I read your article, “Is there a doctor in the house?” (Sept. 4, 2008) with some pain. I’m a doctor, I live in San Luis Obispo County, and I don’t see how I can ever practice here again.
I closed my office in 1998 and worked for the prison system until this year. At the time I quit private practice I was working 80 hours a week, 50 weeks a year. It took about 45 hours per week to pay the overhead. You talk in your article about Medicare and insurance reimbursement: Inadequate reimbursement and onerous paperwork were the reasons I had to work so many hours to support my family.
I spent a lot of time educating my patients about their diseases and treatments. You can save Medicare or insurance companies a lot of money by educating your patients, but it is very hard to get paid for your time. Medicare, in particular, audits physicians and then accuses them of fraud for “overcharging”; the medical chart must explain in detail why you charged so much for an office visit, and frankly, doctors are presumed guilty of overcharging unless they can prove otherwise. Private insurance companies delay payments and demand excess paperwork.
I probably should have charged more per visit than I did, but the federal audits were scary and I hated fighting with insurance companies. I charged a little less and I worked more hours. And then I quit. Are you better off?
I should also mention the insurance companies’ letters: “Dear Dr. Perry: We would like you to consider using more generic drugs. In reviewing your prescriptions from last year we note that only 85% of your prescriptions were filled for generic drugs.” Only 85 percent. I guess I’m a failure.
I would like to practice medicine again. I enjoyed my patients and I think I helped many of them. However, I can’t work 80 hours per week anymore, or even 60 hours. I’m not eager to work more than 40. But if I spend time talking to my patients, 40 hours per week doesn’t even pay the overhead. I can’t do it.