Doctors Feel Like Scapegoats in a Web of Contradictions

It is Jan. 10 and San Diego stores are bustling with post-holiday crowds as the clouds of a winter storm gather on the horizon. Surprised shoppers rush to their cars to try to beat the rain home.

Hours later, high winds have toppled trees and cut off electricity to hundreds, maybe thousands of San Diegans.

Electric company crews leave their families at home and work through the night to restore power. They are performing an essential emergency service, they get paid for it, and a grateful community wouldn’t even consider asking them to work for nothing.

Why is it, then, that when a physician responds to an emergency and later complains about not being paid the reaction is not sympathy, but hostility?

It is at least partly because doctors are convenient scapegoats for society’s failure to deal with health-policy issues, believes Dr. Alan Levenson, a University of Arizona psychiatry professor who has studied the doctor-patient relationship.

“I think it goes back to a fundamental question that we’ve never properly addressed and that we keep trying to address politically and socially: Is health care a right?” Levenson said.

“We believe that health care is a right, and yet we have a structure . . . that puts health care very much into the marketplace,” he said. “So I think there’s confusion in people’s minds. There’s a discomfort between saying we have to have this, and on the other hand recognizing that we have to pay for it.”

Dr. Brian Johnston, president of the Los Angeles Society of Emergency Physicians, puts it this way: “We have not decided in this country whether health care is a public utility or a private enterprise.”

Doctors also are the target for each person’s resistance to the idea of being sick, Levenson said.

“The focus of medical care and of individual involvement with a physician is around the issue of illness, and people would just as soon not have to deal with those kinds of issues,” he said. “It puts them at a sense of disadvantage, a sense of powerlessness, a sense of loss of control.”

Add to that, too, the public image of doctors as rich and greedy.

“I long ago realized that I’m not going to convince anybody that all doctors aren’t rich and that all of them aren’t making huge amounts of money,” said Dr. Jerome S. Litvinoff, chief of surgery at Scripps Memorial Hospital-Chula Vista.

“We have a Toyota parking lot. We don’t have a Mercedes parking lot,” Dr. William O’Riordan, chief of staff at Paradise Valley Hospital, protested to state officials recently as he tried to convince them that doctors there don’t have dollar signs in their eyes.

Still, the average physician in California has an income, after office expenses and before taxes, of $119,000 a year--or five times the average annual income of workers in private industry in the state.

But the effect of the one in four patients who is uninsured is felt primarily by specific hospitals and the doctors who choose to practice there, Johnston said. The system in effect penalizes doctors for making that choice, he said.

“There are many cases that I can take the entire night taking care of. I’m absolutely certain, if a plumber came out for the same number of hours at the same time of night, he would make much more,” said Litvinoff, a neurosurgeon. “There are many times when I’ll come in . . . at 2 in the morning and the (Medi-Cal) payment is maybe $50 for the night’s work. Maybe.”

It is such examples of dedication that patients give when they are asked about how they feel about their doctors, Levenson said. Indeed, they express much more positive attitudes about physicians individually than about them as a group, he said.

“The issue of how much doctors earn is one of the issues that is very susceptible to different viewpoints, depending on whether one is talking about doctors collectively or individually,” Levenson said.

“Many people have had the experience of talking with others outside the medical profession about some of the problems facing physicians and not getting very much support,” he said. “And having those same people say, ‘But, of course, my doctor is wonderful.’ ”