Kyle Alliman, MD and David Goldman, MD
The times, they are a changin.’ These words, sung over four decades ago by Bob Dylan, have never seemed so appropriate for the healthcare industry as they do right now. Only 2 short years ago I began my vitreoretinal fellowship. In the course of a lifetime, 2 years is merely a long blink but for myself and many of my colleagues in the medical professions, the past 2 years has been a drawn out, lingering grimace.
As I complete my vitreoretinal training and return to the Midwest to begin a job in private practice, the future has never seemed so uncertain or so daunting. Recent failures to prevent Medicare cuts and new tax appropriations for higher earners have placed even more doubt in the minds of many freshly trained physicians. When I began my ophthalmic training nearly 5 years ago, the economic aspect of medicine was only a tickle at the back of my mind. Seeing patients, diagnosing patients, and treating patients with no questions asked was all there was – and I was happy. Since that time, much of my naiveté has been lost and the physician-patient interaction has gained much in its complexity. The goal that most physicians maintain is keeping the patient as the central focus but coding, billing, and reimbursement issues have been forcibly introduced to many young physicians.
In a subspecialty such as medical/surgical retina, the elderly comprise a large proportion of our patient set. What’s more is that in the era of effective treatment strategies for exudative age-related macular degeneration, this proportion has increased significantly. This treatment driven increase coupled with the overall influx that the “Baby-Boomer” generation has created has resulted in swollen clinics with strapped resources. With many patients returning for treatment every 1-2 months, retina waiting rooms have become overcrowded and staff overwhelmed. To address this growth, many practices have hired additional staff and physicians which have raised overhead. Continued provision of these services to an ever increasing elderly patient population will likely not be sustainable with the severe Medicare cuts currently in place. Many practices will be forced to either see fewer patients or decline patients with Medicare. The result may be catastrophic for many of our great nation’s citizens over the age of 65.
There are no easy solutions to the current healthcare crisis. If stubborn greed prevails, change will be slowly painful. All sectors of the healthcare industry must be willing to collaborate in this rehabilitation. Reasonable cooperation between the pharmaceutical industry, insurance providers, government agencies and healthcare providers will be necessary to attain a satisfactory outcome. Unfortunately, it is often the patients who suffer the most during these uneasy times of change.