A 2nd Opinion on Salaried Medical Practice

James Flanigan’s column (“Clinton’s Key Play at the Plate Is Bid to Control Health Costs,” April 14) stating that one goal of President Clinton’s health plan is to make doctors salaried employees, warrants a physician response.

I was paid a salary in my residency, in the Army and in the HMO I worked for during my first years of practice. I spent more time looking forward to and planning my vacations and my days off than I did trying to improve medical care. There were organizations that did that. All I had to do was follow orders. When times were slow, I laid back and planted begonias. When things got hectic, I had to rush people through because I did not have the flexibility to work after hours. I noticed a tendency by certain doctors to triage patients rather than take care of them. A patient would show up with an ache or pain, a lump or bump, and without any regard to taking history or performing an examination, a referral would be made to the orthopedic clinic. Many other problems existed as well.

When I think of what seems to be happening to me in private practice today, I look toward managed care as a possible solution. But even a managed care system has its own craziness. A salaried system does not work for me. The concept of private practice, where the patients come to see me because of my skill, my personality, my generosity, is far better than a guaranteed income.

Flanigan describes in his column the extent of medical inflation in deflationary times. He indicates that medical costs have driven up industrial costs.

Medical inflation appears to have decoupled from general inflation. High technology such as MRIs have become standard and effective. Reimbursement controls contributed to over-utilization. AIDS became a financial drain. Doctor oversupply contributed to over-utilization. The aging population and increasing immigration contributed to the increase in health care costs.

Freezing prices on doctors, making insurance changes that would turn doctors into salaried employees, will not make a difference in health care costs. It is not the same as manufacturing a car. Where will the money come from to pay for 35 million uninsured? The financial markets that are betting on Clinton do not realize the complexity of the issue.

Is medical care a right? Who pays for this right? Society, providers, or individuals? Who monitors the system, including the self-abuse and lifestyle behavior? These are not simple problems, and simple solutions will surely fail.

The preservation of a healthy system requires a private practice, fee-for-service option. This is essential to high-quality medical care. So let market forces determine the future of health care delivery in this country and, given the right incentives, doctors will continue to volunteer in the struggle to control medical costs.

ROBERT M. SHERIDAN, MD

Tustin

The writer is an orthopedic surgeon and a member of the board of the Orange County Medical Assn.