dr_saiz obamacare Historically, the physician-patient relationship has been a one-on-one interaction. The ultimate goal was to provide the best care possible. Over the past two decades, the middleman has become as important as the doctor or the patient. The middleman (insurance companies, hospitals and the government) was initially brought on to help the physician-patient relationship. However, the middleman has now taken over and oftentimes determines what the doctor or patient can do.

Bigger Is Better?

We all have experienced what happens when an intermediary or middleman becomes involved in any situation. If I have a problem with an appliance, I place a call into a call center which takes the call and attempts to answer the question but has no real experience with the product. This usually leads to a delay in taking care of the problem. Anytime we purchase a product or service through a middleman, we have increased cost, decreased efficiency, added more paperwork, and provide poorer services. The bigger the industry (hospitals, insurance, and government) the more these entities muddle the doctor- patient relationship, making it harder to provide quality healthcare.


With the expansion of government into healthcare, the individual practitioner is drowning in paperwork and extra expenses. The simple act of loading a disc containing MRI’s of the spine becomes difficult because the program will not interact with the disc on the computer. My medical assistants have estimated they spend an additional 15 minutes a day trying to figure out how to access imaging studies from discs or the computer. This time would otherwise be spent taking care of patients. The increased paperwork burden includes asking permission (and filling-out forms) from insurance companies to order labs, MRI, physical therapy, and surgery.

With the initiation of Obamacare, the strain of regulation has increased with the requirement to purchase an electronic medical record (EMR) system and upgrade the existing electronic infrastructure to accommodate the requirements of technology. In theory, “going electronic” means easier communication between providers and hospitals, less medical errors, less expenses, and hopefully better medical care. Unfortunately, that is not reality.

Technology = Efficiency?

The expectation of making all medical information electronic was touted as “simplifying” the life of a doctor. If all the information would be readily available, this would make care easier and decrease the potential for medical mistakes. Non-physician experts spouted advantages such as less paper, fewer employees (file clerks, medical assistants), and better communication between doctors.

My answer to that is to look at the situation in most home entertainment centers. How many remotes do we have? One for the TV, cable receiver, DVD player. When we visit a friend’s house or relative, how hard is it to figure out the TV? The universal remotes rarely work because they are too complicated to figure out. We end up using different remotes for different activities. Imagine this same scenario in healthcare.

The federal mandate for all healthcare practitioners to buy (at a six figure expense for a 3-4 man group) and incorporate EMR into their practices failed to take into account the additional expense of upgrading the server, redoing wiring to accommodate the increased data, backup system for when the internet goes out, increased purchase of mobile tablets, stands, etc. These so-called experts also failed to take into account the learning curve with each EMR system.

Estimates prior to our practice, Las Cruces Orthopedic Associates (LCOA), implementing EMR was anywhere from a 33 percent to a 50 percent slowdown. In other words, if I was used to seeing 24 patients a day, I may be only able to see 12-16 patients in the same time period. Estimates also declared perhaps a three to four month window to ramp back-up and get back to normal. However, practices who started with EMR at an earlier date also warned “You may never get back to where you were volume wise seeing patients.”

Best Laid Plans

What the federal government failed to take into account was that all of these EMR systems do not talk to themselves. In other words, the doc, aside from learning a new system, also realized that his EMR doesn’t talk with the hospital EMR or his consultants EMR. No communication. Ironically, the way doctors in separate practices currently transmit info is via fax with paper — the same system that we were using before EMR! The federal mandate of EMR to improve health care has also increased my overall expenses not decreased. The promise of fewer employees needed to maintain an office has proven opposite.

We at LCOA have increased our employees to include a scribe (an assistant who records in the EMR notes during the patient visit) and informational technology consultant. In the spirit of improving our health care system, the government has required me to buy and implement an expensive electronic medical record system (EMR), become more inefficient during the process, and hire more employees to keep my head above water. Why? Because the middleman wants to improve the physician-patient relationship.

Physician Practice Will Be Easier, So They Say

Currently, I feel, as a physician, that I spend less time seeing patients and more time documenting and negotiating with insurance companies to provide care that is needed. Patients tell me it’s harder to get in to see a specialist and often feel as if the doctor doesn’t know who they are because the MD spends his time looking at the computer and typing as opposed to listening to the patient. Going back to the original question: “How has healthcare changed because of Obamacare?”

The burden of regulation has made the business of private practice more difficult and expensive. That is why nearly 50 percent of orthopedic graduates have joined hospital practices and have simply become employees of the middleman. They have turned over the business of rent and overhead, scheduling, human resources, billing and collecting to the hospitals or health care organizations. These doctors can, in theory, just concentrate on seeing patients. However, when the middleman is your boss, inherently the physician/ patient relationship will become strained.


I became a spine specialist because I wanted to help patients control pain and maintain their lifestyle. The intimate interaction between doctor and patient has become more difficult with our current system. The healthcare industry (government, insurance companies, hospitals) is part of the problem. Any time there is increased regulation and more rules, there is inefficiency.  Allowing these middlemen to influence healthcare decisions depersonalizes medicine and strains the physician/patient relationship.

This relationship between doctor and patient was the foundation of private practice care. As this weakens, doctors decide to work for hospitals, secondary providers of medical care (Physician Assistants, Nurse Practitioners) become the primary contacts for patients, and decision making is biased as to what is best for the middleman.

In the end, are we looking at the death of the private practice doctor? Maybe.

-Dr. Paul Saiz
Las Cruces, New Mexico

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