weighing in on the healthcare debate

work has been very stressful lately. it's feeling like, well, work. and here in lies the problem with healthcare. it's people's work, jobs, and it's a business. i make a salary based on treating the sick. if there were no sick people, i wouldn't be employed. recently we've been having meetings regarding how to increase our productivity, as an outside company audited our hospital staffing and determined that our department was overstaffed by 3. HA! and here we are working through lunch, unpaid overtime, and have a waiting list to see patients. Yet, the physical therapy department was quoted as being accurately staffed, even though they have 3 additional positions than OT. How can this be?

Well, the auditors looked at units billed. A unit represents 15 minutes of treatment. Not time spent educating, talking with families, or whipping up some crazy piece of adaptive equipment. During those 15 minutes the patient must be participating in an activity. A lot of time is not billable. And it's often during that time that I feel like I'm doing my best work. We don't get paid to think. Only to do.

Doctors work on the same payment system, it's called fee for service. They are paid by how many tests and procedures performed. So guess what the incentive is? Treat more, do more. Quantity, not quality is rewarded. Even if the time and energy might be better spent sitting with a patient and family and discussing the patient's risks for surgery or plans for end of life care. Until the reimbursement system is redesigned, our country is not likely to get any healthier.