Physicians face closing their doors

By Melissa Evans
http://www.contracostatimes.com

Brigitte Clayton’s attitude toward doctors changed dramatically when her life was at stake. Diagnosed with stage 3 colorectal cancer, she wanted more than five minutes of their time.

The Rancho Palos Verdes resident found Dr. Gene Sherman, then an oncologist at a large South Bay medical group. A few years later she followed him when he left that group to start his own practice in Torrance.

“You develop an emotional dependency on your doctor,” said Clayton, 64, who is now in remission. “It’s a much stronger bond than, say, if you just have a backache.”

Clayton and hundreds of other patients, however, are in the process of being transferred to other physicians. Sherman is shutting his practice this weekend, finding it impossible to survive financially as medical costs soar, reimbursements for care plummet and insurance companies become more difficult to deal with.

At the same time, he refused to go back to the type of medical group where as many as 40 patients a day are shuffled through and individualized care is impossible, he says.

“That’s not the kind of medicine I want to practice,” Sherman said late last week, his office cluttered with boxes headed for storage.

He is not alone. Doctors who practice independently – where they can choose to see fewer patients, give out their home phone numbers and spend more time with patients – are a dying breed.

“The medical field has become a business, and these doctors didn’t take business

Brigitte Clayton’s attitude toward doctors changed dramatically when her life was at stake. Diagnosed with stage 3 colorectal cancer, she wanted more than five minutes of their time.

The Rancho Palos Verdes resident found Dr. Gene Sherman, then an oncologist at a large South Bay medical group. A few years later she followed him when he left that group to start his own practice in Torrance.

“You develop an emotional dependency on your doctor,” said Clayton, 64, who is now in remission. “It’s a much stronger bond than, say, if you just have a backache.”

Clayton and hundreds of other patients, however, are in the process of being transferred to other physicians. Sherman is shutting his practice this weekend, finding it impossible to survive financially as medical costs soar, reimbursements for care plummet and insurance companies become more difficult to deal with.

At the same time, he refused to go back to the type of medical group where as many as 40 patients a day are shuffled through and individualized care is impossible, he says.

“That’s not the kind of medicine I want to practice,” Sherman said late last week, his office cluttered with boxes headed for storage.

He is not alone. Doctors who practice independently – where they can choose to see fewer patients, give out their home phone numbers and spend more time with patients – are a dying breed.

“The medical field has become a business, and these doctors didn’t take business

Brigitte Clayton’s attitude toward doctors changed dramatically when her life was at stake. Diagnosed with stage 3 colorectal cancer, she wanted more than five minutes of their time.

The Rancho Palos Verdes resident found Dr. Gene Sherman, then an oncologist at a large South Bay medical group. A few years later she followed him when he left that group to start his own practice in Torrance.

“You develop an emotional dependency on your doctor,” said Clayton, 64, who is now in remission. “It’s a much stronger bond than, say, if you just have a backache.”

Clayton and hundreds of other patients, however, are in the process of being transferred to other physicians. Sherman is shutting his practice this weekend, finding it impossible to survive financially as medical costs soar, reimbursements for care plummet and insurance companies become more difficult to deal with.

At the same time, he refused to go back to the type of medical group where as many as 40 patients a day are shuffled through and individualized care is impossible, he says.

“That’s not the kind of medicine I want to practice,” Sherman said late last week, his office cluttered with boxes headed for storage.

He is not alone. Doctors who practice independently – where they can choose to see fewer patients, give out their home phone numbers and spend more time with patients – are a dying breed.

“The medical field has become a business, and these doctors didn’t take business in medical school,” said Marianna Lamb, executive director of the Medical Oncology Association of Southern California, a trade association for cancer specialists. “They were only taught how to cure.”

Oncologists and hematologists – physicians who specialize in blood illness – are being squeezed out of independent practice more rapidly in recent years due to skyrocketing costs of chemotherapy drugs, coupled with the increased time and resources it takes to get insurers to pay for the drugs.

Adding to the financial woes of these physicians, Medicare and Medi-Cal have cut reimbursement rates consistently over the past few years, even as medical costs rise.

Sherman said he spends about $2 million a year on cancer-fighting drugs such as Rituxan, which costs several thousand dollars for just one dose. After the medical billing company he contracts with takes its 6.5 percent cut, he said he often winds up taking a loss.

His small office on Lomita Boulevard employs just three workers: a nurse, a medical assistant and an office manager. With rent, staffing costs, insurance and shrinking revenue due to cuts and changes in the medical field, “I’m not making it financially,” Sherman said flatly.

“You purchase an expensive drug, you administer it, you treat a patient in standard fashion, and you don’t get paid for it,” he said.

Many doctors across the specialty spectrum are either taking early retirements – Sherman is 60 – or are joining larger medical groups that can afford more staff to fight for payments and often have the leverage to negotiate better reimbursement rates from insurance companies.

The trade-off, however, is that these kinds of groups usually require doctors to increase their patient load, said Dr. Howard Krauss, president of the Los Angeles County Medical Association.

“Doctors are filling up their schedules, seeing more patients and spending less time with them,” he said. “Doctors in this model are not able to provide the same level of care. – It’s a real tragedy, and unfortunately the overall level of care being give to patients is on the decline.”

He added: “As we spend more and more time being business people and dealing with administrative issues, it becomes a less satisfying profession.”

Many doctors are having to make difficult choices.

Dr. John Link, a Torrance oncologist, recently sold his practice to a company that makes diagnostic equipment with the goal of making it more cost effective to stay in business. He struggles with the same financial obstacles as Sherman – expensive drugs and low reimbursements.

“The margins have become so thin,” Link said. “If an insurance company puts a payment on hold for a few months, suddenly you’ve got a real problem with cash flow. – I know a lot of people are saying it’s just not worth it.”

Another oncologist, Dr. John Kurnick, decided to retire at 62 after it became too frustrating to fight with Medicare over payments. Doctors are almost made to feel like criminals, he said, having to justify every treatment and fight for payments that are denied for those suffering from a terminal illness.

“My conclusion was and is that many doctors who can afford to retire early will, and those that can’t will continue to work unhappily,” said Kurnick, now 66 and working in property management.

Kurnick still lives on the Palos Verdes Peninsula, and teaches voluntarily at the University of California, Irvine, medical school. But, after 30 years in medicine, he says adamantly: “I don’t miss the hassles at all.”

Lamb and others say, in the end, patients will suffer.

“I don’t think I would have gotten that kind of humane care anywhere else,” said Eileen Roberts of El Segundo, who went to Sherman after she was diagnosed with stage 3 breast cancer. “He was always there and always listened.”

Marlene Gardiner of Hermosa Beach first met the physician when her father, now 88, was diagnosed with lymphoma 15 years ago. She was immediately impressed that Sherman would book appointments for 30 minutes, an eternity in the doctor’s office.

Later, when she went through some medical problems of her own, “He stood by my side,” she said. “He’d look at other doctors’ opinions and fight for me, something he didn’t have to do.”

Sherman, frustrated and angry, said he didn’t want to retire so young. He said he may consider joining a medical group, but not if it requires sacrificing patient care.

“I want to be able to sit down and talk to my patients and look them in the face,” he said. “These are people who are dealing with cancer. – They’re scared and they want to talk. That’s how I was trained to practice medicine, and I won’t give that up.”

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