Unhappy doctors, unhappy patients
Susanne L. King, M.D.
Berkshire Eagle
10/24/2007
Have you been having trouble finding a primary care physician, or been put on a waiting list for months to see a specialist? For the 13th year in a row, Massachusetts physicians have seen a deterioration in their practice environment, according to the Massachusetts Medical Society (MMS).
For this reason, doctors are leaving Massachusetts, and the state is having trouble recruiting new physicians. The result is physician shortages in both primary and specialty care. This reduces patients’ access to care.
The factors contributing to this decline, according to the MMS, are low reimbursement rates from insurance companies, increasing costs of operating a practice, and growing administrative burdens because of insurance company demands for preauthorization for services, the complexities of billing multiple insurance companies, and the tremendous difficulties in collecting insurance reimbursements. The rising operating costs for doctors include higher costs for maintaining an office, as well as increases in malpractice liability insurance premiums. Last year the priceof professional liability insurance rose 5 percent in Massachusetts, while holding steady nationally. Doctors are frustrated, unhappy, and moving out of the state. The health care reform legislation that was recently passed in Massachusetts does not address this issue.
Physicians in Massachusetts are not alone in their dissatisfaction with the current health care system. More and more doctors across the country are joining Physicians for a National Health Program (PNHP), which advocates for single-payer health care, funded and administered by the government. PNHP membership has increased to more than 14,000 members, and is growing rapidly. Single-payer health care is not socialized medicine; physician practices and hospitals would still be private, and patients would have their choice of providers. Single-payer health care is about the administration of our health care funds, not the delivery of health care.
How would single-payer health care be beneficial for doctors? First, it would decrease the physician’s administrative burden and paperwork — one plan, one insurance form, fewer office workers. Doctors would actually get paid: no more calling insurance companies because of claim denials for unforeseen and often inexplicable reasons. Second, it would restore autonomy to doctors. I’ve been in practice long enough to remember how that felt, before the advent of managed care. Single-payer health care would allow decision-making to occur between the doctor and patient.
Pre-authorization for services has been the bane of a psychiatric practice. To be required to speak with an insurance company gatekeeper (who has neither the level of training nor the experience of a doctor), about the needs of a patient whom the reviewer has not seen or evaluated, in order to receive authorization for services, is an intrusion into the doctor-patient relationship. This intrusion raises concerns about the confidentiality of the medical information, and devalues the doctor’s judgment concerning treatment recommendations. Doctors should be making decisions with their patients about needed health care, not reviewers for profit-driven insurance companies who do not have a patient’s health care as a primary focus. Most important, single-payer health care would allow equal access to health care for every patient; this is the ethical reason for doctors to support health care reform.
Massachusetts ranks a dismal 40th in the country in reported cases of the seven most common chronic illnesses. This means we have a higher percentage of our population who have cancer, diabetes, heart disease, high blood pressure, stroke, pulmonary conditions, and mental disorders than 39 other states have. Who is going to care for all these patients if doctors keep leaving the state? The cost of these diseases in Massachusetts is $34 billion annually for treatment and lost productivity.
Doctors and patients working together, with regular visits that focus on prevention and treatment, enhance a patient’s level of functioning and prolong life for those with chronic illnesses. Insurance companies don’t like to pay for the kind of care in which doctors and patients meet frequently in this proactive model. The president of the Joslin Diabetes Center in Boston said that roughly 40 cents of every dollar spent on patient care for their diabetic patients is not reimbursed by insurance.
As a psychiatrist working with children and adolescents, many of whom have developmental disorders or serious mental illnesses, I know the need for that kind of ongoing care and treatment, and I also know how insurance companies resist paying for it. Having trained and practiced in an era before managed care, I have experienced the changes in the practice environment in Massachusetts, and witnessed the additional stresses put on hard-working doctors.
Now is the time for doctors to rise up in protest and become involved in health care reform, along with patients who are suffering from their lack of access to care, whether due to not having health insurance or not having a physician. Doctors must be involved in health care reform; their practice environment has been shaped by other forces for too long.
Susanne L. King, M.D. is a Lenox practitioner.