Forced Retirement Isn’t That Bad, Is It?

By Alec Pruchnicki, MD

Diverse people waiting in line to see a doctor.

Wednesday March 26 was probably the last day of my medical career, which started in 1990. Retirement was forced on me by the medical group I was affiliated with when they replaced me with a person who could give them the productivity they wanted. It doesn’t take much to see that the problem of one little person doesn’t amount to a hill of beans in this crazy world (I love stealing lines from old Humphrey Bogart movies), but here are the details that explain my situation and a lot about how medicine is practiced today in the United States.

My practice was in a Medicaid supported, non-profit, community run assisted living facility in Manhattan, called Vista on 5th Avenue. The patients I saw were old, 90% were on Medicaid, and all had some medical problems or another. I had been there since 2003 and had affiliations with St. Vincent’s Hospital, St. Luke’s Hospital, Mount Sinai, one private practice that billed per office visit, and one managed care organization. My final affiliation was with a group called Visiting Docs (aka Visiting Services d/b/a Visiting Docs) which is a private group billing Medicare and Medicaid by the visit.

My patients were old, mostly poor, and sick. Often, I would spend a lot of time listening to their detailed history and multiple medical complaints. Usually, I would see few patients, maybe five or six a day, besides interacting with the staff, some drug plans for prior authorizations, and an occasional managed care insurance company. My first five affiliations never gave me a problem about my low number of office visits because various subsidies kept the practice going. But Visiting Docs had no such subsidies and only survived by billing Medicare and Medicaid, both of which reimburse doctor visits poorly.

I was able to increase my office visits to about 10 a day, but they were requesting 20-25 visits a day like many internal medicine practices. A long-detailed visit of 30-45 minutes would have roughly the same reimbursement as a 15-minute visit, so if I could replace a 30 minute with two 15-minute visits I would bring in twice the income. I tried to change my style of interacting with my patients but could seldom get my encounters up past 15 or so a day. This wasn’t enough. I don’t know if my practice was in the red or in the black, but I know it wasn’t enough to keep my sponsoring organization happy. They eventually replaced me with another physician who they hope can have the productivity they want.

What does this mean to people when they interact with a physician? When patients switched to me as their primary physician, the most common reason was that their previous doctors were just too rushed. Sometimes a simple visit for a healthy patient could be done in 15 minutes and sometimes it just wasn’t satisfactory to the person. I’m sure many people reading this may have had similar experiences. This is the way medicine is practiced in many settings with low primary care funding being the root cause of the assembly line pace of medical office visits. If you find that your doctor is asking you to come back for another office visit for any reason instead of taking care of all your issues at one time, this might be the reason.

I wish the new doctor well and hope he can keep my former patients satisfied with the care while keeping the practice solvent. After 22 years at this location, I want to make it succeed and provide good care for my former patients. Meanwhile, I’m trying to figure out what to do with my time now that I have a lot of it. I’m thinking of more writing, maybe a few books, maybe on social media, whatever. Fortunately, I’ve stashed enough away in my 401K pensions that the stock market is keeping my own finances solvent. Wait, what…the stock market?!