OT Primary care doctors struggling to survive
- From: Don Tiberone <s_knight8@xxxxxxxxxxx>
- Date: Mon, 15 Dec 2008 20:00:03 -0800 (PST)
http://www.latimes.com/business/la-fi-doctors15-2008dec15,0,4293105.story
Primary care doctors struggling to survive
Relatively low earnings, rising overhead and overwhelming patient
loads are sending veteran physicians into early retirement and driving
medical students into better-paying specialties.
By Lisa Girion
December 15, 2008
The morning's last patient, a disabled woman on Medicare, trails her
doctor into her office and confides that she doesn't have money for
lunch. Tanyech Walford pulls out her billfold and hands her $3. It's
money the doctor really doesn't have.
"I tell patients I'm broke, and they just chuckle," she said. "They
don't believe me."
Walford's fashionable medical suite in a sleek black-paneled building
in Beverly Hills was hiding a grittier reality: She spent much of her
lunch hour that day in her office opening mail -- hoping to find
payment checks to help fill the gap between her expenses and her
revenue.
She hadn't drawn a paycheck for herself since February. On top of
that, her practice has cost her $40,000 in personal savings and left
her with $15,000 in credit card debt. Walford, 39, also owes $80,000
in medical school loans. She shops at Ross and other discount
retailers, and rarely eats out or takes time off.
"I'm totally stressed out," Walford said. "How can I take care of my
patients when I'm that stressed?"
Walford is not alone in her struggle. Relatively low earnings, rising
overhead and overwhelming patient loads are sending veteran primary
care physicians into early retirement and driving medical students
into better-paying specialties, creating what the New England Journal
of Medicine recently called a crisis.
Primary care doctors "should be able to leave work thinking not of
their income, or of unanswered phone calls, or of test results that
they might have overlooked," Boston physician and associate journal
editor Thomas H. Lee wrote in the Nov. 12 issue. "They should go home
thinking, 'This is what I was meant to do.' "
But after five years, Walford couldn't hang on any longer. She closed
her office nine days ago.
"It's sad," said Walford, who has shoulder-length wavy black hair, a
cherubic smile and a slight lilt that betrays her Jamaican roots. "I
worked really hard. It's a tragedy."
The loss of a single physician thrusts hundreds of patients into
medical limbo. But the effect is far broader. Experts say the pool of
primary care physicians is insufficient to meet the needs of an aging
population. Already, shortages make it difficult to see physicians in
swaths of northern and rural California, as well as neighborhoods in
South Central Los Angeles and other urban cores.
Much of the problem lies in an endangered business model: the one- or
two-physician general practice. Such practices are particularly
difficult for primary care physicians to maintain because of their
relatively slim and declining margins.
In her best year, Walford grossed about $360,000, more than enough to
cover her overhead and take home a tidy income. That stands in sharp
contrast to this year, when her practice slid into the red.
Small general practices afford doctors autonomy to practice medicine
as they see fit and can produce strong doctor-patient bonds. But these
physicians have little or no clout to leverage better payments with
insurers; they have no economy of scale, which makes overhead more
burdensome.
"It's very difficult, even in rich neighborhoods like Beverly Hills,
to set up a solo practice," said Richard Scheffler, an economist at UC
Berkeley. "The doctor has to pay rent, a nurse, have a bookkeeper,
billing systems, computers. All of those fixed costs are very, very
hard for a solo practitioner to have and survive."
Dr. Jerry Connell kept his family practice going in Santa Rosa for 29
years. But he closed it in October because his income had slipped to
$50,000 a year, even though he had 2,600 patients.
"I could make more with my Social Security and investments than I
could by staying in practice," said Connell, 66.
He didn't bother looking for a buyer because "no one in Sonoma County
has been able to find a replacement in five years."
Connell sold his equipment, but not to doctors. A biofuels company
bought his scales and microscope. A veterinarian bought his laboratory
equipment. And a tattoo salon bought his autoclave to sterilize
needles.
The economic slowdown is making matters worse. Physician revenues
nationwide are falling as patients who have lost jobs or homes stop
paying their bills and skip appointments.
"As people are tightening their belts, they are deferring things they
think are a luxury or not absolutely necessary," said Long Beach
physician Jeffrey Luther, president of the California Assn. of Family
Physicians. "We see people putting off physicals and mammograms and
blood tests because they just don't have the cash."
.
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