in the past been something that would have been done in a hospital. I know she is being pinched by everything, loss of interest income and the usual. So that is one example of people economizing.

Some docs here lost enough business to lose their homes. Others moved to cheaper offices.

But the docs seeing Medicare patients are still working a lot. They are getting insurance approvals for things outside the approval range tho...I bet to make their payments.

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How can the .gov force a private doctor, who has a private business, to accept medicare or medicaid?

Simple. Add one line to the state medical license renewal form entitled "Medicaid provider ID#:______________."

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docs seeing Medicare patients are still working a lot.

Yup, but don't confuse being busy with being profitable. If they gave away free beer everyday they'd be busy as hell but that's not a very good way to stay in business.

Oh, and another thing I see is insurance companies rejecting more claims and delaying payments. But isn't that illegal? Yup. They get around it by waiting 30 days and then sending you a letter requesting "more information." And then another at 60 days.

When I was 16, I once tried to convince my dad to let me suture a puncture wound in my hand up. "Get me some JD, a needle from grammy's sewing kit and some thread and I'll have this fixed in a jiffy Dad!" All while my Mom is freaking out and my girlfriend is bawling at all the blood. Needless to say, bones look cool!

Nope. Four hours in the hospital for 7 stitches - god knows how much $.

Don't sword fight with copper pipes, kids.

My girlfriend is an Allergy/Autoimmune doc. Her business is actually booming right now. She is booked a month out. She still loses money on every Medicare/Medicaid patient for the most part, but when Medicare/Medicaid up their payouts, it is normally in the codes in specializations like allegy that are increased while heart stuff isn't. Of course, more people have heart issues and that is much more expensive than allergy treatments.

But, I do know that my gf is worried about the future. Obamacare will put her out of business. She feels that allergy schooling will be merged with ENT or dermatology eventually.

BTW, KD, I sent her your 4 steps to fix the medical system in your ticker yesterday. Her whole office (2 allergy docs and 4 dermatologists) loved it.

Cool!