Could I Go Back Again?
Last week I described how one of my coworkers asked if I thought I could go back to working in the States again. I thought the answer would be a quick and easy, "Sure!" It wasn't.
I haven't had to fight with an insurance company in over a year. I've enjoyed autonomy that I'd never known in either Florida or New York. I can prescribe medications to my patients using the guidelines provided by the NHS. I work in a variety of services - community, outpatient and intermediate care. I am constantly challenged to improve my practice and expand my skills and the NHS supports me in that endeavor. I'm part of practice review groups that examine how and why we do what we do in order to create better processes and programs.
I like it here. I don't want to argue with an administrative gatekeeper to justify one or two more sessions for my patients. I don't want to spend numerous phone calls to MDs to give me permission (orders) to do what I know better how to do anyway. I don't want to have to take vacation or personal time in order to take a course. I don't want to be told how to practice with no input into the process myself. I don't want to have to discharge patients with potential and motivation because their insurance company denied further treatment.
Mr. Cameron is bound and determined to change (eliminate?) the NHS. I don't think he'll succeed in doing away with it; the national ethos simply wouldn't put up with that. He will change it though - probably to be more like the Medicare model in the States. I know that I could survive that change, perhaps even flourish in it, but do I want to? There are no easy answers to these questions.