Why would a doctor
spend so much time doing
non-doctor things?
Hello, I am Alexander Lakowsky,
a board-certified,
Internal Medicine physician
in private practice
in the San Francisco Bay Area and I am also
the founder of Reimbursement Rx.
By now you've seen a lot
of videos that I put out,
a lot of posts that I
put out, and I've gotten
a number of comments from a lot of you.
And I guess one question
that is still on everybody's mind is
well, who am I?
Truth of the matter is
that I am no different
than most of you.
As I mentioned, I'm in private practice
I strive and want to do the best
for my patients,
to make sure
they get everything they need,
and make sure that at the end of the day,
I do the right thing.
And I'm certain most of us
in the profession do that
and that's what most of us want.
Now, how I got here is
probably a little different.
I want to go back to my
third year of medical school,
when I began doing my clinical rotations
at Methodist Hospital
in Brooklyn, New York,
I was flabbergasted by the fact that
the attending physicians who I worked with
did a lot of work, did a lot of medicine,
but they did more non-medical stuff.
They fought with insurance companies,
they fought with Medicare,
they fought with hospitals.
They did a lot of things
that didn't make sense
to me back then, I was
only a third year student.
Why would a doctor
spend so much time doing non-doctor things
and then they always complained.
They always complained about
how little they got paid.
Now, I wasn't privy to the
actual information about
what exactly they got,
but the common theme was
that everyone complained.
And going further, in my third
and fourth year medical school training,
I observed that a lot of
physicians, both attendings
and residents who were supervising us
would order tests, would
send patients for consults,
for imaging, for everything,
without really knowing
what they were doing as far as the cost
and financial implications on the patient.
Later on, moving on to
residency, when I was the
one ordering those tests,
I began to ask myself,
"Well, how much does this cost?
And why do I need to know that?"
Because the answer was very simple,
I mean patients would ask, but, you know,
when you're in training,
when you're a resident
or a fellow, you don't really
deal with that part, yes?
That goes to the attending,
so you just go along,
and you just do whatever
you think is the right thing
to do, without any regard
as to how much they cost
and what the cost is to the patient.
So, having those questions
in mind, I wanted to better
understand the business of medicine.
So, I decided to enroll in
the Executive MBA program
and I did that at University
of Massachusetts Amherst,
while I was finishing up my residency at
UMass in Worcester.
Having gained some business
knowledge and business know-how,
I was able to understand how
business foundations are laid,
and how businesses can
flourish or come apart.
One thing became apparent to me is that
the world of medical business,
at least in this country,
is very different from any
other business from the ground up.
After residency, I became an employee
of a private multi-specialty group.
I was there for a couple
of years,and then moved on
to a private, independent
internal medicine group.
Still trying to learn
more and still trying
to apply the knowledge that
I gained from years past
and from my business
education, in order to be able
to be a better physician and
a better patient advocate.
About five years in, we were acquired,
like many of you have been, by a hospital.
Now California hospitals
can not employ physicians.
So, we were acquired by a
large hospital foundation,
which is essentially that same thing.
And I became a true employee
and I could only last
there for two years,
because I could not stand
the bureaucracy, I could
not stand the hierarchy,
but most importantly,
I did not like the fact
that we as physicians, had no control
over how much our patients
are being charged,
over where we can send
them, and over how we
practice overall. So what
I did? I did the opposite.
I did something very few
doctors do these days.
I got out of employment
and I opened up my own
private practice right across
the street from the hospital.
Now, I'm very lucky, because
I have a great partner,
who's actually my wife, who is also
an internal medicine physician.
We've been working in a private practice
across the street from
the hospital for the last
six years and we've never looked back.
It was not always easy.
It was difficult at times,
especially in the beginning.
Not so much to build and
maintain the practice,
but to deal with other
aspects, just like I told you
in the beginning.
The same aspects that those
attendings that I worked
with as a third year
medical student were dealing with,
but building up on my previous knowledge,
building upon my business expertise,
I was able to circumvent
certain angles, I was able
to ensure us better
contracts, and I was able
to make sure that we treat patients
how we wanted them to be treated.
Now we know what they're going for
and how much they're going to pay,
anywhere we send them, anything we order
so that there's no surprises.
Now, after talking to
many of our colleagues,
many physicians in the area
and across the state,
it became apparent to me
that doctors still don't
understand how to do things.
And physicians are still complaining
about how little they get paid,
how much more and more
non-clinical work they have to do
in order to maintain their
current level of income
and how little say they
have in patient care,
especially if they're employed.
I'm not here to vilify employment,
or extol private practice, I think
that anyone, any medical
provider in this country
should be able to
practice medicine in a way
that brings both personal and
professional satisfaction.
That led me to start Reimbursement Rx.
Once again, I'm Alexander
Lakowsky, and this is my story.
