Controversial statements from the CEO of the Mayo Clinic recently came to light, as reported by Medscape and a Minnesota newspaper. In what was likely intended to be a behind-the-scenes report, he indicated that a priority would need to be placed on seeing privately-insured patients over those supported by government-funded programs such as Medicaid and Medicare. This has drawn quite a response in recent days in our current healthcare arena. It has been reported that the Mayo Clinic had an almost 10% decline in income in 2016 compared to 2015. The CEO subsequently indicated that need of care was the first priority. He also pointed out that half of the services at the Mayo Clinic are funded under government programs.
When one applies to medical school, the focus of a medical career surely is always altruism. Helping others is the main goal, right? I am interested in helping others. I thought of medicine as the ultimate career to use my full intellect, and I believe that God gave the ability to do this job. I also thought of it as being a financially stable way to support myself. I went to private osteopathic medical school in Kirksville, MO. My first day of medical school was in August, 1989. The tuition at the time was $13,500 per year. I borrowed over $100,000 from 1985 to 1989 to support my tuition and living expenses. Interestingly, I borrowed only $21,000 in year one, which included tuition. The cost of living in Kirksville was quite low. Tuition there now is more than three times what I paid. I wonder now how those students, to whom I teach endocrinology each fall in Kirksville, are ever going to be able to pay off the loans taken to fulfill their dream of becoming a doctor. It is hard to see what I see now from the other side. I am sure that I never considered the potential weight of bureaucracy.
My patients report physical movement in medicine. Movement of the doctor from one practice to another. Movement out of state. Movement into concierge medicine. There was a time in decades past when a doctor could land at one spot on the corner of Main Street and 2nd Avenue in big or little town, USA, and that doctor might stay in that spot for years. He or she could earn a decent income and have manageable paperwork. For time put in, income was good. Now doctors move around to achieve income goals because the income is not always sufficient. We must also worry about autonomy in a system that seems to want to squash us.
Medscape reported in 2016 where my specialty and internal medicine land on that income ladder. Endocrinologists are listed just above the bottom rung, which are pediatricians. General internists are not too far up that ladder, as well. This report also indicated that family physicians and internists are the most likely to choose medicine again as a career choice looking back, but the least likely to choose those two areas of specialty again. So what must each doctor do to get to the mark? The system is pushing us away from autonomy. The demands of bureaucracy possibly are more easily addressed in a group of physicians under a hospital administration. Cash-only medicine appears to have potential. Any solo practitioner and some institutions understand the difficulty of making a living on government-funded medicine only. Most doctors need at one time or another to discuss the payor mix, as happened at the Mayo Clinic. Meeting the bills would be unsustainable on a Medicare-only practice, and Medicaid payment is impossible. Medicaid may be the likely reason that pediatricians are at the income bottom.
I love endocrinology. I like being the expert in a very difficult topic area. I also like being able to focus on one set of topics. I often say: “God Bless the general internist.” I think I am not really smart enough to do all that is expected of the general internist. I consider internal medicine to be at the pinnacle of medical practice. I need to be able to pay my bills. What we as osteopathic internists bring to the market is valuable. We have all done our fair share of care without getting paid. “I don’t have my copay.” “I forgot my checkbook.” “I don’t want to jump through any hoops or work at my healthcare, but I want to be well.” “I want to be well at the lowest possible cost and effort on my part.” Our patients make these kind of statements.
It is not all about money, but it is partly about money. As the red tape increases year-to-year, doctors have to play the field to make a buck. Sometimes the focus is on the paperwork of getting paid. I think too much of the focus is there. As osteopathic internists, we must focus on the goal of high quality, distinctive care of the adult patient with excellence, professionalism and integrity. This is our altruism. This is what is in our hearts and souls. The ACOI intends to support you as you navigate your career as an osteopathic internist. We are home base. We believe in you and your skills.
Internist in the Trenches
Shannon McMann, DO, FACOI, is a graduate of Michigan State University College of Osteopathic Medicine. She is a classic Osteopathic internist, trained in the osteopathic post-graduate tradition of Mount Clemens General Hospital (now McLaren Macomb) in Mount Clemens, MI, as part of the Michigan State University Statewide Campus System. Her training involved a consortium of Osteopathic internal medicine residencies across Michigan for collaborative education and training.
Dr. McMann practices ambulatory internal medicine and supervises internal medicine residents in the McLaren Macomb continuity clinic and serves as assistant program director of the internal medicine residency there. She is board certified in Internal Medicine by the AOBIM and is a Fellow of the American College of Osteopathic Internists. Dr. McMann also serves as a Clinical Assistant Professor of Internal Medicine for Michigan State University College of Osteopathic Medicine. She serves at MSU-COM, Macomb Campus, as a small group instructor, and she instructs first and second year students in osteopathic patient care.
Dr. McMann is originally from Ferndale, MI. She currently lives in Troy and is married to Steve Smithberger. Rocky and Arthur (both rescues) are also a part of their family. Please join me in celebrating Shannon McMann, DO, FACOI: Internist in the Trenches.
Peace to you,
John R. Sutton, DO, FACOI