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    Thursday, June 03, 2004

    Question for the Sages II: Another reader emails:

    Last January I had a client contract me to conduct a communications survey of medical malpractice of Ohio Doctors. The primary conclusion I can share with you is that doctors don’t have single mindedness on this issue. Theirs was a smattering if ideas as to what is the cause and what can be done to help improve the issue of skyrocketing prices. My question to you is this.

    1. Why at this late juncture, do doctors still not have a plan on how to combat the skyrocketing prices of medical malpractice insurance?

    Doctors are an opinionated, and often arrogant, bunch. Getting us to agree on a course of action, especially a political one, is almost impossible. For one thing, not all of us share the burden of the malpractice crisis equally. Doctors who are paying $8,000 a year for malpractice insurance in southern Ohio can't empathize, or sometimes even sympathize, with doctors in northeast Ohio who are paying $50,000 a year.

    I think the medical profession has been working hard on a plan, though. The Ohio State Medical Association has been at the forefront of lobbying for tort reform, and they've made a real effort to reach out to doctors and the public for support. It's getting doctors to tear themselves away from their practices (or what little free time they have) to provide the support that's difficult.

    2. Why are medical professionals afraid to prioritize the issues and combat the dismantling of how they practice medicine?

    We're too distracted by the day to day practice of medicine. And one doctor's dismantling is another doctor's improvement.

    3. Who should lead & speak for doctors in Ohio?

    That's a tough one. I guess the Ohio State Medical Association should, but not every doctor is a member. Professional organizations, like the American Medical Association and its sister organizations in each state, are widely perceived as being too narrowly focused on the needs of sub-interests within the organization. Primary care doctors think they cater to the needs of specialists over primary care, and vice versa. Which makes it difficult to unite all of us, contributing to the problems noted in questions one and two.

    4. It was clear from my interviews with doctors, that the independent practitioner is being squeezed out. Eventually we will see a few large corporations running the medical profession. Why are doctors allowing this? In the end the doctors will be charged back for expenses and told this is how much the corporation is willing to pay. Take it or leave it! Why are medical professionals allowing corporations to define how they will practice medicine is such an intimate way?

    I'm not sure it's true that the independent practitioner is being squeezed out. It was the trend about ten years ago, when HMO's were all the rage, and "economies of scale" the buzzword. Doctors were selling their practices to hospitals and management corporations to reap the benefits of bargaining power with insurance companies and supply companies, and to gain market share in a tight HMO field. But, then, just as the question states, they found they were "charged back for expenses and told this is how much the corporation is willing to pay," and that the corporation wasn't willing to pay much. The corporations, on the other hand, found that medical practices don't make a lot of money, at least not enough to support several tiers of management at anything above minimum wage. So the trend in the past few years has been for these corporations to kiss the doctors good bye.

    Actually, in the past two years, I've known more colleagues who have gone out on their own than I did in the years immediately after my residency. Part of that may be because we're older now, and more confident in our business abilities, but I think most of it is because the two major hospitals in our area who used to own a lot of practices have been dissociating themselves from outpatient medicine.

    5. Doctors have been too nice for too long and accepted the fall-out. Why hasn’t anyone suggested a “united public relations effort” to prioritize how their patients can assist them in the crisis? A simple leaflet on the table top of each doctors office title “10 things you can do to reduce your medical expenses” Patients want to help if only they know how to help. Something like this leaflet would make a world of difference – extending beyond the doctors morale.

    That's a good idea. Maybe I'll write a pamphlet like that and see how it's received.

    6. Any thoughts? I have lots more but it will immobilize you.

    I'm almost immobilized now, or at least late for work. Readers are welcome to email me with any thoughts or suggestions, and I'll add them to the post as updates.

    UPDATE: One readers' thoughts on how to reduce medical expenses - take a more active role in your health:

    I would love for a community to get this going: Persuade local pharmacies to offer discounted BP cuffs and stethoscopes, or perhaps some drug reps could donate a few. Announce a "How to Take Your BP" day at various areas, such as Walmarts, or the Northside pharmacy locations here in town. Have volunteers (I would be happy to do this) at a couple of areas in the store, teaching people how to listen and take BPs. Then have a second volunteer check they're doing it properly.

    Put a note up in your office that a filled-out daily (weekly?) log of BP will be good for a $10 discount on office visits. (Or some such inducement.) If I knew my husband had high BP....he might not be in Adams Lane Care Center now, following a big bleed 5 years ago.
    Think what we could do.....

    Even something as simple as opting for generic medications instead of brand names helps reduce expenses, although many people don't see it that way because they don't pay the full cost of their drugs, their insurance companies do.

    And a comment about the pamphlets:

    Re your comment about writing a pamphlet -- saw a poster for an org called, I think, fightingdocs.com, that is putting out materials. The poster said 'Save Pennsylvania Physicians' to which I asked 'collect the whole set?' The receptionist, at least, was amused.

    UPDATE II: Bard-Parker, surgeon extraordinaire, has some thoughts on why doctors have trouble getting behind their medical associations - it's a generational thing.

    posted by Sydney on 6/03/2004 10:36:00 AM 0 comments


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