Physicians

PHYSICIANS: Dr. Mom sounds off

Angela Heider is no longer practicing as an OBGYN, and has written a book about why not, called The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future. What went wrong? Well she starts to explain in this piece:

Wanted.  Part-time.  Private practice seeks obstetrician and gynecologist.  Forty hours a week, some nights and weekends.  Pretax income $70k/yr and falling.  Life-altering medical malpractice claims average only 1/3 years.  Electronic medical record – partially functioning.  Administrative skills required.  Medicare, Medicaid, self-pay, and dozens of insurance plans accepted – billing, coding and prescribing proficiency needed for above plans.  Keep up with this ever-changing medical field and all technical skills on your time.  $80k exit fee due at termination of employment.  Expect childcare expense approaching $35k/yr.     Fortunately, I vacated the above position before the required $80k in malpractice tail coverage took effect.  Unfortunately for all of us, many female obstetricians are forced to make the same choices.  In my practice alone, five of nine female partners elected to retire within the past two years.  I left the practice after only three years when my inability to balance work and family life became obvious.  I was clearing less than $20k a year – and money wasn’t even the biggest problem.  Clearly, my case is only one example; my concern is that it is not the only example, but a nationwide trend for women in private obstetrical practices.

Much has been said about physicians and the part their greed plays in the current health care crisis.  Admittedly, many examples can be found of physicians who have milked the system, over-billed, over-treated, and committed outright insurance fraud in order to make more money.  On the other hand, some physicians have been praised for their utter selflessness, physicians who devote all of their time and resources to charitable care.

Most, myself included, do not fit the description of either extreme.  Like many Americans, we want to excel professionally, enjoy our work, have others appreciate the contributions we make, and raise our families comfortably.  As a physician, I would have been happy with my salary minus the bureaucratic nightmare the practice of medicine has become, the constant threat of catastrophic legal action, the ingratitude, and the long hours away from my young children.  Some physicians long for the honor that once accompanied the profession.  Others miss the joy associated with personal doctor-patient relationships.  Still others enjoy their work, but also want to enjoy their families.  Money is not always the bottom line.

My current job – wife, mother of three small children, new author of the book, The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future, and advocate for health care reform – doesn’t generate any income, but the benefits are better.  I hope to be a part of needed change in our health care system simply by telling my story.  The compensation is not important; the fact that I can enjoy and am proud of what I am doing is.  We can raise awareness by examining the effects the system has on individual doctors, patients, and communities.

We all depend on our physicians to provide quality medical care, to take our lives into their hands.  If for no other reason, should we strive towards health care reform so we can restore their job satisfaction?  Do we not want them to be happy when they are guarding our lives?  Do we not want the best and the brightest to continue to sign up for careers in medicine?  And how much should they earn anyway?

In my opinion, reform will be required in order to retain a qualified, diverse pool of primary care obstetricians and gynecologists for women across the country.  Such reform must include medical malpractice reform, as current rates make the cost of less than fulltime practice prohibitive.  Changes in the training of obstetricians and gynecologists could be made to allow for women to focus on either obstetrics or gynecology, thus improving their odds of being able to keep abreast of changes in practice patterns.  Finally, the enactment of a national health care plan with health care coverage for all would reduce the administrative costs and barriers to practice and improve physician job satisfaction.      

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Angela HeiderPeterjohnJack E. Lohmanmadhu singh Recent comment authors
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Angela Heider
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Angela Heider

I agree. The problem with the med mal system is not so much the direct cost of jury payouts alone. It has a far greater impact on physician attitude. First of all, when a case is tried, the physician is expected to drop whatever they are doing and sit in court for the entire trial (which could last weeks). They experience loss of income, along with loss of control over their lives. Almost half will describe symptoms consistent with major depression, which clearly has a negative impact on everyone around them. Furthermore, physicians practice defensive medicine on a daily basis… Read more »

Jack E. Lohman
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Those are the numbers I remember, Peter. It’s clear that our malpractice system needs cleaning up, but it is not the culprit driving high health care costs. Malpractice insurers are allowed to increase their rates to offset losses in other industries (9-11, Katrina, etc), and the medical profession could eliminate that cost-shifting if they’d just form a malpractice coop that cuts the insurers out.
What is really driving the costs up is well described in Maggie Mahar’s “Money-Driven Medicine” and in my own book, Politicians – Owned and Operated by Corporate America.
It’s not a pretty sight.

Peter
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Peter

Jack, I found this which has some interesting comparisons. Johns Hopkins Bloomberg School of Public Health study: The U.S. also logged 50 percent more malpractice claims per 1,000 people, at 0.18, than the United Kingdom and Australia, and 350 percent more than Canada. But the study’s authors found malpractice payments in America are lower on average than in Canada and the U.K. The U.S. average as $265,103 per settlement or judgment to Canada’s $309,417 and the U.K.’s $411,171. The U.S. average was higher than Australia’s $97,014. Those dollar amounts were adjusted to account for cost of living differences between the… Read more »

Jack E. Lohman
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The malpractice issue is interesting, especially since claims take a bigger percentage of the Canadian health care dollar than in the US, but their overall costs remain at 50% less than ours. Claims in the US have remained at about .5% of health care costs for the last 5 years, but they are increasing at the same double-digit rate as is HC. As well, physicians cite malpractice as the reason for overordering tests, and if they didn’t get a piece of the profits I suppose I would feel sorry for them. They must also start getting the bad doctors out… Read more »

Peter
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Peter

Canadian doctors are paid by rates for each procedure that are set through negotiations between the provincial governments and the physicians’ organizations. I’m not sure what the situation is now but in the past docs could strike, although they did not fair well in the public opinion arena. But at least they know up front exactly what they are going to be paid for each procedure. The patient also knows what their costs are – nothing, except for the taxes collected. Docs also only deal through one insurer and one set of rules in which they are guaranteed payment –… Read more »

Jack E. Lohman
Guest

It is a delimma, Angela. I like the idea of salary based on the quality of care, but you are right. How is that determined? What about the doctor that is (un)willing to take on the more difficult cases? Perhaps the issue of the patient needing care at the end of the day can be addressed with a fair rotation system, as can the difficult cases be equally distributed. Part of where we want to be years from now must include a good universal IT system. It should be centralized, and I like the VA model because it avoids the… Read more »

Angela Heider
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Angela Heider

Several comments have addressed physician compensation mechanisms and the government’s ability to control cost. As I began to outline a plan for national health care in writing my book, these were the questions I did not find great answers for. As to physician compensation, compensation based on production (number of patients seen and procedures performed) could encourage physicians to hurry through patients or order unnecessary tests. Both could be bad for patients. Pre-established annual salaries could encourage lassitude. Not that most doctors would be outright lazy, but the practice of medicine is often inconveniently packaged. For example, I worked on… Read more »

Jack E. Lohman
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I agree with Peter on using retired nurses to judge malpractice awards. They have long been critiquing patient care with the patient’s best interest in mind, though they may need the ability to consult specialists. Payment of the attorney can be approved by the panel after review of the hours invested (though this can be fudged significantly). Not unlike most of us, physicians have a tendency to prefer total control with zero accountability, and somewhere in the middle is where I think we should be. At this point my preference is a Medicare-for-all system, but there is still opportunity for… Read more »

Angela Heider
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Angela Heider

Peter said doctors long for a time when they had more power. I can admit to the truth in that. Doctors are often independent and opinionated. I must admit that I did not enjoy insurance companies telling me what drugs I could prescribe, administrators telling me how long my patients could stay in the hospital, or patients telling me what I would do if I wanted to avoid a law suit. I think with a national health plan with clearly established guidelines some of those issues would be less central to the practice of medicine. In some ways we would… Read more »

Peter
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Peter

Ms. Heider’s piece is heartfelt but I do disagree with her point, “Some physicians long for the honor that once accompanied the profession.”, I think they long for the time when they were not questioned and they held more power than honor. I also mostly agree with Jack Lohman. On malpractice, once the cost to the injured patient is covered by a universal health system, the amount necessary in malpractice awards would be greatly reduced. His wish to have the punitive award go the system sounds Ok, but where will the money come from to pay the lawyer? Prosecuting these… Read more »

john
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john

My take on this is a little briefer: I’ve never understood why Democrats oppose sensible reforms to the malpractice system. Sure, there are greedy docs. But there are greedy people under almost every rock you care look under. My personal view is that docs are demonized because a lot of people view them as the most convenient targets at which to vent their wrath. Administrators are tucked away in their offices. Drug companies are off in New Jersey. Insurance companies are bland and anonymous and by and large boring. Every time I hear a speech about how bad physician behavior… Read more »

Jack E. Lohman
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I’m sure Angela Heider’s experiences as a physician are not unique, but I must say that I think physicians have painted themselves into a corner. Many have been lulled into thinking that the free-market approach is going to be their savior; that if they’d just turn the business and administrative chores over to the MBAs they’d be much better off. Nothing could be further from the truth. The MBAs are smarter than physicians when it comes to business, and with them running the show they want all of the profit they can muster in this medical/business relationship going into their… Read more »

madhu singh
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madhu singh

I so agree with her- this current “bureaucratic nightmare” is helping nobody- except the health plans-unhappy patients and unhappy doctors make the practice of Medicine sad and denervating. This is one of the main reasons a mother like me is avoiding full time medical pratice.The idealist in me hopes that health care for all will come soon. The realist in me, however thinks I may be delusional- every political gesture in the US has been cosmetic and what is needed now is a change in paradigm-but I doubt anybody is brave enough.