VOICES / A FORUM FOR COMMUNITY ISSUES : Gripe : California Doctors Now Prisoners

6An insurance company is neither a provider of care nor a judge of what kind of care may be offered. An individual physician is ultimately responsible for the care provided and the liability associated with providing it. Physicians are trained for many years to offer our patients diagnosis and treatment options. This service and expertise has great value.

The report that the average income of physicians is $190,000 is mythic in light of hours worked and investment of time and capital into a practice. Personally, my total revenue has decreased by more than 50% in the past five years, and my costs have increased. If I look at my compensation, I make $32.17 gross revenue per hour. My plumber makes more money, and he expects cash when he visits, double time when it’s after hours. The CEO of your insurance company, who collects your monthly premiums, makes millions per year and never gets called at 3 a.m. about your pain.

The public expects a physician to be available every day, all night, on holidays and weekends. We don’t have a problem with our responsibility to our patients, but we do not have the ability to continue to accept liability for care that goes reimbursed.

Physicians, with an inherent responsibility for outcome, and after months of going unpaid or being underpaid, may possibly decide not to be used to bolster an insurance company’s financial standing. If they are to be compensated at all, it’s normally after extensive delays and numerous requests for payment.

The bottom line: Insurance companies fail to provide reasonable payment for physician services. They have exploited the Hippocrene Oath we physicians take by assuming we will continue to give care in spite of decreasing remuneration. In effect, we have lined the pockets of the middleman with gold. The middleman has become more and more greedy, the patients more and more demanding, and the physician more and more weary.

You, our patients, have continued to accept this deprecating quality of care handed to you by insurance carriers (and Medicare). You accept nurse practitioners over physicians. You accept five-minute office visits for problems that really require extensive exploration. And, you accept health care coverage from your employer that pays providers so meagerly that physicians would rather not extend themselves to provide care.

You must take some control of the type of insurance you purchase so you can protect yourself. You and your employer have thrown dollars blindly into a huge money pit. Before you purchase, you must investigate the company and how they meet their obligations. That is your responsibility.

For instance, there are some insurance companies that actually charge the physician for the medications you purchase. Read that again. The doctor buys your medicine. More egregiously, some insurance companies take money from the physician who prescribes expensive medicine regardless of necessity. That’s right, there is a disincentive to offer the best care. Is that what you understood when you purchased your health care insurance? Did they explain that part of the “contract”?

Health care has value. If we physicians choose to give our time and expertise to those who cannot afford to pay reasonable fees or afford to pay at all, that is our pleasure. The pleasure and delight of giving remains a core part of our day. But, when the opportunity to give is obscured by exploitation by a third party, the joy rapidly turns to resentment.

Physicians also must share a large measure of the blame. But our fault is that we have continued to give and give and give. We have created this expectation because we have continued to have faith in the system. We have shouldered health care costs for years for the privilege of caring. But, our shoulders have collapsed, and with that breach, the entire health care system is eroding.

Wake up patients. Get educated. The insurance that you purchased is accountable to you and represents your needs. Make sure that you are directly in charge of choosing that company. Ask your physician which insurance companies are most responsive to patients. Become active in your health care before a crisis. Don’t expect that all physicians will continue to bear your insurance company’s responsibility.