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When I was 25 I got pregnant with my first child. I worked in a medical office and my husband was a construction worker. Needless to say, we didn’t have insurance that would pay for the delivery of my baby—so we decided to go on Medicaid. I felt justified in the decision and continued to work throughout my pregnancy.

That’s just a little background for what I want to discuss. You see, I never dreamed back when I was 25 and on Medicaid that I would receive any different care or be seen any differently than any other pregnant woman when going to the doctor. And frankly, I don’t believe my amazing doctor at that time, or the hospital where I delivered, treated me in a biased manner.

Fast forward to what I see today on the other side of the bed: clinic patients, i.e. those on Medicaid or without insurance, sure DO receive a different standard of care. Not from me, or my nursing coworkers, but from SOME of the attending doctors. I am mortified and absolutely ashamed.

I can’t really go into specifics. Let’s just say docs really drag their feet, pass the buck, etc. with clinic patients because the money isn’t there. For example, a clinic/Medicaid delivery pays a fraction of what an insurance delivery pays, so docs don’t feel doing deliveries for the clinic is “worth it.”

But I can say, that with the economy the way it is, and insurance being so hard to obtain, it is hard for me to understand why there would be a bias against those people who have to resort to using government programs (legitimately) or have no options at all. And why in the world would that make a difference in the care they receive? It blows my mind.

In fact, it puts patients in real danger when this behavior occurs. And it puts my career in danger. I end up teetering on going beyond my scope of practice in some cases just to protect and care for my patients. And though I can’t detail the situations I find myself in, it would not be exaggerating to say that I get nervous for my license. I am constantly put on the spot!

Yes, there are laws, and the state supposedly watches over things and bla, bla, bla. But the reality is that there is a HUGE problem. I am seeing it and it disgusts me. Besides reporting it, I am at a loss.

This is where patient advocation plays a huge part in our jobs—but I’ll be honest and tell you my advocating does little to nothing. The healthcare machine itself is broken, and until it’s fixed, advocation is just a band aid that hardly covers a gaping wound.

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Amy Bozeman

Amy is many things: a blogger, a nurse, a wife, a mom, a childbirth educator. She started her journey towards a career in nursing when she got pregnant with her first child. After nursing school and studying "like she has never studied before" she entered the nursing profession eager to get her feet wet. The first years provided her with much exposure to sadness, joy and other complex human emotions. She feels that blogging is a wonderful outlet and a way for nurse bloggers to further build their community. Traditionally, midwives have handed down their skill set from midwife to apprentice midwife. She believes nurses have this same opportunity: to pass from nurse to new nurse the rich traditions of this profession.

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7 Responses to Unbelievable!

  1. Shay

    I work in long term care and most of our residents are meaicare / megdicaid. I see more government problems than I see anything else. Our staff has been cut in half! This includes everyone is nursing to housekeepers. The lack of care makes me sSICK! all I here is the is no money in the bbbudget. People are people! Humans! I chose to be a care provider. How can I give good care to 38 pt? These are not little old healthy people. They are skilled and most have critical illnesses that deserve attention. Oh and yes I stayed even after a pay cut.

  2. Granny Rene, RN x 35 yrs.

    Not sure where you live and work but here in the rural Deep South, Medicare and Medicaid are the norm rather than the exception.
    Even in the nearby ‘urban’ hospitals, if a patient presents who HAS Medicaid we are overjoyed! And their treatment is usually no different and in some cases even BETTER than the VIP across the hall who flew in on a corporate jet. Why? Because the poor, homeless, etc. have NOTHING TO LOSE and EVERYTHING TO GAIN by suing the hospital. Also, the VERY BEST docs that I have worked with still practice because they CARE about their patients. I had one prominent pulmonologist/intensivist who worked for an entire summer with patients he received on call who had NO medical insurance of any kind. Several were illegal immigrants-one from, literally, a one-mule town in South America! But this MD gave all of them his best-the only way that he knew how to be. So at the end of his ‘dry spell’, when a Medicaid patient FINALLY rolled his way, I simply reminded him that he had been doing the Lord’s work all summer, and that his ‘payment’ was in his account in heaven.
    Personally, I would RATHER take care of someone who has nothing than the richest man/woman in the world. The one who has nothing appreciates you more.

  3. Norma R.N.

    Well after reading that article the best sentence is the healthare nachine is broken and will take more than a bandaid to fix, that and i as well as a nurse my advocating does little to nothing. now days the more speak up the more :your a troube maker” Sad but true it’s the the type of medicine I started out in 25 yrs ago everyone was treated the same now i even hear co workers make comments about younger disabled patients on medicaid “there just trying to get a check” Sad but true but I am just a small fish in a large pond of pirranha’s. That’s why I promote no one to go into today’s nursing unless your there to just ride the clock and get a check.

  4. Linda Pritchard

    I have medicaid and I thank God for it. But, I think the treatment is different. Doctors don’t want to do anything for you or suggest anything to help because to often Medicaid won’t paid for it. I have arthritis really bad and got a referral to see a rheumatoid doctor. I know early treatment is so important to prevent it from worsening. I tried but could not find one in our state or the surrounding states that takes medicaid. I’m 58. I have diabetes and I’ve had one heart attack and stroke last year. My family doctor has never said anything about getting me any kind of help. Just says he has to see me every month. Of course he does, so he can get his money. I’ve lost faith in our government. All they want to do now is cut programs for the disabled and elderly and that is so wrong. I think we need to throw out all the politicians, insurance agents and lawyers and start over.

  5. There is good, bad and even ugly in every industry. But it becomes disturbing when things like this are identified in health care. I have learned that providing good health care is complex and although money should not be included in our decision making – it is. There are 3.1 million nurses in this country but only about 600,000 physicians. I truly believe we have a hugh opportunity to make a difference. As Amy mentioned, to be advocates for our patients. It’s not an easy road but we have an ethical responsibility to forge ahead!

  6. Jeri

    I have some personal and professional experience with this issue. I had health insurance with my first pregnancy, but did not with my second and therefore obtained medicaid assistance. Going to the same hospital for the deliveries within two years of each other, I believe I received drastically different care while on medicaid. Maybe the nurses that I had with the second were just not as professional and caring as the ones from my first delivery, but I felt that it had to do with my status. Now, as a healthcare professional, I have seen different treatment of patients depending on their economic status. I don’t know the reasons behind the difference in the care that is given, it may be that lack of profitability is a reason, or it may just be lack of concern. It isn’t every healthcare worker who treats patients differently, but it does happen.
    As far as Norma’s comment about not recommending anyone go into nursing, I don’t see why nursing in and of itself isn’t still a great position to affect people’s lives. It’s not an easy profession, but even just one caring nurse can have a possitive impact on so many lives.

  7. Desiree, LVN

    After reading the article, and the comments, I’m saddened. I’m a child of God, first. Then, a daughter to my parents, a grand-daughter to my beautiful grandparents, a mother to my 3 plus 3 step-children and my children’s friends, a friend to my friends, a companion, and a wife to a beautiful man. I am all these. And then, I am a Nurse. Even outside of the daily work at a SNF, I come home, and I’m still a nurse. At work, I provide the same care to my patients as I would here at home. I’m looking out for them all. Their physical health, emotional health, spiritual health and all over well-being. It upsets me to hear (or read) “I promote no one to go into today’s nursing unless your there to just ride the clock and get a check”. Yes you get paid. But if that’s all you’re out for is a check, then sister, you’re in the wrong profession. Even with healthcare and reform the way it is. These people need someone who cares for them and about them. No matter what their situation is. Granny Rene, RN, I applaude you. Our paycheck is greater in heaven. I’d hate to be anywhere else. So to all my patients and their families, I hope I bring you comfort in knowing I’m giving you my all when I’m caring for you. And when I’m not caring for you, I’m always praying.