Primary care doctors struggling to survive - SHOCKING STORY

[Liberal_in_LA]

**shocking to me anyway, I never imagined a doctor could be so broke***

Primary care doctors struggling to survive

http://www.latimes.com/business/la-fi-doctors15-2008dec15,0,4293105.story


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.

[ingac70]

1. "fashionable medical suite in a sleek black-paneled building in Beverly Hills"

:nopity:

[Liberal_in_LA]

2. she's shutting that office down.

[Donnachaidh]

8. yes, for THIS

"Early next month, Walford will join 200 physicians in a multi-office practice affiliated with Johns Hopkins Medical Center in Prince George's County, Md. Her base salary will be $115,000, plus bonuses based on the complexity and quality of care she delivers. Benefits include vacations, health insurance, a pension plan and paid continuing medical education."

Too bad she has to suffer so much and join a group that gives her a base salary of 115K. :sarcasm:

She's abandoning her poor patients for a cushy position with another team of doctors.

:nopity:

[wolfgangmo]

14. You have no idea

My wife is one of those primary care physicians with a cushy job.

She has student loan payments that are larger than a mortgage payment. She doesn't draw a salary but supports the income of several assistants. She works about 70 hours a week in a high stress kind of job. We live in a very small, very old, very broke down house and have no savings because we can't have both on just my salary.

Get off your high horse. $115,000 is not too much for that kind of dedication and training. Unless you want Walmart to take over medical care in America. Good luck with that.

Non specialist doctors are on your side and most of them want single payer universal care.

[Liberal_in_LA]

23. agreed. 115K isn't that much money for a profession that takes many years & so much money 2 achieve

[ContinentalOp]

25. Plus 115k is what she's leaving for! Which implies she's making less here.

That's a pretty low salary for a doctor in L.A.

[lostnfound]

32. Don't you place a value on independence and diversity?

To me, this story is about the independence of a doctor and the diversity of options available for patients, getting reduced through the (inexorable) logic of beancounters. The megapractices will survive in the suburbs, though they too may end up cutting doctors from their staff.

There was a time in America when we had entire towns of small independent businesses 'hanging out their shingle', including doctors.
Soon the whole country will be 1) low wage labor working for Corporate Inc., 2) the unemployed, and 3) a handful of well-paid beancounters and executives.

Just like in retail, the big box stores may be able to outlast a recession while the small independents are driven out of business. Goodbye, diversity of options. Wonder where her patients will be able to go now?

[ContinentalOp]

24. You don't live in L.A. do you?

I mean, I'm sure "Beverly Hills" sounds impressive, but I used to go to a doctor with a Beverly Hills address and it really wasn't all that. Same as any other crappy cookie-cutter doctor's office. I'm sure they called it a "medical suite" though. :eyes:

[K8-EEE]

29. sorry, dup

My eye doc retired but used to be in one of those 1960's era high rises on Wilshire and I was always nervous riding in that old elevator!

[K8-EEE]

30. Agreed, some of the med buildings in BH are pretty grody

My eye doc retired but used to be in one of those 1960's era high rises on Wilshire and I was always nervous riding in that old elevator!

[ingac70]

34. Is cookie cutter another word for "fashionable"...

in LA?

[janx]

3. The "primary care physician" is the insurance industry's term for the

family doctor. If the term had stayed that way, we wouldn't have the horrible crisis we have now.

[Double T]

4. Single payer health care to the rescue.

Try setting up shop in a lower rent area; anything 'Hollywood' costs a fortune.

[Horse with no Name]

5. I know several docs that are moonlighting because they can't pay their bills with their day job

I know it is fun to smear them and label them elitists...but they work long hours and have invested their time and money into their careers, and they are hurting too.

[annabanana]

10. Send each and every one of them this link:

http://www.pnhp.org/

[Lebam in LA]

6. Our major client base are doctors and dentists

and we are seeing alot of them lapsing insurance policies. We have dr clients that just last year were really raking in the bucks and are now struggling.

[Mari333]

7. hmmphh. so thats where my GP went

I am now stuck with some physicians assistant. my GP left. I guess I just wont see a doc unless its an emergency.

[ogneopasno]

9. It's a huge crisis in rural areas. Not only do doctors not want to be family doctors, they also

don't want to practice in rural areas:

http://www.minnpost.com/stories/2008/12/02/4925/lack_of_doctors_threatens_rural_residents_health

[eridani]

11. The problem with practicing in rural areas--

--is that you never get any time off. Ever. Seems to me that this problem should be solvable with modern communications technology.

[Missy Vixen]

12. Our doctor is the greatest

He sees almost everyone in our small town. I don't even know how he keeps up with the patient load, the insurance BS, and people like us who just lost our insurance and are scared shitless. I'm sure he works fourteen hours a day on top of it. Calling him an "elitist" makes me sick to my stomach. Nothing could be further from the truth.

We came to him when it wasn't working with my husband's high-priced endocrinologist; he agreed to treat Mr. JulieRB after I had the mother of all battles with the former endo over his refusal to take my husband off Avandia. Imagine my joy to discover that the former endo is a spokesperson for Avandia.

Our doctor spent half an hour last week helping us fill out paperwork from www.needymeds.com so my husband can get his insulin. He saw us for free, too. To say that we owe this guy more than we could ever repay is an understatement.

Julie

[slipslidingaway]

13. My daughter tells me that hardly anyone in her class is

considering general practice, at least for now, they are worried about the debts they are accumulating.

:(

[1]

15. boob jobs and hoo-hoo reconstruction is the future. so sad... n/t.

[slipslidingaway]

17. Some will...others will choose another specialty. n/t

[1]

19. hey, i'm with you and your daughter. i remember gp's. the only doctors i ever saw growing up...

and they were wonderful. in 10 years there might not be any more.

that's sad...

[slipslidingaway]

21. Only doctors we ever saw as well, yes it is sad that many

may make this choice because they are looking at massive loans.

Thanks.

:hi:


But there are no lack of credit card offers.

[SmileyRose]

28. Er - hoo hoo reconconstruction?

Do I want to know?

[Lance_Boyle]

41. 'vaginal rejuvenation' -- with frikkin' lasers

http://www.lasertreatments.com/vaginal_rejuvenation.html

[SmileyRose]

42. meh -- $9000 ? For um - ahem - a hoo hoo?

I'm sure I don't even know what to say.

[wolfgangmo]

18. And that won't change until we get the insurance companies outlawed.

We have a medical intern in our office who will not be practicing in a family practice like ours. There is not way she can afford to which is too bad because she loves it and is obviously talented.

As for us, we are looking at Canada where our work week will be 1/2 as long and the money just as good if not better.

Call your congress critter before you need to get your medical care from a seeing eye dog. It's not as if there a surplus of nurses or PA to replace the physicians that are leaving in droves.

[slipslidingaway]

20. Hoping that something will be done about our HC system...

good luck if you are thinking of relocating, another sign of the times.

:(

[EmeraldCityGrl]

16. Our family physicians insurance company went belly up

during the AIG failure. The building his practice was in and the practice itself was in insurance limbo
last time I saw him.

[RB TexLa]

22. Both attempted insurance fraud and successful insurance fraud by doctors has been up the last

few months.

[ContinentalOp]

26. Wow, my doctor in Santa Monica is great. I hope she's doing OK. Haven't been to see her in a while

I always thought it was a little tacky that they have Botox brochures in the exam rooms but this put it into perspective...

"Many primary care physicians boost their income by offering Botox injections and other cosmetic procedures for cash. Walford couldn't afford the training."

Pretty scary to think that my doctor may not be there tomorrow. It's so hard to find a good one.

[tabbycat31]

27. how about student loan forgiveness

for any doctor who goes into primary care?

[Fumesucker]

35. I have a family member that graduated from medical school last year..

He is going to work in a rural community as a GP and his schooling will be compensated by the practice he is going to work in after he finishes his clinicals and residency.

It's interesting that my family member decided to become a doctor after a career as a hospice nurse, he is over forty years old and was by far the oldest person in his medical school class.

[lostnfound]

31. Another victim of the scamming of America

I don't begrudge her the $115K one bit, but it is a shame that patients' choices are being cut off.

I suspect that in most other civilized countries, medical school doesn't leave you with $80,000 in loans, either.

[Vinca]

33. My doctor closed his doors last December. He was getting a double

screwing from the insurance companies. Only a percentage of his fee was being paid by them - kind of a take what we'll give you and be happy situation - and then, when he was diagnosed with lymphoma, his own insurance company covered only a fraction of his bills. He's now working per diem in the local ER. The insurance industry is the root of the problem.

[melm00se]

36. most of the posts

are focusing in on the income, address or student loan balances of the doctors but what about this part of the article:

overwhelming patient loads

right now there are 40+ million uninsured Americans, the bulk of whom are probably not availing themselves of day to day preventative healthcare a primary care physician provides. Universal healthcare/insurance will put them into the system which will, more than likely, increase the "overwhelming patient loads" this article talks about.

Universal healthcare/Single payer insurance etc is only part of the solution: you need a corresponding increase in healthcare providers to care for these folks who are now being included in the healthcare system. One without the other will not really solve the underlying problem.

[sendero]

37. My doctor and I...

.. used to have long conversations on each visit. At the time (around 2001), I was making more than he was. (The dot.com bust took care of that).

He was seriously underpaid, the insurance contracts primary care physicians have to enter into pay very little for an office visit. His office included himself, and 2-3 staffers - PA, reception, etc.

The whole system is rotten. Primary care physicians are getting squeezed to death while specialists of all kinds are seriously overpaid.

The system is in danger of collapsing of its own excesses.

[jakem]

38. My family doctor is a country doctor in the best sense.

He makes house calls, does not charge much or anything to the poor and uninsured.

He is busy as hell.



He also installs wood stoves on the side to make money.


The system is so broken.

:cry:

[Liberal_in_LA]

39. He sounds like a great guy. Too bad he has to moonlight.

[yardwork]

40. I've been posting about this on DU for years.

[Canuckistanian]

43. This doesn't happen in Canada

GP's get regular paychecks from the provincial government.

They don't have to wait for patients or insurance companies to cough up some dough.

[MazeRat7]

44. Word tonight, they are closing many of our "regional" clinics and laying-off doctors...

Some of the best care I've ever had after I swore off the corporate run health providers.

My guy was great, you got the feeling he actually cared, and certainly was not in it for the money...

Don't know his status as yet, but I'm sure he will land somewhere. People like that always do, or at least deserve to.

Sad.

Peace,
MZr7