Where Have All Our Doctors Gone?

The recent closing of the medical practice of Drs. Casas, Kundrat, So, & Lee was a huge blow to many of Laurel’s residents who have been going there for the past 20+ years. Why did this and other apparently successful practices close? At first, it appeared that the closing of a number of practices in this town over the past 2-3 years was just the normal attrition of older doctors retiring. This practice, however, was staffed with young doctors full of energy.

Many practices in the area have been struggling to pay their staff because of cost-of-living increases, 75-100% higher malpractice premiums, facility fees that are rising 8-10% a year. Meanwhile, reimbursements from Medicare and insurances have been stagnant since 2001. This year as of January 2008, if Congress doesn’t act, Medicare reimbursement will be reduced a devastating 10.1% in one year- it is unlikely many practices will survive this kind of cut.

How did this situation get so out of control?

About 10 years ago, before malpractice soared, Congress decided they would control increasing costs by setting a ceiling on how much they will pay each year for all Medicare costs. Their misguided idea was to reduce reimbursement to the doctors who were ordering too many tests and perhaps lining their pockets with these fees – if they ordered extra tests, this would reduce their salary in proportion. However, with increased malpractice litigation activity and rising payoffs, the doctors had to order additional tests to cover all possible diagnoses. Radiology services requested additional tests to make sure they didn’t miss anything. Labs increased their fees, and more tests are ordered than before as doctors tried to avoid any possible misdiagnosis, and to meet new guidelines recommended for chronic diseases like diabetes & heart failure. Nursing home costs rose as doctors were forced to get patients out of the hospital sooner – patients went to the nursing homes to complete their treatment. These extra costs were treated by Congress as unnecessary, inappropriately causing reduced reimbursements to the doctors that ordered them due to changes in the way medicine now had to be practiced.

Each year for the past 7-8 years, costs have exceeded this artificial ceiling by a few percent, and up to this year, they have delayed cuts in reimbursement to the doctors by passing emergency measures. The doctors have not benefited much from these delaying acts because of the dramatically rising costs of doing business as noted above. Doctor’s salaries have dropped as much as 40-50% in the past 4 years as they struggled to stay in business. This year is different and even more gut wrenching because of the cumulative damage of Congress’s decisions. Basically, they have added up all of the delayed 1-2% yearly decreases in reimbursement, and plan to cut the total of 10.1% starting this January. As primary care providers, we are not making $150,000 a year as some may believe – many of us have been lucky to make more than a PG county school bus driver, plus we’re working 60-70 hours a week, and on call 24-7 dealing with very some difficult issues. It is no wonder many of us are despondent and leaving what we love and worked so hard to achieve.

If more doctors bail out, you will first find that your emergency care will be limited to minute clinics (hopefully the nurse won’t miss a serious problem masquerading as a cold) or extremely long waits in the already overcrowded emergency rooms. This is because the few doctors left will have filled their schedules with needed follow ups of chronic diseases such as diabetes & heart disease. After a while, waits for all appointments will be unacceptably long. Unfortunately, the graduation of new doctors may not help – much fewer of them are going into primary care now – they have heard about the problems and are going into surgical specialties. Insurances continue to pay well for surgical procedures and traditionally don’t pay well for complex medical evaluation and treatments that involve considerable time & experience.

As Congress continues to waste billions of our dollars on their pet projects and the war in Iraq, our primary care system is truly in a crisis. We hope that you will voice your opinion to your elected officials just as soon as you can get your pen to paper. Your opinion need not be eloquent, just heartfelt and sincere.

We encourage that you also view the American Medical Association website at www.ama-assn.org for more information - they have a particularly good automated system based on your zipcode that will forward your letter to President Bush & your elected officials. Comments are encouraged to this publication, your elected officials, President Bush, the presidential candidates, and the AMA. 

Thank you for your interest and help.

Timothy McClain, MD