Opinion: Doctors on retainer doing their best for their patients


Since Nov. 13, the Times has carried an invidious story and letters about physicians who opted for retainer medicine. Neither story nor letters do justice to the condition in which primary-care physicians find themselves.

The banes of primary care medicine are third-party payments (in particular the pressure exerted by Medicare and Medicaid bureaucracies controlling billions of dollars), huge premiums for malpractice insurance and administrative burdens required to comply with regulations imposed by federal, state and local government.

According to a November report from the Physicians Foundation, physician offices spend about 41 percent of revenue on administrative and billing/claims paperwork. Redundant paperwork costs as much as $25,000 annually for each doctor. Since 2001, Medicare payment for physician care has fallen or stagnated. Since 2001, the cost of operating a medical practice has increased by 20 percent. Consider staff salaries and benefits, rent/mortgage, utilities, equipment and consumables and it is clear why medical students opting for family medicine declined by more than half from 1997 to 2005.

If our health care is the ultimate good, why the outrage over a physician’s decision to restructure his practice to approximate our expectations? We have lawn and appliance service on retainer; why not a trusted doctor? Under many retainer agreements we receive invoices that can be submitted to insurance, recovering part of the retainer.

If our health-care is so important, many of us can make spending choices to obtain it. Or we can stampede our politicians to give everyone “free” health care of the quality enjoyed by the citizens of Canada or maybe Cuba.

Gennaro Cibelli


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