I read with both interest and horror in the New York Times of a neurosurgeon at my hospital who was paid $117,000 to assist on a spinal procedure.

http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?

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The medical billing system is indeed dysfunctional and broken. No ethical physician believes that this is right. The problem lies in what the author of this article was trying to accomplish. Is this ridiculous payment a result of doctor greed or is the underlying cause more insidious and subtle? The day after I read the article my email and voicemail were flush with reaction to the Times piece and I was resigned to just filing it away until the next shiny object negative news story about doctors appeared. That afternoon however my view on this changed. I am a divorced father with a great ex and a 15 year old son between us. He looks forward to our time together and I had a planned trip to the New York Jets Monday night game. He was looking forward to it. I was looking forward to it. At 2 pm I was called into an emergent case as a Neurosurgeon to evaluate a 31 year old schoolteacher who had gone acutely blind. An MRI of the brain showed a massive tumor from the nasal cavity extending into the brain and compressing both of his optic nerves. He needed emergent surgery to remove the tumor from his brain and attempt to save his vision. No Jet game. No dad and son time. No focus on insurance. Trying to save a life or someone’s vision has no price point. After I finished the case, I got home at about 1 AM. My son was awake to say good night and I sat in my kitchen eating cold leftover fettucinni alfredo. I ruminated about the New York Times article again. The Times chose to place on its front page an article decrying doctors for their greed and ethics. That sells papers. The vast majority of us, neurosurgeons or otherwise, work tirelessly and under increasing strain from expectations of our employers, our patients and under attack from insurers. We are the face of medicine to our patients.

Doctors today are under tremendous pressure to satisfy the bureaucratic and administrative demands of our government and our health care organizations. Our workflow has been compromised by HIPAA, EMR integration and massive increase in oversight. Insurers have made billing and collection increasingly complex with indirect involvement in many aspects of medical decision making. Much of the changes are occurring because of a system run amok, driven by fee for service and it’s resultant perverse incentivization. Payment models are rapidly changing due to a combination of government intervention and health care enterprise expansion. Physicians are caught in a complex web of insurer, hospital, patient and passion. Blaming physicians for the failed legacy of fee for service is unfair and carries a steep price on morale and quality of care. We have had enough. We need to celebrate what we do everyday in order to overcome the intense sacrifices that we are asked to make. Blaming and singling out the physician for this broken system is unfair and immoral.