Being a Doctor Has Several Disadvantages That Makes It a Questionable Career Choice - Research Paper Example

Being A Doctor Has Several Disadvantages That Makes It A Questionable Career Choice. Being a doctor has several disadvantages that make it a questionable career choice. To better understand each of these facilities it is important first to understand what services physicians provide, how they are funded, how they are structured, and what role the HIM professional has in each. In the dialysis setting there are two general types of dialysis facilities: End-stage renal disease (ESRD) facility and ESRD network. The ESRD facility typically is an unconnected facility that provides on-site dialysis services for most patients. Both hemodialysis1 and peritoneal2 dialysis are performed at these facilities. After some training a small percentage (0.5%) can perform hemodialysis with special equipment at home and this is risky due to the increased possibility of infection and the requirement of having a very motivated patient. ESRD facilities are reimbursed mostly by Medicare part A (after the first 30 days). In fact, the vast majority of over 90% of dialysis patients covers this way. The patient’s physician is reimbursed through Medicare part B. Reimbursement coding at the facility is done using the International Classification of the Disease, 9th Revision, Clinical Modification (ICD-9-CM), while the physicians submits for reimbursement using the Healthcare Common Procedural Coding System (HCPCS). Data collected by the facility and physician play a critical role in the patients ongoing treatment plan. These environments are a uniquely challenging setting too many due to the very nature of the population needing services. Another challenge our health care doctors face is the deficit of nurses who assist them in treatment of patients. Part of this shortage is due to the lack of infrastructure. In the academic year of 2010-2011, 67,563 qualified students were not admitted into nursing schools due to the lack of faculty, training facilities and other budget constraints and this is a clear indication that unless there is improvement in the infrastructure, such as state and national funding, that there could be a collapse in the nursing educational system (Dunham, 2009). An increase in population has also caused the need for more doctors. The number of nurses is not growing at the same rate as that of the population. The lack of younger students moving into the field of nursing is also a primary concern. The current age of a Registered Nurse is between 43 and 45 years of age. In the next ten to fifteen years, these nurses will reach retirement age, which will only add to the current shortage (Williams & Torrens, 2010). Higher spending costs. The development of new treatments for previously untreatable conditions, including long-term maintenance therapy for things such as diabetes and AIDS increases the overall costs of health care. As we see advancements in technology and the invention of new medical devices within our health care system, we will also see an increase in cost involved in the research and development of these products. Newer surgical methods and devices to assist the surgeons will further increase the cost. Even though, technological advances have been a wonderful thing in the health care system, the cost associated with this technology is very high. Health Information Management Systems utilize electronic health records. The use of this technology has helped doctors to access a patient’s record easily and more efficiently. Despite this, there are challenges concerning missing records, long-term storage, and retrieval. The software must be customized for each hospital; each of these factors can increase the overall costs of the technology. There is always the ethical dilemma of a conflict of interest. Pharmaceutical companies target doctors, nurses, and other medical professionals in order to promote their medicines and other drugs. Many pharmaceutical representatives cater lunches, offer gifts and free products to doctors and hospitals in order to influence them to purchase their pharmaceutical items. Many hospitals and physicians have started to implement guidelines concerning free gifts and a code of conduct they expect their staff to follow on the receipt of gifts. There is an issue of educating health professionals to assure racial and ethnic diversity in the training and practice of health professionals (Williams & Torrens, 2011, p. 324). There are ethical issues in developing resources such as health personnel, facilities, drugs, and equipment. The number and kinds of personnel that is required are necessary to public health. We need an adequate supply of staff and facilities for particular areas in order to meet the ethical requirement of being able to provide health care for everyone. There are special measures that are needed to protect such people as the economically disadvantaged, the unemployed, uninsured and under-insured individuals (Williams & Torrens, 2010). The patient’s blood is circulated outside the body (extracorporeally) and filtered through an artificial kidney (dialyzer) Peritoneal dialysis uses the patient’s abdominal cavity to filter out waste audience is among the most dangerous and highly untrustworthy category of patients. Their motivations will almost always contain hidden agendas with little or no concern for the safety of doctors, themselves or other inmates. Common health concerns encountered in this setting are acute and chronic conditions such as AIDS, cardiovascular disease, respiratory problems, tuberculosis, hepatitis, and ESRD. Additionally, the inmates suffer from stab wounds, blunt trauma, and many other urgent health conditions. Adding to this problem is the fact that much of the flow of information is inhibited by the correctional facilitys organizational structure that significantly imposes upon the HIM professionals’ ability to control the heath record. In the mental health service, there is a broad range of settings: outpatient, group home, personal care home, psychiatric crisis, and inpatient psychiatric. Primarily patients are treated in the outpatient setting. An example of which is the community mental health center. It was the advent of psychotropic medication that made the process of outpatient treatment of the severely mentally ill possible. Consequently the use of medication to control patients with psychosis problems spawned a deinstitutionalization movement which led to the downsizing of mental health institutes. These facilities, which were “warehousing” patients with the seriously mentally illness now believed that these breakthrough medicines could allow patients to live in the community. Unfortunately, this thinking turned out to be seriously flawed. Many of the patients once released choose not to take any of the medications as opposed to suffering from the rather unpleasant and occasionally dangerous side effects. Another problem with these former patients faced was the fact that they had lived most of their lives in a structured environment where most all of their decisions were made for them. The primary source of reimbursement and funding are client fees, Medicaid, Medicare and grant funding. Client fees are calculated on a sliding scale based on income and are only small part of the overall budget. Mostly the budget is comprised of state funds with a recent trend toward accreditation, making way for the possibility of payment by Medicare. Managed care is becoming more prevalent as a player since states has begun to contract with managed care organizations (MCO). This great variety of funding streams makes for a complex billing and accounting system that could eventually become an area of specialization for the HIM professional. There is a variety of coding and classification systems used in behavioral health organizations. The methods used are strictly dependent upon the purpose of the coding. Psychiatric diagnosis is coded using the Diagnostic and Statistical Manual of the Mental Disorders, Fourth Edition (DSM-IV) providing classifications and criteria to assist clinicians in making psychiatric diagnosis. For billing purposes, the ICD-9-CM and the CPT/HCPCS codes are used. The role of the HIM professional in the mental health setting has gained an increased interest over the recent years. The role technology is taking in data management is expanding and mental health centers are finding that decision making around management information systems is growing complex and requires an expertise of its own. As efforts to create a nationally standardized data set along with a universal system of data collection, the mental health setting will continue to offer opportunities from within the setting and from agencies like the Center for Mental Health Services (CMHS). The substance abuse facility has several settings: outpatient, intensive outpatient, residential inpatient, medically managed intensive inpatient, education and prevention, self-help and aftercare. In some ways, there are similarities found in both substance abuse and mental health. Both have the distinction of caring for those who are unable to take control successfully of their treatment. Whether it is a “thinking disorder” or a “substance use disorder” that controls their lives, many of the same treatment options fit both scenarios. Unlike mental health, substance abuse until recent history was not considered a serious problem or even a disease. It was not until 1956 that alcoholism the (primary focus for drug addiction) was classified as a disease by the American Medical Association (AMA). In fact, addiction is and has always been an important health problem in the United States. The most notable treatment program is the now famous self-help program “Alcoholics Anonymous” (AA), a non-profit organization that has as its cornerstone the “12-step program”. The “12-step program” acts as both a philosophy and program which has been adapted by numerous treatment facilities. Unlike a “thinking disorder” freedom from dependence for the substance abuser is possible, providing the treatment is sought and the patient is compliant. Similar to patients suffering from mental health issues, substance abusers are never actually cured, and they are only freed from the “substance use disorder” as long as they continue to abstain from the use. Reimbursement issues facing inpatient substance abuse facilities are essentially the same as those for other types of inpatient mental health services (Peden, 2004). Comprised of client fees, private insurance, Medicaid, Medicare, and other government funding sources, the funding stream for outpatient substance abuse is complex. There is no universal fix to the complexities of each country and what they face with regards to their health care needs. Health care is a fundamental need among all peoples. Each country will have to work on solving the disparities that exist in access to care and we must work with all countries around the world. Every country faces the potential of an outbreak of a disease like SARS or a terrorist strike involving biological or chemical agents. Global initiatives to improve the health of nations across the board, regardless of resources in these countries will benefit all. We need to continue with consistent and comprehensive measures to ensure health equity to all (Williams & Torrens, 2010). In developing resources, health personnel, facilities, drugs, equipment, and knowledge are all critical to public health. The types and amount of these are being crucial to meeting the ethical requirements for public health. Personal autonomy and respect for privacy remain critical, but the welfare of society merits close regard for justice. It is important that everyone have equitable access to health care with dignity. In many cases, this warrants universal health care. In the organization of services, the most important thing is that the services be organized and distributed according to the needs and ability to benefit. The management of health services involves planning, administration, regulation, and legislation. These management services need to provide efficient, appropriate health care to all who seek it. Administrators have been faced with the profit squeeze and been dealing with many things like downsizing and providing care with less qualified staff instead of using nurses. Although it seems to be neutral at first glance, health services management has to rely on principles of humanitarianism, autonomy, and justice in making decisions. Government grants administered by federal agencies are available in support of abuse treatment or prevention. These grants are awarded to individual states that turn around and distribute the money to eligible community organizations. In some cases, these subsidies account for 75 percent of the overall revenue. Coding for substance abuse treatment facilities is dependent upon the level of care provided. Generally, services will use the ICD-9-CM and CPT coding books for reimbursement. As in the mental health service, the substance abuse facility uses the Diagnostic and Statistical Manual of the Mental Disorders, Fourth Edition, text revision (DSM-IV-TR), which provides clear descriptions of diagnostic categories for mental disorders which includes conditions related to substance abuse and dependence. Using the ICD-9-CM as a base the DSM-IV includes a compatible five character coding system with some significant differences. The DSM-IV offers the clinicians the attractive feature of assessing clients and recording findings in a multiaxial format and this allows patient assessment on several levels. Each refers to different domains of information such as clinical disorders, personality disorders, medical conditions, psychosocial problems, and evaluation of functioning. Using this continually evolving tool patient treatment plan, and outcome predictions will become more knowable. The HIM professional role in substance abuse will become increasingly more important as the need for collecting, analyzing, and maintaining reliable patient data grows. MCOs and other payers will need viable evidence that the reimbursements in these areas are clearly the lowest possible cost while providing quality service to their clients. Confidentiality is the greatest challenge facing the HIM professional in both the mental health and substance abuse facility. Traditionally, both settings have been the cornerstone of confidentiality since patient anonymity is crucial to the success of treatment. Each of these four settings poses significant challenges and opportunities for HIM professionals. The chance to contribute and make a difference is the greatest when extreme challenge is met head on and conquered. Perhaps these settings are not the most glorified of settings, but they are, however, essential to the society. References Harrington, C. (2008). Health policy: Crisis and reform in the U.S. health care delivery system (5th ed.). Sudbury, Mass.: Jones and Bartlett Pub. Hughes, J. (n.d.). Inside the minds: The art & science of being a doctor : Leading doctors reveal the secrets to professional and personal success as a doctor. Organizational learning and knowledge: Concepts, methodologies, tools and applications ([Enhanced Credo Ed.). Smith, J. (1966). The New Zealand doctor and the welfare state. Ak: Blackwood & Janet Paul. Straker, N. (2013). Facing cancer and the fear of death: A psychoanalytic perspective on treatment. Lanham, Md.: Jason Aronson. Sweeney, A. (2014). Scared scriptless: A novel. New York: Hyperion. Read More