It's tougher to be a doctor than it used to be, for many reasons

Wassim Mazraany

It’s hard to attract specialists to rural areas as pay drops while hassles are rapidly increasing.

I have been in a surgical practice in Maine for 5 years now. Like me, most surgeons enjoy what they do. Some might even tell you, a little embarrassed, that they feel bored when on vacation.

But some aspects of surgery are not as gratifying. The cost of health care continues to rise exponentially, as does the number of patients with decreasing access to medical care. This occurs mostly in rural areas. Maine is a prime example.

It is fair to say that surgeons earn a good living. I call it “earn,” rather than the sometimes painful phrase “rake in.” Forgotten sometimes is the amount of time, effort and emotional investment the surgeon and her or his spouse have to endure from the time of high school graduation until their first day of work. (In my case, 15 years and change).

Forgotten is the burden of responsibility and the level of expectations that face us.

Physicians in rural states are making far less money today than they did 20 years ago. This has created a major burden on trying to attract new graduates to Maine. Why should they come here if they can work less and get paid more if they go to another state?

Better yet, they can work as an administrator, or whatever is the fancy title bestowed upon them, for a “health care” agency or a pharmaceutical company. The end result is a severe shortage of physicians, oftentimes affecting the weakest links of our society, the children and elderly, the worst.

EMMC in Bangor has currently around 350 physicians on staff. Roughly one-third received their medical degrees overseas. The majority of them are here to fulfill an immigration requirement that mandates them to work three years in a rural setting, following which many become free agents and depart.

From Calais to Fort Kent to Rumford, children have to travel for hours each way to have their tonsils checked, often after a month-long waiting period. In the area from Greenville to Millinocket to Pittsfield, there is no trauma surgeon on call on every night.

Therefore, if you happen to be traveling north to experience Maine, the way life should be, and God forbid you hit the same moose you were wary of for hours and you end up injured, even Joe Bornstein won’t be able to find a surgeon to sue on your behalf.

Which brings us to another point, malpractice. There is no doubt in my mind that some physicians, being human, make mistakes. Sometimes the result can be disastrous. As a society, and as health-care providers, we owe it to our patients to enforce the highest standard of care by all practitioners.

The problem is, those bad doctors are very few and far between. When you review claims and lawsuits, the majority are nuisance suits, and the minority that go to court end up being won by the doctor eight out of 10 times.

But even if doctors win, their malpractice insurance will skyrocket. And for the small number won by injury claimants, the awards are astonishingly high, and the average keeps increasing every year. Keep in mind, the plaintiff’s lawyer gets a third of the award.

Now who is raking money out of the patient’s misery?

Another aspect is defensive medicine. Many physicians end up ordering tests and procedures that they probably wouldn’t have ordered if they didn’t fear a lawsuit.

Twenty years ago, a family doctor might see a hundred patients complaining of headache before ordering a CT scan on one of them. Today it might be everyone, just in case that one in 10,000 patients who has a brain tumor will not become John Edwards’ next client.

At $500 or more per scan, that price is coming either from the government (your tax money), or the insurance company (your premium).

Either way, we as a society end up losing the battle to an “injury lawyer” commercial that is the equivalent to intellectual terrorism.

I recently attended a conference where one panel was supposed to include the vice president for human resources of Xerox. But it was announced that he couldn’t come because a child in his family had a baseball game and he chose to attend that instead.

If, God forbid, you end up in an emergency room, the hospital’s CEO is not going to be there, your lawyer is not going to be there, and the vice president of Xerox is definitely not going to be there.

Your family will be on one side of your bed, and you can count on me to be on the other side, even if my child were pitching for the Red Sox in the World Series. Now tell that to your elected officials in Augusta and Congress.

Wassim Mazraany is a surgeon at Eastern Maine Medical Center and Sebasticook Valley Hospital. He is a native of Lebanon and lives in Hampden.
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