Red tape, low pay drive out docs

Dr. Alexander Strasser
Guest essayist
http://www.democratandchronicle.com

One seldom hears physicians express satisfaction in the way medicine is practiced. Why? What has changed over the past 10 to 15 years?

Doctors used to be self-employed. They worked for their patients and if they did a good job, they prospered. Now most physicians are employed. Yes, they have relatively more stable hours, but working for a system has its problems. Instead of a foreman in an industrial facility, physicians have medical directors determined to have work done in a cost-effective manner.

Insurance companies have set up standards of medical care by establishing algorithms to follow. Yet, care pathways do not measure what goes on in the physician’s office. Diagnosis remains the art of listening to the patient, which takes time. However, doctors now are told how long they can spend with patients, what tests to order, how to manage the patient and when to hospitalize and discharge.

In the past, physicians cared for the whole patient. First seen in the office setting, the patient would be followed by the attending physician when hospitalized. Now this is rarely the case. Hospital medicine has become so time-consuming and poorly reimbursed that it is more cost-effective for physicians to turn patients over to the hospitalists.

Hospitalists are employed physicians who care for most of the in-hospital patients previously seen by the generalists.

The public’s perception and appreciation of medicine has declined. In the past, newly licensed physicians were anxious and proud to have an M.D. license plate. No more. Large segments of the public feel that physicians are overpaid, and this concept is reinforced by the media that publicize the income figures of a few highly paid medical specialties.

Doctors work under the microscopic scrutiny of insurance companies. Armed with powerful computer programs, insurance companies monitor physician practices and find ways to downgrade and pay less for physician services. When errors are made, physician offices must undertake time-consuming, and often fruitless, efforts to correct the mistake.

The costs of running a private office have escalated. In addition to computers, physicians face the endless production of the fax machine. This is complicated by the demands of insurance companies to justify what physicians routinely do in the office.

Physicians have had to hire additional personnel to process patient referrals to specialists, requests for medical tests and prescriptions. This raises the cost of running a medical practice. Furthermore, most physicians have been forced to practice defensive medicine, resulting in more cost and paperwork.

The public has been promised perfection in medical care. The wonders of medical science are hailed and the pitfalls that exist in clinical practice are ignored. Illness and hospitalizations that result in poor outcomes are often exploited by malpractice attorneys who stand ready and eager to sue.

In our area, the average physician is reimbursed considerably less than in other parts of the country while insurance company oversight is stricter.

These are all the reasons physicians who have no family or local ties choose not to settle or remain in the Rochester area.

Strasser is an internist in private practice in Penfield.
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