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Commentary | VOICES / A FORUM FOR COMMUNITY ISSUES

Primary-Care Doctors Suffer Fiscal Maladies

June 14, 2003|Jill Hoffman | Jill Hoffman is a Los Angeles writer married to a family physician.

There is a standing medical school joke.

Question: What do fourth-year medical students who choose to go into primary care get?

Answer: A brain scan to see what is wrong with them.

Does our society want a health-care system without primary-care physicians? It is quite possible that within the next few years, the only doctors able to afford to remain in business will be plastic surgeons.

The ever-increasing cost of running a practice combined with ever-decreasing reimbursements to primary-care doctors (pediatricians, family doctors, internists) has created a situation in which many providers are close to going out of business.

This will result in less access to health care for all of us.

Some primary-care doctors see up to 50 patients a day (not by choice), return the same number of phone calls, review a similar number of charts, fill out useless forms and interact with insurance companies, while trying to keep up to date with the latest medical discoveries.

Medical care is the most regulated profession in the country, and doctors with managed-care contracts cannot change fees to reflect any increase in costs.

Before you tsk-tsk and refuse to have sympathy for "rich doctors," let me assure you that primary-care physicians struggle to pay bills like everyone else. Health insurers are not only slow to reimburse patients, if they do so at all, but they treat doctors in the same manner.

We also live in a society in which patients are much more eager to spend $5,000 on a tummy tuck than to pay a $15 co-payment to the physician who takes care of them when they are ill.

There has always been an unwritten understanding that in choosing to serve society for the greater good, a physician sacrifices a large chunk of his or her own life. Through the years, this means many missed or interrupted Little League or soccer games, school activities, family dinners, holiday celebrations, plays and concerts. In short, a primary-care doctor gives up a large part of his or her own family life to be there for someone else's family.

To make it even more complicated, a doctor is expected to be perfect 100% of the time. No one is just a patient anymore. Each and every one of us is a potential litigant. There are certainly physicians who have no business staying in practice, and the medical establishment doesn't do nearly enough to weed these people out.

However, most primary-care doctors are skilled professionals who do the best they can to provide patients with the best possible care.

Primary-care doctors began their journey knowing full well that they would never be at the top of the medical income pool. They could not have imagined that the many sacrifices they made through the years would lead to the health-care system of today, a system that puts their survival and our access to quality health care at risk.

It is time for us to prioritize what is important to us, for our politicians to stop dawdling and take action, and for insurance companies to rein in their greed. Otherwise, the next time you have the flu, you may have to go to your local family plastic surgeon.

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