I totally agree with this take. I could never do PA work for similar reasons plus others. I used to think these individuals should be banned from ASTRO and now I think everyone should drop their membership
What changed for me is learning how many people in medicine that are accepted as "good noble physicians" are just out there maximizing the profit margin for other companies.
There are a million examples of decent people doing enraging things either due to ignorance or conflicts of interest or both. I've never seen a single tweet about X academic hospital turning away an uninsured patient, but this is actually the single thing that made me most mad when I worked in academics.
Has anyone read Vinay's book Malignant? I read it
after graduating residency and knew very few things in that book.
Recognize that we are taught fantasies about honor in medicine and several significant (appalling) conflicts of interest are just part of the system. I really believe that if we teach this point first we might actually fix the problems.
The insurance industry is perfectly happy to sit around counting money while watching us pile on other doctors.
My practical advice for PA relief:
1. Move to Colorado. I cant explain it but I do very few PAs and treat a lot of lung and rectal with IMRT, lots of SBRT. I have a few theories about why this might be, but no one seems to know anything specific about regional variation. This is across at least 2 independent billing/auth teams. We will be hiring end of 2024.
2. Keep a list of "the idiots" and reschedule. I have 2 individuals, both very rude and shockingly dumb/disingenuous. I never accept scheduling with them. Ive never waited more than a half a day for a new person.
(Don't name/shame online if employed, it's likely your company will side with the payers over helping you because money is important to hospitals)
3. Find out early if they can actually reverse a denial on the P2P. People always tell me, yes this for clarification or no here is the guideline. If "the guidelines" prevent it, hang up and spend your time on the letter. The P2P is not worth your time. I have been in a situation where I literally wrote the guideline and they do not care (Simul may, but Evicore did not). Again, the guidelines are not a quality measure, they are telling you what they decided they will pay for or not.