The Doctor Is In – But For How Long?

I am home for a couple of weeks straight, which these days is an unusual run for me.  So I’m using this as an opportunity to reconnect with people in California who I feel I have somewhat neglected lately.  It’s easy, and avoids much pain to ignore California politics.  It’s abysmal here.  I could give you the details, but everyone already knows.  Everyone of course, except the politicians running the state.

Last night I was asked to attend a meeting of Doctors in Sacramento.  It was a small informal event, put together by a retired general surgeon I met in the local tea party here in Nevada County, California.  Pat has been telling me for a year that things are very bad for doctors in our current health care system, and getting worse.   In fact, several years ago, he left the practice of medicine that he loved, because it was just getting to hard to earn a living.  He’s described to me a system where the federal government, insurance companies and HMO’s are doing their best to squeeze every bit of joy, and most of the money out of the practice of medicine.  It’s not a pretty picture.  He wanted me to hear it from more docs than just him, so he arranged a dinner in midtown Sacramento at a local pizza joint.

I arrived at 6 p.m. and sat down at a table with my friend Pat.  Doctors wandered in over the next 45 minutes until there were seven of them; two anesthesiologists, a plastic surgeon, a general surgeon, an OB/Gyn, an emergency room doc, and a surgical hand specialist.   One of them is in charge of all the doctors employed by a local hospital (90 docs).  A couple are in private practice.  Some are now employed by the hospitals.   They were an impressive group.  These are people who have dedicated their entire lives to the continuing study of cutting edge medical science with the intent to help others in need of healing.  They are all smart, passionate human beings who love what they do and care deeply for the patients they are sworn to help.  And they are all now frustrated, angry, bitter and somewhat hopeless because of the situation in which they now find themselves.  These are our doctors.

I learned that behind the facade of geniality that you see when you cross paths with your doctor is a man or woman who is no longer in control of their own professional destiny, and not able to practice medicine according to the ethical code they are sworn to uphold.  They are told how to practice medicine by the government.  If they work in a hospital, they must give the “approved” medicine, at the “specified” time.  They must run the government specified tests at the specified times.  If they do not, they are ranked down, and the hospitals lose reimbursement compensation from Medicare, and the administrators.  The doctors say these specified standards and meds are often wrong.  They are not “best practice.”  And even more importantly, they leave no room for the physician to do what he is trained to do, which is to use his learned skill, insight and experience to do what is best for his patient.   Patients receive what is sometimes inferior care, based on government mandates and financial pressure due to lost reimbursement if the physician does what he believes is right, instead of what the government specifies.   It was not easy to hear.

In private practice, the physicians are forced into horrible financial situations by the government.  The hand surgeon in attendance no longer does major hand surgeries because Medicare reimbursement was causing him to go broke.  He was having to take out loans to practice medicine.  He told me the story of a construction worker who showed up with his hand in a bag.  He rushed the man into emergency surgery.  After many hours of complex vascular surgery which had taken the him years to learn, he was able to successfully replant the hand.  He continued to work with the man over the next year, until he was finally released to go back to work as a construction worker.  This is incredibly satisfying to the doctor on a personal level.  But behind the scenes, the picture is not pretty.  He billed and billed and billed…over thirty times his office had to bill and rebill to get the payment he was due from the government.  Ultimately, his total pay for the good work he did was $400.  How can a doctor due that and keep practicing?  The answer is that he cannot. .

Today, in Sacramento, California, if you lose a hand or a finger in an accident there is no longer a practicing surgeon that will reattach.  Instead, you will be helicoptered to San Francisco at a cost of almost $50,000.   $400 for the surgeon that spent the years learning the skill; $49,000 for the helicopter ride because the local surgeon can no longer afford to practice medicine.  These are the numbers.  They are mind boggling.  But the suffering is more than financial.  The doctors who love what they were trained to do are now shackled by the system to the point where they can no longer do it.  The patients who need the care simply can’t get the care, even here in California’s capitol city.  The system is much sicker than I ever knew.   The system is much sicker than most of us know.

After spending several hours with these doctors several things became clear to me.  First, I was sitting with great Americans.  These are people who live among us, and everyday derive great satisfaction from helping their fellow human beings to heal.  They are the best the world of modern medicine has to offer, they are good people who care, they are doing great work, and we are lucky to have them.  They are in serious trouble, and they need our help.

I learned that the majority of the money being spent on healthcare is not going to the practitioners.  A tiny fraction of every dollar spent on our healthcare system goes to our doctors.  The money is being squeezed out of the system by the HMOs, insurance companies, drug companies, medical device manufacturers, and bureaucracy.  Some of that expense, the astronomical cost of the best health care in the world, is just part of reality.  If you want the very best, you are going to pay for it.  An emergency room contains millions upon millions of dollars of equipment.  That wasn’t true 50 years ago.  We have high tech meds, high tech tests, high tech equipment, and all those things cost real money.  It is more expensive today, because our health care is so much better, and so much more intensive than it used to be.  But again, that money isn’t going to the doctors.  They are getting the squeeze.

Mostly, I learned that doctors are unhappy, frustrated, dissatisfied with their professions and longing to simply practice the kind of medicine they love; the kind where the doctor patient relationship is sacrosanct, and they can honor the ethical code they are sworn to uphold.  The problems they face are complex and not amenable to any single solution.  The doctors themselves seem unable to yet agree on how to fix what ails their profession.  But at least in this small group, they have made a commitment to stepping up and beginning the hard work.  The problem is much bigger, deeper and older than Obamacare, and it will take time, energy and sacrifice to solve.  But it can be done.  It can be done if the doctors themselves will engage and take charge.  They are the only ones who can fix this mess.

I will help them however I can.  But like every citizen, they need to step up to help themselves.  I heard that they are all very busy.  So are the rest of us.  I heard that it is difficult to fix the problems ailing the medical profession.  So it is with all the serious problems facing our nation.  But like those stepping up in the tea party movement, the doctors must ask themselves the question President Reagan asked his cabinet, and the nation upon his second inauguration: “If not us, who? And if not now, when?”  The doctors I was with last night in Sacramento, California answered those questions with, “It begins with us…right now.”   So it begins now, as it always has, with a small group of dedicated people.

The doctors are beginning to fight.  We need to support them.  In the end, it’s our medical care they are fighting for.


Mark Meckler