MOC began as a voluntary effort among physicians to put on post-doctoral training programs to keep physicians informed about new health care methods and technologies. There was a time when CME was done purely from an intellectual interest of physicians for medicine and knowledge. Medicine was still considered to be practiced within the boundaries of doctor-patient private solo situations where reputation and excellence were what brought patients to doctors and word of mouth and trust created the ‘market’ of medicine. Hospitals were run by doctors and boards of trustees and were not ever for profit, which was considered unethical, to profit from the suffering of others. Making money and profiting from suffering were morally wrong. Then hospitals often barely kept their doors open with charity care and write offs a normal part of doing business. No one was turned to collection agencies. No one was not given care, although since they still expected to buy their own medications and pay the bill eventually, patients had the honor of being trusted to pay their bills and most did. Back
then the average American saved 10-15% of what he earned after bills,
so these costs were not the same as today. And office visits and medications were expensive, but within the monthly budgets of most people. Now the co-pays are as much as we used to charge, and the co-pays on medicines are also about the same. But what has happened, is a lot of other people have cut themselves into the transaction. The insurance gets to authorize, the pharmacy gets to bill online, the doctor gets to bill online, the pharmacist gets a fee for simply telling the patient how to take the medicine and a lot
of ridiculous and unnecessary steps have been put into the transaction, and all these steps are controlled by someone besides the patient and doctor.
And it is in those steps that the costs of medicine have been incurred,
and our powers taken away. Instead of controlling resources, we have to see what we can get from the impersonal, depersonalized, no real human to talk to world of voicemails, emails, EHR, authorizations, automatic payments, payments by phone, payments online and a confusing array of technical processes that take up our time and reduce us to drones.
Carlisle Holland DO