Each doctor was looking at roughly a quarter of a million dollars worth of debt as they completed their residencies last year at California Hospital Medical Center.
“What are you going to do?” Dr. Susan Morris, a white woman from Northern California, asked Dr. Timothy Lee, a black man from Kansas.
Despite more lucrative offers, Lee said he was thinking of doing something risky, if not nuts. He was going to open a small family practice in a neighborhood virtually abandoned by the medical community.
Need a partner? asked Morris, who is nice enough, if not always of sound mind.
Nearly a year later, the two-doctor Baldwin Pacific Medical Group is operating on the sixth floor of a Crenshaw district building that has seen better days.
So, how’s it going?
“Look at this,” Morris says, showing me an insurance statement on a $1,300 bill submitted by the doctors. The elderly patient had been treated for diabetes, hypertension, degenerative joint disease, depression and several other things you wouldn’t wish on your worst enemy.
The reimbursement to the doctors?
Twelve dollars ($12).
Yes, it’s insane. But there’s a long list of crazy things in the American health care system. Somewhere near the top is the fact that it’s hardest to do business in neighborhoods with the greatest medical need.
Every month, this particular patient’s HMO Medi-Cal plan pays the doctors $12, period. If they don’t see the patient at all, they still get the $12. But if they see the patient twice, four times, eight times, even if it costs $1,300 to make that patient feel good again, $12 is all the doctors get.
“The problem is that almost everyone we see is really sick,” says Lee, which is no surprise, given the shutdown of L.A. County health clinics. Then you’ve got a doctor-patient ratio south of the Santa Monica Freeway rivaling those in some Third World countries.
About one-third of their patients have coverage like that $12 plan, says Lee. About half have straight
Medi-Cal, which is better, at around $30 a month. Roughly 5% have no insurance at all and dig into their pockets for loose change.
In other words, nearly 90% of their patients are costing them money. The remainder have Medicare or a good HMO, but that’s not enough patients to offset the losses.
“It’s tragic, but it’s not surprising,” says Linda Rosenstock, dean of the UCLA School of Public Health. “What these young physicians are facing is the pinnacle of all that’s wrong and failing with the system.
“We are the richest country that’s ever lived, and we’re the only developed country that does not provide universal access to health care, even though we pay more per capita for it than any other country.”
The trouble is: Morris and Lee are the end of a long line of outstretched palms, starting with insurance companies, lawyers and health-care conglomerates. If you think the system is about keeping you healthy, you might want to consider a brain scan.
Just open the paper, and what do you see? A patient dropping dead after being refused a referral. Hack doctors doing unnecessary surgery. Health care giants scamming the government like common thieves.
Morris, who’s 40 and lives in Eagle Rock, and Lee, 33, of Windsor Hills, face the handicap of trying to run an honest business in an industry where no good deed goes unpunished.
Are they frustrated? Of course they are. And tired too. In addition to four days a week in the office, each doctor is working a second job to earn some real money.
Are they giving up the fight? No. They’re improvising, doing things that aren’t taught in medical school.
Neither one ever expected to leave fliers on doorsteps or star in a traveling medicine show. They’ve been to a Sizzler, an IHOP, senior centers and churches in South Los Angeles to preach a healthy lifestyle and teach about diabetes and other chronic diseases. They leave stacks of business cards wherever they go.
“You’re at the IHOP, and they’re eating the pancakes with all the butter and the syrup and a side of bacon,” says Morris, “and you just make sure never to take their blood pressure after that.”
But even with all the hustle, how is this going to pencil out?
The trick with those $12 reimbursements, Lee says, is to build a big enough pool of patients so you at least break even. If you’ve got 500 of them, for example, and 400 don’t visit the office in a given month, you’re still collecting their $12. Meanwhile, you try to bag a few more patients with decent insurance.
They’re closing in on 400 patients total, and Lee thinks they can turn a profit if they hit 1,000. In the corporate lingo, they’ve learned you need high volume and low acuity, meaning lots of patients who aren’t on death’s door.
But if a patient can’t make it to the office, that’s not a problem. They make house calls. Morris met a man at a health fair who was so sick, she later called to check up on him.
“He said he couldn’t get a ride to the office, so I told him, ‘We’ll come to you,’ and that’s how it got started.”
I accompanied Morris on a home visit to 104-year-old Etta Jones in Lafayette Square. Jones, who often exclaims to Morris, “Lord Jesus, I need some doctoring,” was doing better this day. Morris put a stethoscope to her chest and said:
“Sounds like a Cadillac with 20,000 miles on it.”
Next we called on a blind man in the Baldwin Hills district known as the Jungle, and young kids in bright red jackets eyeballed us as if we were undercover cops. This is one of the reasons Morris’ mother sometimes asks when she’s moving back home to Palo Alto.
It ain’t going to happen, Ma.
“I have moments when I feel frustrated,” Morris says, “But when I see these people handle crisis with such poise and grace, and with great resiliency under stress, I trust that we’re in the right spot and that we’re doing the right thing.”
Lee had known he wanted to be a doctor in a black community since he was a boy in Kansas. He says he and his family had to wait until their doctor saw all the white patients before he’d treat them, which usually meant “tossing some pills at us.”
“Although there are a lot of obstacles, it’s been worth it,” says Lee.
“The idea was to treat people who don’t always have access to quality care. We aren’t going to get rich at it, but we’re here and we’re not leaving.”
Steve Lopez writes Sunday, Wednesday and Friday. Reach him at steve.lopez@latimes .com.