The US corporate medical machine is quietly crashing.

Doctors are leaving. There are articles all over about physician burnout, which is ludicrous. If the average family practice doctor works 60-70 hours a week, how much do you think mindfulness is going to help? And the crash is accelerating. I used to get about one prior authorization demand from an insurance company for a medication about every 2 weeks. Now I am getting 5-10 per week. Remember that I have chosen to work 40 hours a week which means that I see half the number of patients of a mainstream family physician. They are seeing 16-18-25 per day. My clinic is half over age 65, so mine may be on more medications than a clinic with a younger demographic. But... the entire country average age is climbing, the baby boomers like a swallowed goat, slowly diminishing in size as it moves through the python of years.

Each prior authorization either requires a time consuming phone call to the insurance company, one of the 800 companies, or is it 1300? I forget. Or it requires a separate log on to each insurance company with each having a different website, multiple different plans, everything arranged in different ways and places. I have a bit of trouble learning 800 websites. My bad, right? I could drop all insurance except medicare. Then I would have the medicare primary, Noridian, that handles 80% of the allowed bill and then multiple different secondary insurances and then patients have a "part D", a third insurance that covers their medications. Only mostly it doesn't cover them or covers less and less. Medications that a person has been on for 25 years, the insurance company suddenly decides that they no longer cover it. Or the copay goes from $30 to $260 per month. Or the medicine is no longer made. Or the secondary says the medicine is covered and the part D says it isn't. No, really, I am not making this up.

My receptionist is noticing too. "We saw less people this week, but the paperwork is piled higher." I think of it as deeper. I have a week of vacation coming and I am trying to clear out as much as possible. It is running on a treadmill that no matter how fast or well you run, each day it goes faster and each day the slope is steeper, until you want to lie down and let it dump you on the ground.

An elderly patient calls outraged because he has a bill. We check: medicare Noridian has a yearly deductible. His particular secondary insurance does not pay the deductible. "But it did last year!" says our patient. Yes, well. Don't we all read the entire policy yearly? Isn't it written in simple language so anyone can understand it? Don't the insurance companies put our health first and profit second?

The breakdown is accelerating now. I can't get notes from the specialists. Perhaps it the note is not done. I reviewed a specialist note with a patient yesterday: the specialist is the state expert and his note has three major errors about her care. One is an incorrect medication dose, one is that she has not tried a medicine that in fact she tried, and well, I forget the third. "That's wrong." she says. "Yeah," I say, "I am sorry. I could write to him but no one has time to correct the notes anyhow."

I try to get a note on another patient and the patient says that that particular specialist seems really tired and his office is a disorganized mess. It must be, since we've requested his consult note three times in the last two months without getting the note. He's the only one of his specialty on the Olympic Peninsula, 450,000 people. When he calls me back, it's always after 7 and he's always still at the office. "Why are you still at work?" I ask, "Can't you go home?" He laughs.

The trajectory is clear, as if a train has come over a mountain and started down, accelerating. The brakeman knows the brakes are gone and the curves are near the bottom. He thinks about derailment but the train is going too fast for him to get off. He wishes he had quit last week. Now all he can do is say a silent farewell to his family and those he loves, as the train hurtles through the quiet dark.

It's a Friday night, or to be more specific, Saturday morning, 12:52am.

I have spent a couple of days worrying about this job opportunity, it's a similar role to my old job, so I'm worried it'll be like my old job. The new job description is similar to old job description, but pays nearly twice as much and is not ran by sociopaths.
This work is very technical and drains your brain, it often takes every ounce of your jiggly matter to make sure that everything has been reviewed and included in the final design.

I have had projects with 1000+ pages of.. crap, within those 1000+ pages, sometimes there is ONE, this one is not like the others... all others contradict this one, but because this ONE is there, I cost my company $5000
Now... this is not even a square inch, on page 223 of 1057.
Page 2, 5, 7, 11, 43, 63, 222, 224, 356 and 1056 do not show this, but on page 223, there is a dotted line, it is my job to pick that up, to combine however many pages of writing and pictures into a perfect product. It is (not) my job to pick up mistakes made by ANYONE that comes before me, but somehow everyone else has a "if we fuck up it's your fault" clause and we don't.

The industry is what it is,
My old job.. I have 5 hours to review, combine, design and engineer a final product from those 1000+ pages
I don't think most people know what 1000+ pages look like, if you spent a second looking at a page, you'd be staring at a screen for over 15 minutes... down, down, down, down, down, down... oh interesting, down, down, down, down, down, I'm assuming the next 20 pages don't relate to what I'm doing, down, down, down, down, oh, that looks interesting, up, up, up.. no, down down down down, what kind of a... down, down, down, down, who.. why???, down, down, down... these people go to Uni for years, why can't they... etc..
If you stop and read here and there, that's easily over an hour of just reading and reviewing...

Obviously you learn to pick up on what stands out, but there are things that just don't compute..
Page 02: Do the following.. for the whole project unless otherwise specified.
Page 63: keep doing the following for the whole project unless otherwise specified.
Page 64: For this whole project, do THIS, it's twice as expensive as the above for no reason
Page 65: do what Page 02 tells you to do.

(I've just re-read this and wanted to point out that in my example Page 64 made a $200,000 difference)

This is a reasonable task if you get time... 2-3 days would be reasonable, less than a day is not.

The new job seems more promising:

Firstly, the boss is not someone I want to throw out of a window
He is not a psychopath
He helps out with the workload and fully understands it
More $$$
10mins from home
Learning new skills

More stress and responsibilities, my mistakes cost company money.
(to be confirmed) more free overtime
Dreaming about work
Dreaming about work and waking up in the middle of the night going .. "oh shit... page 034 had a detail that I didn't allow for"
Not sleeping the rest of the night and then calling office at 5am to make sure the mistake is picked up before it's too late.

Well, I called the GM and told him that I'm interested in the job
They might not even want me and all this silliness is for nothing.

I have decided that I'm only going to take this job if I get $20k a year more than what I get atm. It's not enough for my sanity, but it might be enough to buy a house within an hours drive from there.
Here in Melbourne, I would be lucky to buy a house for $500,000 within 100km of the CBD.
Actually, new job is 40mins away from CBD, and if I'm lucky, I can afford to buy a house that's an hour away from there...
This is obviously complete BS and we should all stand up and stop China from buying 40% of our properties (I joke, I joke, sit down, do as you're told, stop being racist and eat your cbf pills)

On a different topic,
I had a pleasant little exchange with someone in the chatterbox about chaos theory, which reminded me of an exchange of ideas I had with my fiance:
(I may have covered this in an earlier log)

me: there's a new mathematical theory that seems to back up the Men In Black marble universe
her: eh?
me: you know, the marble universe, alien rolls a marble that contains our galaxy/universe, camera zooms out and he's in a galaxy, in a marble, being rolled by another alien, etc...
her: I don't like Men in Black
me: Well.. (as expected, smallest atom and largest galaxy crap) it turns out that Schrodinger's equations can be utilized for calculating galactic/ecliptic wiggles.
her: yeah..
me: You know how the standard physics model doesn't fit in with quantum physics, and NOW... standard physics is breaking down at the very large scale (once again, old and boring and predicted by most of us).
me: so now, quantum physics seems to run our universe at the smallest and largest scales, and it seems that only our Newtonian physics that are not fitting in.
her: well, that's obvious, we humans create our reality
me: I love your brain

she makes me feel so dumb sometimes

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