Primary care from page 34 times) the fox guarding the henhouse. The rest of the crowd seems to feel that we should turn health care over to the federal government, which already controls half of health care and has obviously done a less than stellar job of that up to this point. We do need the insurance industry, because we do need insurance—if nothing else, as a hedge against a complete federal takeover by a government quickly running out of money. What we don’t need are expensive “prepaid health care” plans that have replaced the traditional concept of insurance—you know, the stuff you used to buy that insured you against catastrophe instead of claiming to cover all of your medications. Alas, huge portions of our total health care dollars keep getting funneled into such plans, ensuring that the insurer gets its cut and that the risk pool still supports the spending of 30 percent of our health care dollars on 1 percent of our population. Bad health behaviors, expensive patient demands, and increased
profits continue their onward march, while physicians are told that we must be the stewards of the health care dollar and, now, simultaneously (even as employees) assume ever-increasing financial risk under the ACO model as well as under “pay for performance.” On top of that, add the coming onslaught of the Affordable Care Act, which is long on new patients but short on any real reforms. What’s the answer?
Essentially, for Minnesota’s primary-care physicians, it’s already game over. The other day, a colleague of mine remarked, “These days, when people ask me what I do, I don’t even bother to use the word ‘doctor.’ I tell them I do customer service and data entry.” This is where doctors have ended up in the pecking order of importance in our health care system. Somehow, though, even at that lowly perch, we apparently can still be billed for the ills of the system and its high costs, while we watch certain health care administrators collect huge
Heart of Minnesota Lakes Country Practice Opportunities Sanford Clinic North – Excellent practice opportunities in communities located in the ‘Heart of Minnesota Lakes Country.’ Good call arrangements and modern well-managed community-owned hospitals. Alexandria • Dermatology • ENT • Family Medicine • Hospitalist/IM • Internal Medicine • Ob/Gyn Detroit Lakes • Dermatology • Family Medicine • Internal Medicine • General Surgery • Pediatrics
East Grand Forks • Family Medicine • IM/Peds Moorhead • Family Medicine New York Mills/ Perham • Family Medicine • Orthopedic Surgery
Thief River Falls • Dermatology • Family Medicine • Hospitalist/IM • Internal Medicine • Ob/Gyn • Optometry Wheaton • Family Medicine
drive personal responsibility and personal cost control. Generic and life-saving drugs would be covered, and the price of others would drop to a reasonable level in a true free market. If we still want to try to insure health maintenance, we could make it a separate plan (or at least an 80/20 proposition) that puts its financial onus on its user group, and makes real health care more affordable to those who really need it. Demanding something of everyone at every point of health care access—on a sliding scale, starting even at a dollar—will also help remind even those with “full coverage” that health care is not free. Looking back at the last 30 years of failed experience and government/insurance industry control, I feel inclined to invoke the question often posed by Dr. Phil: “So, how’s that workin’ out for ya?” Wayne Liebhard, MD, is a primary care physician and the author of “Elephants in the Exam Room: The BigPicture Solution to Today’s Health Care ‘Crisis.’“
Minneapolis VA Health Care System Great place to work, great place to live. You are invited to be part of the Department of Veterans Affairs that has been leading change in the health care sector.The Minneapolis VA is a 341-bed tertiary care medical center affiliated with the University of Minnesota. Our patient population and case mix is challenging and exciting, providing care to veterans and active-duty personnel.The Twin Cities area offers excellent living and cultural opportunities. Opportunities for full-time and part-time physicians are available in the following positions: • Cardiac Anesthesiologist • Chief of Surgery/Director of Specialty Care Service Line • Compensation & Pension (Occupational Medicine) • Gastroenterologist • General Internal Medicine
Sanford Health, serving western Minnesota, eastern North Dakota and South Dakota, is redefining health care. Sanford offers innovative technology, support of a multi-specialty organization and dependable colleagues. Our employment model includes: market competitive salary, comprehensive benefits, paid malpractice insurance and a generous relocation allowance. To learn more contact: Shannon Ellering, Physician Recruiter Email: Shannon.Ellering@sanfordhealth.org
Phone: (701) 280-4817 EOE/AA
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salaries and accolades for “transforming health care.” Don’t get me wrong; we need good, caring administrators. We also need good, caring doctors, and we won’t get or keep them by blaming them, philosophically or financially, for the ills of our system. The reason why many of my former private-practice patients can’t seem to find a primary care doctor, and why many primary-care practices can no longer find doctors who want to carry a decent workload, is blatantly obvious—and it’s not just a generational thing. It’s time to admit that practicing physicians have been taken out of the reform equation. The only entity that has any chance of regaining control of health care and effecting real reform is made up of responsible health-care consumers, who first need to demand a separation between health care and health maintenance. They then need to demand of their legislators and employers a highdeductible health plan/HSA model that will do away with prepaid health care and instead
MINNESOTA PHYSICIAN OCTOBER 2012
• Internal Medicine/Family Practice – Rice Lake, Chippewa Falls and Superior, WI • Psychiatrist – Ramsey, MN and Superior, WI Physician applicants should be BC/BE. Possible recruitment bonus. Interested applicants should email CV to: Brittany Sierakowski, HRMS • brittany.sierakowski@va.gov Fax 612-725-2287 • Telephone 612-629-7873 EEO Employer