Doctors Blurred In Health Care Debate

Doctor in ER - Doctors work in the emergency room at Coney Island Hospital in Brooklyn, N.Y., in 2002 (Mario Tama / Getty Images)

I am a 54-year old-physician who has been a general practitioner, emergency physician and, for the past 21 years, a urologist. I can't speak for how all physicians feel about the ongoing national health care debate, but I feel I am being unfairly demonized. Politicians are talking as if the M.D. at the end of my name meant "Million Dollars." The message I'm hearing from politicians is, "blame the bad, greedy doctors."

I have listened to Rep. Jim Cooper of Tennessee on NPR's Morning Edition say that one of the key factors driving up health care costs is physicians doing more procedures. He also said, "I liken fee-for-service medicine to the situation, if we paid lawyers by the word, or by the paragraph, we would have the longest legal documents in the world."

President Obama included a similarly scathing indictment of physicians in his speech to the American Medical Association on June 15. Obama told the AMA, "We are spending over $2 trillion a year on health care. ... for all of this spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren't any healthier." He said that physicians are using more treatments that patients don't need because the more tests and services provided, the more money patients pay. Obama charged that this incentive system pushes the doctor to order that extra MRI or EKG and is driving up the national cost of health care. Then he addressed malpractice reform briefly, stating, "I'm not advocating caps on malpractice awards, which I personally believe can be unfair to people who've been wrongfully harmed."

During his address to Congress last Wednesday night, the president laid out his plan for reforming what he sees as an extremely troubled system. But he virtually ignored the system's key actors: doctors. Obama spent an hour talking about insurance, but he said "doctor" or "doctors" only seven times; his only references to patient care were examples of how care was stopped because of lack of insurance.

My profession is at once being lambasted and taken for granted, and I'd like to respond.

Rep. Cooper, as a Harvard-trained attorney, must know that we pay attorneys by the minute or 15-minute increments whether they are researching your case, thinking about your case, on the phone about your case, or have a legal assistant working for you. Physicians only get paid for face-to-face time with the patient — nothing for consulting with other doctors, reviewing records, X-rays, or researching treatments. The contracts I have signed, particularly with insurance companies, have to be some of the longest documents in the world.

We have some of the best medical care in the world but are not the healthiest because we have an obesity epidemic, don't exercise, smoke, don't follow doctors' recommendations, and don't take medicines as prescribed.

As for those procedures that make doctors so much money, I am now reimbursed 35 percent of what I was when I started practice for a common urological procedure. Doctors are all facing a 21 percent decrease in Medicare reimbursement starting Jan. 1, 2010. Most physicians don't get any increased income from that extra MRI, lab test or EKG, as referral to a facility in which you have ownership is illegal, with just a few exceptions that have been determined to improve patient care.

We rely on doctors for our health, and that means for our lives. This is what it is really like to be a doctor: I spent four years after college in medical school to graduate to a 100-hour-a-week job paying me $11,500 a year. I spent five more years to become a urologist, only to see a steady decrease in physician reimbursement in the face of doubling insurance premiums and out-of-pocket patient expenses. Yet during a recession, United Health Group, Aetna and Cigna had second-quarter profits of $859 million, $347 million and $313 million, respectively.

I see patients every day no matter their insurance status. I have never stopped treating anyone or turned anyone away because he couldn't pay. I have taken apples, tomatoes, honey, birdhouses, taken payments as low as $5 a month and written off thousands of dollars in unpaid bills, as I believe most doctors have. If the people reforming health care don't understand what doctors go through, then I fear their reforms — in whatever form they come — will be ineffective.

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