A Doctor Speaks Out
He's mad as hell and won't take it any more.

I guarantee that some busy primary care physician's office will get one of these form letters and blindly sign it without taking the time to check the patient's renal function numbers ... but of course only the physician can be sued for a mistake like this, not the insurance company.

How about the patient I'm trying to treat with Symlin, a new diabetic drug specifically for Type II diabetics already on maximal treatment (including insulin) who are not reaching the goal of controlling their hemoglobin A1C levels? The formulary morons rejected my request for authorization based on the fact that my patient's sugar numbers were -- get this - too high! I've tried for three weeks to get the insurance company physician who denied the authorization on the phone, but he's never in the office; and every time I'm told he'll call me back within 24 hours, he never does. I've reported this to the Commissioner of the New York State Insurance Department, but the case could take months. Meanwhile, this poor patient is suffering a slow death from her uncontrolled disease. Yet all I see in the press is how it's the greedy doctors -- broad brushed as an undifferentiated class -- who are driving up costs of health care. Take a look at the disgusting piece printed by The New York Times earlier this month, headlined Survey Finds High Fees Common in Medical Care, about doctors charging exorbitant rates for out-of-network care. Guess who provided the survey data? American Health Insurance Plans, a lobbying group for the insurance companies! ("The health insurers, saying they felt unfairly vilified, gave the report to The New York Times ... explaining that they wanted to show that doctors' fees are part of the health care problem.") I bet they and the Times reporter had to dig down pretty deep to find what amounts to 0.0000001% of the problem with the current system.

I can tell you for a fact that in the past 20 years, my reimbursement rates have dropped to about 30% of what they were in 1988, while my costs have at least tripled. My income has steadily declined every year over the past 10 years. It's now down to about half of what it was during my peak earning days. Meanwhile, the CEOs of the health insurance companies are making $10 million and more a year, with lord knows how much in deferred compensation and stock options. The CEO of United Healthcare walked away two years ago with $1.5 billion in compensation over his last five years running the company. Imagine how much care you could provide with a fraction of that money?

And so I am currently working on my exit strategy, as are many of my friends in primary care medicine. And if you think there are younger people eager to fill my spot ... think again! With an average of $300,000 in student loans, eight years of college and medical school, and four years of indentured servitude at minimum wage as a resident physician in a hospital, these poor fools will be starting out on their own at age 30 and often older in a job that might earn them $100,000 a year ... and that's if they're lucky.

Yes the system is badly broken, but not by my primary care colleagues. It's broken by the greed of the insurance and pharmaceutical giants who have sucked every dollar out of the system, and by the politicians who are in bed with their lobbyists, take their money, and do their bidding. So enjoy your new health care system. Nurse practitioners and foreign medical school graduates will be your new primary care providers managing 95% of your needs. I hope you don't come down with something serious that would actually require someone with knowledge and experience, to say nothing of the training ... as my friends and I will all be long gone.

You can sign me:
20 Years of Primary Care Practice and Totally Fed Up ...

Done.

(Crossposted at HuffPo)