AF ablation Doctoring Health Care Health Care Reform Reflection

Where’s my “foundation?”

This week I traveled to a major “arrhythmia institute” in the southern US.

For a specialist in a rapidly evolving field, venturing out of the protected cocoon of one’s routine, to see other’s approach, especially those at major referral centers, is immensely helpful.  Although trips like this do not count for CME, they are just as, or possibly even more valuable than repeated didactic presentations.  Useful, practical learning is always more helpful than syllabus learning.

This particular twenty four-hour jaunt, through the forest of the business traveler, to the castle of the “arrhythmia institute” was an especially educational one.

For example, I learned about “the foundation.”


Like the state it was in, the arrhythmia institute was large in every way.  Even more impressive than their five state-of-the-art EP labs, was the army of nurses, technicians, research associates, paper-writers, and industry representatives, all present to help care for both patients and doctors alike.  One of the doctors told me of his office experience, in which there were allied-health associates available to answer pre-procedure and post-procedure questions, patient oriented educational videos to watch, and websites to peruse.

Wow, imagine one’s potential productivity if there were EP nurses to perform tasks like dictation of post-op notes, and answering of un-reimbursed patient phone calls and emails.  Or, the research one could publish if there were nurse-specialists who write down all manner of patient data in spreadsheet form on each ablation, and then have dedicated research associates write up the papers. “AF homework” as it was called by one of the friendly EP nurses.  If I had such luxury, I might do more than one AF ablation per day, or I might occasionally start a case after three o’clock. On second thought, starting complicated elective cases after three is always a bad idea.

Knowing the realities of declining compensation, and now having experienced post-hoc denial of a proven effective procedure, I asked one of the institute doctors the 64K dollar question, “How do you pay for this army of helpers?”

“Oh, the foundation pays,” came the answer, as if to say, doesn’t my foundation pay for the same.

I didn’t ask who, or what the foundation was.

But I can say there are few foundations in the real world.

Sure it is easy to be envious of the luxury, but my real envy comes from the quality of patient care that could be delivered in such an oasis.  Not to say that more luxury guarantees better care, as surely things like common sense cannot be bought, but gosh it sure would be nice to have all this dedicated help. Imagine.

Where is my foundation?

In the future, as our new system of health care delivery strives to provide care to more, but at less cost, I wonder which patients and doctors will be lucky enough to bask in the luxury of foundation-supprted health care.