Local Doctor Concerned About Changing Practices in Medical Profession

To the Editor:
I am honored to be a member of our country’s medical community and a private practitioner, but I am very concerned.
I grew up in a medical family and was told that society will “value you” as a physician and you will earn a nice living in medicine. This was true for the first few years. Then, Mr. Katz sold the idea of an HMO to the government as a way to save money on healthcare. Initially, I was the pediatric ophthalmology advisor to HMOPA, which became U.S. HealthCare, then Aetna HealthCare. My initial suggestions were accepted, then a 180 degree turn occurred and suddenly we were paid only 50 percent for more than two eye muscles at one sitting and 25 percent for more than four.
My colleagues suddenly did only up to two muscles in each operation, then up to another two in a subsequent procedure, etc. This meant that two or more hospitalizations and separate anesthesia exposures and fees for these kids (or adults) who required extensive eye muscle surgery.
I was introduced to the concept of being a “provider,” not a physician. Then other insurance companies followed suit, and since then I frequently have had to spend hours on the phone for “precertification” for tests on surgery or short stay or surgicenter stays. Often, these were determined by some clerk who was not medically trained and was merely reading from a list. This was not in the patient’s best interest, but was designed to discourage correct medical and/or surgical care to “save money and unnecessary procedures.”
My friends were now “retiring” early, saying they refused to put up with the added time, frustration and effort – only for continually decreasing compensation. Meanwhile, I saw people with complex medical problems receive inferior, suboptimal and/or delayed care in the name of cost savings. Remuneration decreased to a mere fraction of the former levels.
Suddenly, in Pennsylvania, ophthalmologists “forgot” how to do the tear duct probings because the compensation was then so paltry that it was literally not worthwhile to go to the hospital, gown and scrub for surgery, do the procedure and increased associated paperwork, and provide follow-up care. These kids were all sent to teaching hospitals for physicians-in-training to handle, much to the inconvenience of the children and their frustrated families.
Then, enter “National Health Care.” The idea that all providers should be paid the same meant that those of us who spend years in training were suddenly brought down to the lowest denominator – “You’re just doing eye exams.”
Finally, we are told to enter the mandates for electronic medical records – pages of unnecessary documentation and paperwork to supplant a brief letter back to the referring people with our findings and suggestions.
While this has proceeded, we are constantly on guard for attorneys ready to pounce on us for not including some (frequently unnecessary or redundant procedure or test). Here comes a week or more spent defending our medical integrity in court, costing our malpractice companies thousands even if we “win.” Losing our practice income, inconveniencing scheduled patients with remade appointments, our incurring ongoing expenses of running our office and compensating our staff, coping with personal stress and family disruption, etc. – And let’s not forget being placed in the national practitioner data bank to “protect the public.”
In reality, we are human beings, like everyone else. We are not infallible gods. By far the overwhelming majority of physicians are sincere caregivers who want the best for their patients.
Why don’t I like electronic records? Because I’m very concerned for my patients’ privacy. Just look at the breach from Horizon N.J. Blue Cross/Blue Shield, Target, Home Depot and even the Internal Revenue Service’s own computers – identity theft, etc.
You may wonder, “Why stay, in medicine with all this going on?” This is a small part of why you are losing many of the brightest and best motivated prospective physicians. Physicians are now often retiring early – a shame that the U.S. is pushing doctors to quit.