A St. Petersburg neurologist is closing up shop. Why?

After 17 years as a neurologist and part-owner of a private practice in St. Petersburg, caring for patients with everything from migraines to multiple sclerosis to massive strokes, the bottom line showed that his earnings were half what they were six years ago. And he saw no signs of a turnaround.

This isn’t a problem unique to only neurologists, either.

An article in the Feb. 12 issue of the New England Journal of Medicine said the percentage of specialists in independent practice has declined 18.6 percent since the mid 1990s. Primary care doctors have also been migrating to larger groups or jobs as employees of hospital systems or HMOs.

The days of hanging a shingle and practicing independently are having the final nails drove into their dusty coffins as we speak. Now that Obama is in office and spouting “reform” everytime you turn around, I certainly see physicians making the transition from entrepreneur to (underpaid) employee in my crystal ball.

Dr. Franklin’s son speaks up in the comments on the article. I like what he has to say:

As Dr. Franklin’s son, I would like to speak from our personal perspective on his issue. Firstly, my father always wanted to teach. Secondly, he never cared about the money; we live well even with the pay cuts. This article is not about money.

Also, in reference to other doctors, this mass exodus of Florida’s healthcare is a byproduct of all of the legislation against them that YOU, THE PATIENT, supported. It’s a two way street whether you like it or not. Also, I’m becoming a lawyer.

Going to school for 8 years and another 3-7 years of postgraduate training to work for the government just doesn’t seem right.

But, I do think that’s where it’s headed.

Medicare is “a program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.”

Everybody pays into the Medicare bucket — if you pay taxes that is. In other words, you’re paying for those non-compliant diabetics who have to undergo dialysis and lower extremity amputations.

“I can’t be bothered to stick my finger every flippin’ day, take those damn blue pills, or not eat sugar. Hell, I’ve been drinking sweet tea every day for fitty years!”

“But Mr. Robertson, you could suffer from some very serious complications if you don’t manage your diabetes.”

“Naw. Ma pa had da sugar disease and he did OK. Lived to be 95 and ate biscuits n’ gravy every mornin’. That sugar disease don’t affect me or my family.”

You’re paying for these incompetent idiots. Doesn’t that piss you off? It certainly gets under my skin.

Medicare Likes Games

Take a look at this recent article from the Association of American Physicians and Surgeons:

If the provision survives, physicians would get a 0.5% pay increase in 2008 and 2009, instead of projected cuts of 9.9% and 5.0%.

Before you get too excited:

The tiny physician payment increases would be offset by 11% cuts in 2010 and 2011. Specialty societies report that the various cost-control schemes will pit physicians against each other—for example, it sets up an advisory panel to re-do Relative Value Units (RVUs) for “over-valued” services.

Let’s take a look at some basic math. Pay increases of 0.5% per year for two years instead of projected cuts of 9.9% and 5.0% This is a net increase of 15.9% However, cuts in 2010 and 2011 add up to 22%, leaving physicians with a net pay decrease of 6.1% Factor in inflationary costs and docs are pedaling backwards.

Other changes include abolishing “Health Opportunity Acounts,” the provision that allows HSA-programs in Medicaid; repealing a provision of the Medicare Modernization Act that restricts the use of general revenues to fund Medicare; and raises fees of certified nurse midwives to equal those of obstetricians. There is a plethora of new requirements that enrich some interest groups and kill off others.

Democrats plan to pay for the bill by boosting federal tobacco taxes and hiking taxes on insurance companies by $2 per person.

On the whole, the bill contains “the most sweeping changes in decades” to American medicine—changes that will affect every American, stated Rep. John Shadegg (R-AZ). It marks a sharp turn away from a re-invigorated private market and toward government-run medicine.

Watch out. Physicians are poised to be the next government employee. Ask any government worker: The paychecks suck.

Universal health care is something that will face this nation probably sooner rather than later. I am not a supporter of universal health care, and strongly believe that health care is a privilege, and not a right.

Lawmakers in Connecticut are proposing an additional 3% tax to physician’s revenue in order to fund universal health care. Needless to say, these doctors aren’t happy.

“I am willing to stay … but this bill and unrelenting overhead costs are putting me out of business. My electrical rates have doubled, my liability insurance has tripled … even after 23 years in practice, I struggle every week to make my employees’ payroll.”

This is a sad fact that is plaguing more and more practices today as costs continue to increase and insurance reimbursements continue to fall. Dr. Gourlie goes on to say:

“Taxing doctors to fund health care for the underserved is not the solution, and it will result in less care for everybody.”

I completely agree with the above statement. Why should physicians, who are already suffering from decreased insurance payouts and higher overhead, be forced to fund something that shouldn’t happen in the first place?

Proponents state that the tax will generate $600 million for the state and be offset by $300 million in federal reimbursement. The plan also calls to increase Medicaid reimbursement by up to 30%.

But, for physicians whose Medicaid reimbursements are a small fraction of their total revenues, this offset might not equilibrate earnings. Furthermore, the increased Medicaid reimbursement doesn’t cover overhead expenses such as storage or breakage for drugs.

It makes me angry when my hard-earned money (some of which I use to pay for my own health care through insurance) goes towards paying for people who are too lazy or don’t have enough drive to either get health insurance, make enough money to pay cash for health care, or find a job that offers a decent health package.

I pay for my health insurance, just like I pay for my car. We’re not giving out cars to those who can’t afford them, and we shouldn’t be giving out health care to those people either. It taxes the system as a whole, and those people who can afford health care are ultimately left with fewer resources at their disposal. In the end, it is the people like Dr. Gourlie who work hard for what they have, being faced with funding the whole shebang.

For all of those people who want universal health care, how do you expect to fund it? Would an additional 3% tax to your gross earnings be something you’d be excited about? Think about that before talking about the benefits of universal coverage. The money has got to come from somewhere.

via: [Courant, SDN]