No doctors, now what?


This is both an observation and a solution to the problems created by the Affordable Care Act, a well-intentioned (by the president, not by the authors) and impossible attempt to let the government control both the process and economy of our national health system. We say ‘national’ because even though doctors and insurance companies and hospitals were private prior to the act, the government regulated who insurance companies could sell to and where, and doctors and hospitals were regulated by a variety of agencies for everything from practice to policies.

It has long been our belief that the president was right to bring the subject of health care reform to the surface but wrong to lock three rabidly ideological people in a room, give them carte blanche over the design, and then lie to the public about what the result would be. From the president’s ideological perch having government control all aspects of the system freed the medical world from those who primarily seek profit at the expense of patients.

The ACA, aka Obamacare, has allowed millions to add themselves to the insurance rolls, virtually all subsidized, but has also removed millions resulting in 30 million uninsured, the same as it was before the act was passed.

There are two major actions that have followed Obamacare, the first one predicted, the second not as widely expected, but both logical:

  1. Obamacare is having a huge impact on the economy as it rolls out, with a cost of more than $1 trillion anticipated. The actual cost has been a little hard to gauge because there have been a number of delays to facilitate election cycles.
  2. A permanent part time economy. The cost of Obamacare was, if anything, under reported and under expected even though adding 30 million people to insurance rolls had to have a huge impact. As it is now – and we just came off the worst job report in 6 years – employers are not adding employees largely because the health plan is not fully in place and long term conditions remain uncertain.

But there is something else that should have been anticipated and was not: massive retirement by doctors and the disappearance of the independent doctor. The American Academy of Medical Colleges (AAMC) tells us there will be a shortage of 90,000 physicians by 2010 and more than 130,000 by 2025: Part of this is age and part of this is the inability of the private doctor to meet the time demanding reporting requirements of the ACA.

From personal experience, speaking to doctors nationwide in seminars, I heard doctors tell me, right after passage of the ACA, they were afraid ‘they would no longer be able to afford to practice privately.’, that ‘reporting and regulation with the ACA would mean less time with patients.’ and, perhaps most troubling, as one doctor me, ‘I have told my kids not to go into medicine. Find another profession.‘ She went on to say, ‘I love medicine, I love helping people, but I had to surrender my practice to a corporation and now they tell me how many patients to see each day and how little time I can spend with them. We are like a car wash just running people through as fast as possible.’

A doctor at the prestigious Mayo Clinic told me, ‘If it wasn’t for foreign students our medical school enrollment would be down 40%.’

These are dire words but this is America and, when challenged, we innovate.

So this article is not all about the disruption the ACA has been to this point, but about how solutions are slowly but surely surfacing and how, when all is said and done, the ACA may be the catalyst that gives us a reasonable and effective medical system at an affordable cost. Granted, the final solution is far into the future but let’s look at the advent of the one innovation that addresses our subject question, ‘No doctors, now what?’

All of us have heard the stories of how the emergency rooms are totally clogged up, often by the uninsured (One of the lies setting the table for the ACA and repeated by both politicians and the media was that Americans were dying because they couldn’t get medical care. Balderdash; every emergency facility has to take anyone who walks in.). But emergency rooms are also filled with those with 100% insurance who show up for any minor issue.

So emergency rooms are clogged, by ‘freeloaders’ both with and without insurance. The challenge is how do you free the emergency rooms to treat, well, emergencies? The answer is obvious: give those without an emergency an attractive option, so –



There is a ‘cottage industry’ within the medical establishment now known as ‘telemedicine‘. I first learned of this more than a year ago while watching HGTV’s House Hunters International show.  A lady was moving back to her home country outside America and said she could do so because her medical specialty was ‘telemedicine’ and she practiced over the phone…  she could live anywhere.

An intriguing idea I gave little thought to for several months when the subject popped up again in an article I read why traveling. The article noted many insurance plans now include ‘unlimited MD calls’ but most people are not aware of this provision or don’t realize just how valuable it can be; many allow calls 24 hours a day … and don’t emergencies seem to come at odd hours?

Before I go further, telemedicine isn’t for every emergency; you can’t fix a broken bone over the phone. But, if your emergency fits within the categories below there is no reason to go to the emergency room:



Colds and Flu




Respiratory infections


Skin inflammations

Sore throat

Sprains and strains

Bladder Infections

And others … as listed by your insurance carrier.

How does it work? You call the number given by the insurance plan, talk to a real doctor, your prescription is sent to your pharmacy, you pick it up. That’s it! No driving to an emergency room, waiting in long lines, filling out endless forms or catching something from someone else in the room. You have the time you need, you don’t feel rushed, you don’t have to dress up, you don’t risk exposure to others.

And doesn’t it seem emergency rooms are filled with people with sniffles?

If you work for a large or mid-sized employer chances are they already include this in their plan or will soon; it is much cheaper for the company and results in far less lost employee time.

If, like me, you don’t have an employer (and don’t intend to have one) there are several private firms such as MD Live and Access Discount Healthcare, with more joining. Fees range from about $49 per month to basic pay as you go plans ranging from $4.25 to $16 each month. Some others bill you per call generally ranging from $50 – $70, far less than the $100 to $400 basic emergency fee charged by most hospitals.

The Affordable Care Act has been anything but affordable, but American ingenuity may save the day. With the advent of computerized record keeping there is no reason you can’t have care available to you anywhere in the world on a moment’s notice; telemedicine is the first of what promises to be many innovations in medical care.

Sometimes we get discouraged by the ever growing government presence in our lives, mandates for everything from food safety to who gets to use which bathroom. But, like the famed physicist, Isaac Newton said, “For every action, there is an equal and opposite reaction.”

The children of our children will grow up in world in which going to the doctor for a minor emergency will be as alien to them as getting up to change the TV channel is to them.

Your comments welcome …