I’ll bet very few readers remember television shows like “Dr. Kildare” and “Marcus Welby.” Those popular shows featured physicians who made house calls and performed miracles of all kinds. There may be a few of these doctors left, but it’s only a matter of time until such dedicated physicians are no longer in existence. Like it or not, the business of medicine is changing rapidly, and not for the benefit of the average patient.
I recently experienced this sea change in medicine, when two of my doctors announced their retirement. One was my internal medicine doctor, who served me faithfully for 32 years, and the other was a neurologist who had monitored me for about five years. It was obvious from our parting conversations that they were exhausted and tired of the day-to-day stresses of serving patients.
If you visit almost any doctor’s office, you’ll notice that there are walls and walls of files on display. They may signify how many patients your doctor serves, but they are also evidence of the amount of paperwork the average doctor must do to get paid by an insurance company. Once upon a time, insurance companies gave doctors an appropriate amount of money for the services they performed, but not anymore.
If you’re a doctor in New York City, you may get $1,000 for a medical procedure. But if you practice in, say, Smithtown, you may get paid $180, if you’re lucky. Geography makes a difference in reimbursement, and no rational observer of medicine will defend such an abominable system. These days, doctors need experienced staff members who have to deal with endless piles of documents, many of which are for small reimbursements.
The daily practice of medicine isn’t a 9-to-5 operation. Many doctors take their charts home, to review medical histories and also to protect themselves from malpractice litigation. The business of suing doctors is a major enterprise, and the volume of litigation forces doctors to pay outrageous fees for malpractice coverage. I’ve heard quite a few stories about doctors who quit the practice because they simply couldn’t afford the high premiums.
Jerry Kremer was an assemblyman for 23 years, and chaired the Assembly’s Ways and Means Committee for 12 years. He now heads Empire Government Strategies, a business development and legislative strategy firm. Comments about this column? firstname.lastname@example.org.