In our discussion the other day about my leg telling the weather, I want to make it clear the brusque, perfect-looking and cruel doctor who made declarations instead of admonitions to help heal my leg is like all the other young MDs I’ve met in New York City.
These young doctors are angry and tired and terrified of going bankrupt in an industry that doesn’t begin to pay their high scale-rents and mountainous student loan debt. Many want to make a killing on the backs of their patients as quickly as possible before the insurance companies cut their payments even more.
The new thing in New York City is for young doctors to accept NO INSURANCE at all and run a cash-only walk-in business. Cash has always been King in New York and the young doctors are cashing in by cashing out on the needs of most people who need an insurer to help cover astronomically rising healthcare costs.
Some doctors, in an attempt to keep their conscience clear, accept one or two boutique insurance plans with high payouts while the rest of us, especially the elderly, are pressed farther apart from a routine relationship with a physician and are fated to suffer at the whims of an Emergency Department. I lost two fine doctors when they went cash-only. One was a dermatologist who, fed up with not getting paid by insurance companies for services rendered, decided to take it out on his patients.
He railed at me one day that the skin tags he had been cutting off of me were not getting reimbursed by my insurance company because that “surgery” was seen as elective and cosmetic. I asked him how taking off a couple of skin tags could be surgery. “Surgery, from the insurance company perspective,” he explained between gritted teeth, “is any procedure where any part of the body is cut or scraped.”
I told him the three tags he “cut” off — pulled off, really — had been rubbing against my shirt collar and causing me pain and while that may have been “surgical” it was not “cosmetic.” “Well,” he said, “You can cut them off yourself now.” I asked him how to remove them. He looked at me like I was stupid and then told me he was kidding.
I asked him if he was going to remove the two skin tags I had left. He would remove them for $100 cash each. I did not have $200 and I wondered if I could cut them off myself at home with a pair of nail clippers. He gave me a horrified expression and said, “No, I wouldn’t do that. You’ll bleed.”
“Well, if you won’t do it,” I reasoned, “Then I have to do it.” I had been in New York City for a couple of years and I had learned you had to aggressively stand up for yourself at all times and, if that failed, then you had to rely on only yourself for remedy. I continued, “What if I heated up the head of a nail with a match and then touched the nail head to the tip of the tag?
That would burn it off faster without any bleeding, right?”
He shook his head. “No, no. You can’t do that, either.” “Will you do it for me today, then? I’ll never ask you to remove them again.” He stared at me with his fists on his hips. “You already used a disposable scalpel to cut away the dead skin on my scar. Can you get the scalpel out of the trash and make two quick swipes?” He stared at me with death eyes and told me to turn around. I gave him my back and I heard him open the lid of the trash can. He spun me back around to face him.
He put his face so close to mine I could see the pores in his nose as he whispered, “And I’m not using anesthetic.” I nodded to give him his vengeance. I didn’t remind him he’d never used anesthetic before. “They’ll only grow back, you know.” With two fast flips of his plastic, green-handled, scalpel, he was done. He threw the scalpel back into the trash can and said, “We’re finished here. Don’t come back.”
I dressed myself and never saw him again because he closed his medical practice the next month and opened up a cash-only Day Spa in the same space. An older doctor friend who, when I shared that story, told me: “I know that guy and he was pulling down six million a year pinching pimples and now he’s making 10 packing mud on old lady faces. Nobody makes more money for less work than a Dermatologist.”
I have since used the nail clipper method of home skin tag removal and it works just fine. I don’t bleed much. The trick to finding an MD or dentist in NYC, I have learned, is to find one over the age of 70 — they’ve made their money and if they’re still practicing they’re doing it because they love their patients and not their payments. The old guys hate the young guns and how they behave.
One solution to remedying Angry Young Doctor Syndrome might be to find a way to reduce the financial burden it takes to get a medical degree. Some teaching hospitals are trying to find ways to achieve happy young doctors. One medical school in Long Island, New York will waive the $250,000 four year tuition price if a graduating doctor agrees to work in their hospital — with appropriate pay — for a fifth year.
I think that is a great first step in helping vest young doctors directly into the ongoing care of their patients and I hope other creative solutions can be found to once again make medicine about people and not prices. If we continue down our current pocked road of medical despair, we’ll be forced to do our own elective surgery at home on the kitchen table. My nail clippers remain ready.