By: Ben B. Boothe, Sr. Publisher, Boothe Global Perspectives

Thousands of Doctors now give growing responsibility in their practice to PA’s. Thousands of clinics don’t want to handle patients that are on Medicare.

We laughingly call the Presbyterian Hospital System of Albuquerque, New Mexico the NDA system (“No Doctors Available”) plan because that was a repeated response we had while trying to find a doctor in their system.

But as Dark K\Daily (Clinical Laboratory & Pathology News) reported in 2015, many hospitals are in decline:

"Many Hospitals and Health Systems Report Flat or Falling Rates of Inpatient Admissions, a Trend that Causes Hospital Laboratory Budgets to Shrink
Published: April 27 2015

Weaker finances at the nation’s hospitals causes administrators to further shrink the budgets for clinical laboratory and anatomic pathology services
Hospital admissions across the country continue to be flat or in decline over recent years. The result is less revenue for many hospitals. As a result, administrators continue to shrink the budgets of hospital service lines—including clinical laboratory services. For pathologists and clinical laboratory leaders, this poses the challenge of setting innovative strategies that take into account the changes in payment and delivery models.
Hospital Inpatient Admissions Have Been Declining over Recent Years."

It illustrates the lack of efficiency of the 'for profit' hospital system, which millions of people must be experiencing these days. Hospitals in decline, doctors leaving the industry, and quality people, such as myself, finding it hard to even find a doctor.

My demographic is not one of a poor person who cannot afford to pay for medical care. I have owned several companies, over a successful business career.
When we moved to Albuquerque, New Mexico, we kept our insurance and doctors in Texas for almost a year because they were good, and all seemed to work so well there. But driving 12 hours from New Mexico to Texas for a routine checkup got a bit old. I am on Medicare and in Texas had a United Health Care (ARRP Sponsored) supplemental program that was terrific. But, finally after being in New Mexico for a year, I set up an appointment with a local doctor just to get established. Of course, the Doctor said that I would have to get a plan for New Mexico, because when they called United Health Care (AARP’s Program) United Health Care said that they could not offer a plan for me in New Mexico. So I went on the search and repeatedly was told that the Presbyterian Hospital System, of Albuquerque had the best program.  I then went on line, and signed up.

After I signed up, Presbyterian informed me that I could not use the Dr. in Albuquerque that I personally knew and wanted, Dr. Steinhoff on Tramway, because her clinic was not in the Presbyterian system. Then they said I could not use a doctor in the part of town that I wanted but that I would have to agree to a “team” of their choosing, in a location of their choosing. I told them I preferred to just have a family doctor who is experienced and Presbyterian said, “No we do not allow that, you have to have a team.” So I said, well, OK, I live in the Northeastern part of Albuquerque, and can you give me a “Dr. Team” there?

They said: “Sorry Presbyterian does not have any doctors available in Northeastern Albuquerque”,

I said, “No doctors, this is the most affluent and fastest growing part of the city.”

They replied, “Sorry, but we have one or two doctors who might be available,  about 40 minutes and on the far southwestern, or southeastern part of town. One has a practice for families with young children.”   We don't know what the other one specializes in.

My reply was, “I am 68 years old and would prefer a doctor with experience with people of my age, a doctor with years of experience and I don’t really want to drive to the other side of town and sit in a lobby with a dozen screaming children.”

Presbyterian repeated: “Sorry you cannot select your doctor, your location, your clinic, or your medical team, we do that for you.”

I said, “Well can’t you send me a list of doctors that might be nearer to my side of town?” They said: “We don’t have such a list.” I cried out: “You have no list of your doctors? How do you keep track?” I heard silence in return, then the girl on the other line said, “Let me look into it and I will get back to you.”

3 weeks letter I got a paper that had a list of 3 doctors offices, thankfully all were within 8 miles of my home. I called all three, one clinic did not answer the phone, the other said that there’s was a specialty practice and could not handle me, and the third one said: “Yes, we will make an appointment, what is your physical medical need and your Presbyterian account number?” “I am not sick, I am just new to town, and Presbyterian said to call and set up with a Presbyterian group doctor, so I want to come in and meet the doctor.” The reply was,

“Oh our Doctor rarely comes in. He is very old, has health issues, so we have 3 excellent PA’s who handle all of his patients. Perhaps some day, on one of those rare days, you can come in to see the Dr., but we handle all medical treatment. ”

I said, “Then who will be my doctor?” The reply was, “We will assign one of our girls to you and you will like her. She is very popular, she is a PA.”
So, I made an appointment at a Doctor’s office with a doctor who was so old and sick he rarely came to work, but he had popular PA’s there. But, at least it looked like I was finally going to get a doctor, or sort of a doctor, who was covered in the new Presbyterian system that I had just transferred my health insurance to.

I serve on the Board of the Shriner’s Children’s Hospital of Los Angeles and had an important board meeting to attend, but cancelled that trip to meet my new “popular doctor assistant”, just to get officially a local Dr. in the event I ever get sick. In all of my years I have rarely been sick, but, one always needs a periodic check up.  On the day of my appointment, as I was walking out the door, 10 min before my appointment, I got a call from this clinic and they cancelled the appointment and said: “Sorry we aren’t taking any patients on Medicare now.” I protested, “But Presbyterian said you were in their system, and that you were approved to be my doctor!?” The lady said: “Sorry, we never got around to looking at your paper work, and just this morning read it and are notifying you that we do not wish to accept any more Medicare Presbyterian coverage patients, whether you are covered by Presbyterian’s plan or not.” In 68 years I have never had a doctor’s office renege on an appointment, at the last minute no less.

After almost 2 years of living in Albuquerque now, I still do not have a doctor. I am in the Presbyterian system, but as of this writing have yet to meet or shake hands with a single Doctor who I can call a personal physician. The only message I get from Presbyterian is that “Some month in the future, we may have a doctor available, but sorry not now.” The one appointment I was granted, that then cancelled the appointment gave me three clinics to call. I called them;
1. One had its telephone lines disconnected.
2. Another was an HIV Aids specialty clinic.
3. The other clinic did not even answer their phones.

What is going on? It isn’t only the lack of efficiency and capacity of Presbyterian, that I seem to have observed. It is a lack of personal attention and respect for the individual, that bothered me.  The Presbyterian approved clinic had a doctor that is too old to come into the office (I was told) and didn't get around to even looking at my paper work (which I sent 2 weeks in advance).  So I did some research on our hospital system and this is an example of what I found:

Robert Moghim, M.D. wrote in Locum Tenens Daily

“4 reasons Doctors are leaving the Profession” Sept 16, 2015:

“Difficult conditions in most medical settings have led to various stages of burnout among almost half of all physicians. Dr. Tait Shaafelt who conducted the study for Mayo Clinic found that 45.8 % of physicians exhibited one or more symptoms of burnout. Of Doctors over 50 years old, 52 percent in his study were planning to retire or change professions. Why?
1. Long Hours
2. Too much paperwork (almost 1/3 of the work day is devoted to paperwork)
3. Insufficient Income Specialties average $461,000 to $519,000 but front line family doctors average $189,000 per year.
4. Quality of Care. Many new insurance requirements limit or block doctors in doing what they think is best for patients. Procedures from regulators and tight payment policies of insurance companies, seem to dictate and take away the authority of Medical Doctors in what they prescribe, how they treat, and which procedures “are covered by insurance”.

Taking it from broad trends to individual circumstance, at 68 I am on Medicare and in the Presbyterian System for "Senior Care" suppliment, and I am without a doctor. What a way to run a medical system…and this is often called the “best system” in the state!

The lingering thought is, “Even though I am in good health, what would I do if I did get sick?” This is not a problem with Obama Care, I am not on Obama care. I am a healthy man, on Medicare, that simply signed up with the “best” program in New Mexico, only to find out that they are inefficient, impersonal, cannot seem to provide a doctor, the clinic they recommended to me did not even keep an appointment. In the process the Presbyterian Hospital System in Albuquerque, apparently does not let their “customers” or “patients” the freedom and power to choose their own doctor or clinic. They want a "Team" so that they can leverage the business volume by using "PA's". 

I know one thing for sure. In the hospital in LA where I serve on the board of governors, (a charitable hospital for kids) we would never allow such inefficiencies. We consider each patient a special individual and work hard to treat them as such. We have real doctors (MD's) treat our patients.  At the age of 68, having had a full and successful life, I have now experienced the frustration and humiliation of having dignity and personal choices taken away, even when I am paying Presbyterian good money every month to be “in their plan”.  Fortunately, I have never been sick while in the Presbyterian Hospital system. I recall during my banking career that a banker was always great to you until you needed to borrow money.

Laughingly, I thought to myself "It seems that some hospital systems are great, until you get sick or need a doctor." 

Communications and advertising of the Presbyterian system is beautiful with photos of happy patients and doctors who look like they care. But this experience, should inform you and no doubt our nation, that there may be hundreds of thousands of people like myself, who are on Medicare, and who have purchased supplements to our Medicare system, that are well marketed with shiny advertisements, and they are great as long as you are not sick.  But what about the many people on systems that can't even meet or have a doctor?   Are we to stand on a street corner with a sign, "Sick, need Dr" or use "Emergency rooms" that indigents use when they get sick?

Is the system with some hospitals such that they simply cannot find hospitals or doctors efficient enough to provide professional, personal service? It is no wonder statistics show that doctors and leaving the profession and the industry in the highest numbers ever seen in America. The administrators and managers of our hospitals are some of the highest paid in the world and the nurses are some of the lowest paid in the world. And more and more of the practice of medicine is being taken over by people in the “between” area, of MD’s and Nurses, the PA’s who don’t have a full “MD” credential. Nurses and professional assistants seem to be doing more and more work, that was once reserved to true Medical Doctors. Why? PA's do not have the degree of training, and thus are paid on a much lower pay scale than Medical doctors...could it be that the profit motive is why so many hospital systems are using more and more "PA's?"

Someone needs to investigate this and the medical system needs to improve inefficiencies and performance. As for me, I have some credential to speak, for I have inspected, reviewed and researched over 200 hospitals and medical clinics personally. I have done research reports, consultancies, appraisals, environmental studies and even helped in the planning and construction of several hospitals. I have reviewed procedures, policies, and have learned to identify operational inefficiencies and procedures that simply are not effective. Good management practices could solve many, if not most of the problems some hospitals are facing these days. If I were on the board of Presbyterian Hospital’s system, or other system facing similar issues,  I could point to specific steps to improve their service to patients, but one of the first things I’d do is say: “Whatever it takes, bring in more doctors to this market. Pay them well, and keep them here, and take care of medical needs by offering personal physicians. The ‘team’ thing is a cop out to try to maximize the use of PA’s, but that could backfire in malpractice suits. Cut the bonuses down on your administrators until they show viable improvement in service and reduction in mortality rates. Give them incentives to provide better service. Create an internal system of quality control, and a follow up system to listen to your patients and nurses, they can teach you much because they see the problems, the patients first hand“

In the meantime, I am 68 and for the first time in my life, do not have a personal physician. Again, I am told that I am with the "Best system in New Mexico".  To those out there who may have a situation such as mine, speak out, shine the light of reality on the inefficiencies of hospitals and poorly managed medical institutions. Try to help them improve by providing clear communication, and try to get the attention of the administrators who make the big bucks.  Point out when medical doctors are so burned out they give their work to Professional Assistants and nurses. Or worse, who rarely even come to the office or the hospital. Hospitals were once considered sacred and untouchable institutions, but that was before the “bottom line” became more important than personal service and attention to patients.

In the meantime, if I ever get a personal physician, a real doctor, with the Presbyterian system, the best system in New Mexico,  I'll let you know.  Stay tuned.