With the 2016 presidential election swiftly approaching, one of the issues that many of the presidential candidates will attempt to tackle will be the topic of healthcare and the provisions thereof.  But just how informed are the candidates who are participating in the healthcare debates?  As a health care provider, I would like to assert that there is a health care crisis that few are aware of or are even talking about.

When most people discuss healthcare, they do so from the perspective of law makers, the insurance companies and from the general public.  However, oftentimes, there is one pivotal perspective that is typically missing from those debates—the point of view of the practitioner.  Most of the arguments that I have heard made against healthcare providers are usually based in ignorance and entitlement.  Our society has grown accustomed to the notion that healthcare should be free.  However, nothing in life is free.  For every freedom someone has paid an extensive cost.  If we as a society desire free or reduced healthcare, we have to have a system in place that will make it beneficial to those who are providing care.  Most doctors, even if they wanted to, could not afford to work for free or work at a reduced fee, which, unfortunately, includes participating in many HMO/DMO programs. Remuneration from Medicaid and various DMO plans can often fall below the fixed costs associated with the provision of care.  For example, if cost of basic supplies and materials associated with a certain procedure is below, equal to or slightly above the reimbursement, then not only is participation in that program non beneficial to the practitioner, it is also detrimental to the practice’s sustainability.  The true question is not whether or not practitioners want to provide service to those who are in need, but whether they can afford to do so responsibly.  At some point, there will be a tradeoff.



  • Cost
    •  Education
    • Student Loan
      • Average Cost of medical/dental/professional education
    • Continuing Education
      • Making sure that practitioner is current
  • Initial Licensure
  • Operating a practice
    • Rent/Mortgage
    • Materials and Supplies
    • Lab fees
    • Equipment purchase/repair
    •  Staff
      • Training
      • Salaries
      • Benefits
        • Retirement Plans
        • Health Insurance
    • Taxes
      • Personal and Corporate
        • Federal
        • State
        • County
        • City
    • Malpractice Insurance
    • Licensure renewal
    • Accounting fees
    • Legal fees
    • Governmental regulatory agencies
    • Incidentals


What are some of the tradeoffs that occur when there is not a system in place to appropriately compensate and/or accommodate practitioners?

  1. Poor care
    1. Decrease in quality materials being used
    2. Decreased time spent with patients in order to ascertain the relevant information needed to make an accurate diagnosis in order to render appropriate treatment
    3. Decreased standard of care
      1. Decreased OSHA compliance
      2. Decreased protocol implementation
    4. Practitioner burnout
  2. Less access to qualified/skilled practitioners
    1. Those who are financially independent/secure (i.e. more seasoned practitioners) might not participate in plans that do not appropriately compensate them
  3. More sick people in our population
    1. More sick people result in a declining economy due to missed work days


I believe that there should be an open dialogue between law makers and practitioners.  As a society, we cannot continue to ignore the financial burdens being placed on our healthcare providers while maintaining an expectation that our treatment/care will not be negatively impacted.  That is just not realistic.  We all want to be treated in a clean, safe environment.  However, that comes with a cost.   There has to be some relief in place for our healthcare providers.  Loan repayment should not just be limited to Federally-designated areas.  It is not just the underserved populations that require quality healthcare providers.  We all do.   In addition to loan repayment, there should be tax reliefs for healthcare providers.  Truthfully, I don’t know what the answers should be, but that is exactly the reason for a dialog.  If we continue with the status quo, we will all be at risk.  Skilled clinicians will leave the practice of medicine and dentistry.  We will be left with a system riddled with mediocrity and apathy.  God forbid, if we are laying on the operating table, we want to know that our doctor is not worrying about whether or not the insurance will reimburse him (or her) for the procedure(s)?