"My biggest concern, Heidi, is that the quality is going to suffer because the patient/doctor relationship is being threatened by a lot of outside influence. When I sit down with a patient and plan for a treatment, it's a very individualized, specific, tailored recommendation that I am making for somebody who is a unique individual and has unique problems and interprets their symptoms in a unique way. When we start talking about medicine as a collective endeavor, which the affordable care act very much does, it's sort of ‘all of us in it together' philosophy. That means an individual's particular needs might be neglected."
"What we end up doing is treating populations based on statistics, based on averages, and I don't think that is what I was trained to do and I don't think that's what a patient expects when they come to the office."
"More than anything, I would say that we increasingly have bureaucrats who are making the recommendations, well intended of course, but it doesn't have to do with what a patient and a doctor decide as much as it used to."
"That's been a general trend in medicine for a long time and that's because medicare reimbursements have got very low and a lot of the things doctors provide under Medicare... Doctors actually lose money by providing the service. So what happens is that people have tried to see as many patients as they can to sort of make up for the very low reimbursements. It's what we call price fixing. When the government fixes prices, it often means that the quality will deteriorate. As we go along, we are going to find that for one reason or another, expensive treatments are being limited. That's simply because our checkbook isn't big enough. So, regardless of how much somebody needs an expensive treatment, it will be more about what we can all afford. That gets to be a very confusing issue when you are in need."
Are doctors going out of business?
"That certainly has been happening and is happening. Doctors are being driven out of business. The Affordable Care Act is just the latest iteration of things that have driven doctors out of business. While many doctors can't afford to retire, they do shut their practices and end up going to work for a hospital or a big corporation. So, instead of the old model of a doctor who came to town and was the quintessential professional, small business man, who spent his life and career developing his practice in one particular location, now we are going to have doctors that are provided by a big company. Imagine AT & T or Verizon deciding who the doctor in Missoula is going to be that day. I think that's the direction we are headed."
Will people be able to keep their own doctor?
"People can certainly request and a lot of times people can get the doctor they want to see, but I don't think there is a guarantee of that. I think you get who is on call and you may not even get a doctor, you may get a nurse practitioner or you may get a physicians assistant, which is fine, you just have to know who you are seeing and what their qualifications are. There are many excellent nurse practitioners and assistants, but they have a different training than doctors do."
"I work in a small practice called Neurological Associates. It's a small, single specialty group practice. We have been in Missoula providing coverage 365 days a year, 7 days a week for 43 years. We right now we are talking with the hospital about becoming hospital employees. The reason is, is because it's becoming increasingly difficult to navigate the bureaucratic network that is required to provide medical care."
"The essence of it is to empower the American consumer and get the consumer involved in care. Time and time again, when I sit and make treatment recommendations with patients, neither of us knows how much something costs. I think that is the root of one of our biggest problems. Neither one of us knows because neither one of us really cares. Neither of us are paying. The theory is that healthcare is free.. Is the guiding principal. I think it should be the opposite."