The physician’s plight
Don Coldsmith
Monday, November 27, 2006
Our town recently took a heavy loss, with the announcement that our capable team of orthopedic surgeons was leaving. Two have reached retirement age and it apparently has not been possible to recruit new partners. Why? It’s a good town; always a community noted for the quality of its medical care.
I’m going to depart from my usual avoidance of writing from the physician’s point of view. Maybe it’s time to take a look back at what has happened to health care. I was intensely involved for more than 30 years. I think that, unfortunately, the profession of medicine, like many other entities, has been swallowed by the world’s corporate structures.
When I graduated from medical training in the late 1950s, a young physician could find a community that needed his skills, move there and open an office (with appropriate licensure, of course). It might help to partner with an established physician, financially or merely for professional support. Liability insurance was inexpensive, a few hundred dollars yearly, as I recall. Malpractice suits were rare. Physicians could still accept farm produce in payment, and did, but this was rapidly drawing to an end. Insurance companies began to dictate WHOM they would pay, and if they’d pay, based on their evaluation, rather than the professional’s knowledge. Next, “No, that’s not the way to do it. Do it that way, we don’t pay.” This, from an accountant somewhere, judging our treatment of something we had done professionally hundreds of times.
Next, management: “Let our corporation handle your office operation. This will be more economical, remove part of the stress of doing business. It will save you expenses.”
Just how, I’m asking myself, can a corporate organization cost less and pay more to everybody involved? I refused to sign on.
Next, patients whom I had treated for years began to stop by to tell me that their employer’s insurance policy would make payment only to specific physicians chosen by the corporation’s insurance carrier. There were very few self-employed patients any more.
I was still reluctant to give up. I was teaching at Emporia State University and working part time in their student health program, but hadn’t yet decided exactly when to close my office. I still had a few obstetrical cases to deliver, of my 3,000 total. I arrived at the office from the hospital at noon on a January day and began to look at the mail on my desk. On the top was the bill for my liability insurance coverage for the coming year, necessary for defense against lawsuits. The amount was a startling increase, very close to my take-home pay the previous year. I wasn’t willing to play the game, to let corporate structure tell me how, as a trained professional, where, when and under what circumstances I might practice medicine. I knew my profession. I called my nurse of 25 years and my office manager into the office and told them we’d lock the door at the end of the month. I knew several physicians who would eagerly hire my nurse. My office manager continues to work with me in my present vocation as a writer.
Probably, by signing on with a corporate organization, I could have merged my insurance with others, shared the coverage cost and hung on a little longer. I refused and have never regretted the decision.
We can judge for ourselves whether the change to corporate structure has REDUCED the cost of medical care or its efficiency. It’s certainly apparent, though, that no beginning physician could afford to cover the liability risks of today, alone.
We have to be realistic about it. The physician is in a vulnerable position and has lost the option to build a reputation for excellence on his or her own. Realistically, self-defense must come first.
Maybe... Do you suppose that it would help any to declare a moratorium and shut down all the law schools for about 20 years? It might be worth a shot...
See you down the road.
Comments
We allow registered users to post comments on this Web site. To learn more about our posting policies please read our User Poster Agreement Policy.
Use the comment form below to begin a discussion about this content.