Posted 1/15/2009

DOCTORS: AN ENDANGERED SPECIES

It is January, 2012 and your child is ill. Coughing, runny nose, and difficulty breathing, topped off with a 104-degree fever.

Panicky, you call your doctor.

But there no answer. Only a voicemail message informing you that Dr. Brown has left medicine.

No referrals were given.

Because there were no other general practitioners in town.

Is this just a nightmare?

It's a nightmare, all right. A terrible, frightening nightmare. But it is more than that. It is real.

A major study by the Physicians Foundation disclosed that half the country's primary care physicians want to stop practicing or make a substantial reduction in patient loads.

And they want to do it within the next three years.

What has made your doctor so discouraged about his once-desirable profession?

It seems there are three culprits:

1. Too much non-clinical paperwork. ("I am turning into a clerk!")

2. It's hard to get paid by the insurance companies. ("They pay late so they can make money off the float.")

3. Government regulations. ("Bureaucrats are running amuck, trying to take over medicine.")

Please note that the trial lawyer is not the primary enemy. Family doctors don't make enough money for the lawyers to get rich on. Shylock tends to concentrate on medical specialists instead.

Now a fourth culprit is emerging, one missed by the timing of the survey: The recession is killing off doctors' incomes.

The recession is so deep and so devastating that it has reached the level of a depression among the middle class. And these patients are canceling appointments with their doctors.

A doctor's wife told me that her husband had eight cancellations one day last week. When he checked on the unusual number, patients explained, "I can't afford the co-pays."

It isn't just primary care physicians who are opting out.

A pulmonologist in town accepted a much better hospital arrangement in a neighboring city. But he hasn't been able to leave because there seems to be no pulmonologist willing and able to take over his patient load.

This recession/depression is likely to last several years, adding one more reason for your doctor to abandon his practice.

If the troika of Obama, Reid and Pelosi reform the health system to cover everybody, they had better concentrate on who will be available to provide the patient care.

Perhaps the plan better be revised to be doctor-centric rather than insurance-centric or government-centric.

Otherwise, the lady with the sick child may have to call India.

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