Do you ever wonder what occupation

doctors and nurses and other healthcare providers would choose if the

money was not there? I often have wondered why healthcare providers choose

the profession they choose. I often have asked. I once fully expected

doctors to tell me how they wanted to help people. No more.

I have asked that question

far more times than I care to remember. First, during 18 years of nursing,

and most recently, during 18 years of writing, reporting and publishing,

I have asked often.

Many physicians immediately

make known their interest in science. That is probably the first answer

I receive. Second comes, "My dad, uncle, grandfather, etc., was a

doctor and I was around him a lot and his influence played a role."

The women? Again, science,

and some will say they actually did have an interest in caregiving or

helping people, and knew they could make a lot more money as a doctor

than a nurse.

I actually have never had a

physician tell me he went into the profession for the money. Yet, I have

had them say they chose to specialize in a certain area because of the

money.

Only in recent years have I

realized how few true "people persons" there are among physicians.

This is, of course, in my humble opinion. Actually, it may not be so humble.

As my convictions regarding this subject are growing deeper every day,

my humility is growing more diminished.

I was misled, I believe, by

a physician I once worked with for more than five years. He was absolutely

the most well certified "people person" I have ever known. He

cared so deeply about his patients it was mind-boggling at times.

I often wonder if he has been

able to maintain that spirit over the past decade or so. I often wonder

how any physician has been able to continue caring to any degree over

the past decade or so.

It used to be that the money

was good enough that it somehow made all the sacrifices worth it. It used

to be that the patient was central to any physician's practice or hospital's

function.

Now, I don't have a clue where

the patient falls. I fear it is no where near the top of anybody's list.

There are facilities to pay

for, staff to pay, equipment to pay for, licenses to maintain, schooling

to be continued, and mountains and mountains of paperwork, or in some

cases, paperless work, to keep up with, in order to know what an insurance

company permits a physician to offer a patient in the form of healthcare.

A few years back, I had a doctor

told me that one insurance provider actually had made it quite clear to

him that there were certain options about which he was not to even tell

his patient. And I will never forget the time I sat for hours in the insurance

commissioner's office pouring over contracts between insurance companies

and providers. It was worth it to discover the bonuses paid if the doctors

followed the rules (of the insurance companies).

And there are the drug companies.

I'm having too good a day to let myself even go there!

So where am I going with all

this? I fear I have no direction, because there is no direction anymore.

No charted course. It's just a matter of which way the wind blows or the

money flows.

Even though the money is not

there like it once was for physicians, it's still about the money. And

it's about pleasing the board of directors. It's about stock appreciation,

and drawing dividends. It's about marketing and beating the competition.

It's about image and prestige and having enough clout to be able to play

a good hand at the annual negation tables. And yeah, it is still about

science, I suppose. But, is ever all about, or for, the patient? Was it

ever? Is the system broke and getting broker by the day?

In light of the fact that premiums

for employer-sponsored health insurance increased almost 14 percent between

spring 2002 and spring 2003 -- the highest increase since 1990 -- according

to a survey released recently by the Kaiser Family Foundation and Heath

Research Educational Trust, one must wonder about money flow.

And since 2000, the annual

premium paid by employees to insure themselves and their families has

increased nearly 49 percent. In 2003, the employee's cost for family coverage

increased 13 percent, while premiums for single coverage increased by

nearly eight percent. Deductible are going up. Drug copayments are increasing.

Out of pocket limits are climbing. Oh, and in many cases, services are

being reduced...

Money's still flowing, for

sure, but where is it going?

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