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In the past, the phrase, “My daughter (or son), the doctor,” was said by parents with pride. After all, only the best and the brightest became medical doctors. And a physician’s status in the community was second to none–physicians were and still are viewed as healers, personal advisors, and occasionally even miracle workers. A parent’s pride was apparent just through the use of the phrase, “My daughter (or son), the doctor.” Did your parents ever introduce you as, “My daughter (or son), the accountant?”

But encouraging a daughter or son to become a physician is not as simple as it used to be. Consider the following conversation that could occur today between a father (who just happens to be a healthcare financial professional) and his daughter, who wants to become a physician.

Father: “So you want to become a doctor? That is an honorable profession, but you know a lot has changed in the past few years.”

Daughter: “Really? I’ve wanted to be a doctor for as long as I can remember. And with new medicines and new technologies, things have changed for the better, haven’t they?”

Father: “Well, yes, the practice of medicine has benefited from scientific and technological advances, especially during the last 20 years. But the life of a doctor has become much more complicated today, for a number of reasons: managed care and health insurance, Federal and state regulations, labor laws–the list goes on and on. And mergers and consolidations have changed the relationship between physicians and their practices. Few doctors are able to practice as independently as they once did.”

Daughter: “Yes, but all of that stuff relates to business and finance, and that’s your thing. It wouldn’t affect me. I want to help people, especially children.”

Father: “Ah, but these things would affect you. For example, once you saw a child in your office, you might order tests, prescribe medicine, or refer the patient to a specialist. How do you think you would get paid for your work?”

Daughter: “I don’t know. I guess the parents would pay for it.”

Father: “Actually, it depends. In some cases, the parents would pay for the services. In other cases, the parents might have health insurance and you, or someone who works with you, would have to bill the insurance company for payment. You would have to document what services you provided, justify why you provided them, and assign the appropriate codes for billing. The insurance company might pay all the bill or only part of it. And you might or might not be able to bill any balance to the parents.

“Or the payment might not be related to what you did at all. You might receive a flat payment per month for each patient you have, regardless of what services you actually provide. Of course, all of this would depend on the arrangements you have made with the various insurance companies and managed care plans–which may number in the hundreds.”

Daughter: “Why would I deal with so many insurance companies?”

Father: “Because many insurance companies limit the physicians they will do business with. If you don’t sign contracts with these companies, you might not be able to see patients covered by those companies. Oh, and I almost forgot. As a pediatrician, you probably would have to deal with state Medicaid agencies. Their rules and billing requirements often are different from those of private insurance companies; they vary by state, and by whether the patient’s family is covered by the standard Medicaid program or by the Medicaid managed care program.

“You also probably would have to see patients covered by workers’ compensation and auto insurance. These types of insurance also vary by state and have unique documentation and billing requirements.

“On the other hand, since you’re interested in pediatrics, you probably would have much less interaction with Medicare, which is a whole different world unto itself. You would have to be careful, however, because if you didn’t do the billing right, you and your organization could be found guilty of violating the law, and be fined or even put in jail.”

Daughter: “Ugh. And I thought medical school was going to be hard! Maybe I should get an MBA after I graduate from medical school.”

Father: “Oh, no! Two more years of college? Actually ‘My daughter, the accountant’ has a nice ring to it, don’t you think?”