“So, I’m not a doctor, why should I care?”

Doctors are not going to be homeless and begging in the streets.  This is not an article to suggest that you should set up some fund for starving healthcare professionals.  But due to economics there is significant, legitimate concern that we will have a shortage of physicians, particularly in the areas of general/family practice/pediatrics/obstetrics in the near future. 

As I said in my last article, the insurance companies have not raised their fees for in-network providers, so if my practice is dependent upon seeing people through their in-network benefits, I am making the same rate per hour as I made 15 or 20 years ago.  This is why you go to your doctor, wait for an hour, and see him for 7-1/2 minutes.  In the past he could see three or four patients in an hour and support his practice.  His rent has gone up.  He has to give his staff pay raises, and provide them with benefits.  The price of a gallon of gas, the proverbial loaf of bread…so if he earns the same per visit, he has to squeeze in more visits, which affects the quality of service.  Do you really want to be the tenth person I’ve seen in a row?  Do you think I’m still “on” at that hour, with that level of hunger and exhaustion?  Do you want your mother to be the fifth cardiac surgery in a day?  Or your child to be seen by a pediatrician seeing a dozen kids an hour?  That is what has happened to healthcare—the caretakers are exhausted.  Recent surveys have shown that doctors spend about 10-14 hours a week on non-direct care, meaning paperwork, billing, consultation, etc.  That’s more than a full day per week on tasks that we are not paid for. 

But your doctor does it because we are helping professionals, which is part of the problem.  We didn’t lobby for ourselves, and I would say that in the mental health field we have been the worst, acting like friends to our patients, pretending we can work for free.  As helping professionals, we are driven to do just that – help.  And we should.  I think we should be REQUIRED to do some pro bono and low-fee work.  Putting aside two or three hours a week for work like that should be mandatory.  But not for the insurance industry which just keeps making more profit.  I will work out a deal with a college student who has to pay out of her own pocket, or a family without insurance; I will not take coolie wages from United Healthcare.

Here are some facts I found online: A recent Princeton graduate with a business degree can make about $200,000 per year.  The same is not true for doctors, who have more education and tremendous student loans.  The malpractice premiums alone can be $200,000 per year for a surgeon, causing some to close their practices because between that and office overhead they needed to gross half a million dollars before feeding their families, and the insurance companies just aren’t paying it.  If I only saw patients through in-network insurance, at the typical rate of the plans in this area, I would need to see about 25-30 patients a week, considered to be a full-time load, before I even buy groceries or clothing, take a trip, or make any type of home or car repair…basic expenses, including my own health and malpractice premiums.  I’d be hungry and naked, and unable to leave the house.  Forget replacing my 35- year old kitchen or saving for retirement.  Thankfully I don’t have any children to put through college, and my own student loans are long gone. 

The heyday of being a doctor is over.

A general practitioner in this area makes about $159,000 – less than the aforementioned Princeton graduate.  A White Plains lawyer with some years of experience behind him can make $450 per hour.  Some specialties do earn $300,000 and above, but their malpractice premiums eat a big chunk of that, particularly in this region.  In Rochester an internist pays about $7000 for malpractice insurance, while here it’s about $35,000.  An ob/gyn: 37K compared to 186K, and a general surgeon about 23K versus 115K.  God forbid someone makes a claim against you, even if unfounded.  Nurses are about the only healthcare professionals without such hefty overhead, as their jobs usually pay their malpractice premiums, and they make healthy salaries even right out of school.  Physical therapists also have low premiums, but what the insurance companies pay them is insulting.

Why should someone go through the time and expense to struggle to run a practice?  Why not go to business school instead?  Or law school?  We may think a lawyer charges too much money and seek another, but no watchdog group is telling her what she is allowed to charge; the market sets the fee, which is no longer true in medicine. Insurance companies are getting rich, and I can’t afford to save for retirement.  Something is wrong here.  One thing I liked a lot when I read about Obama’s plan was that it limits how much profit insurance companies can make; anything over that amount is to be given back to the members somehow, through refunds or lower premiums the following year.

So, why should you care?  You should care because you don’t want your kid seeing someone who became a pediatrician because he didn’t have the grades for law school.  If I won the lottery I would still work, at least part time, because I love what I do.  But the reality is we want to be, and SHOULD be, compensated for our time, effort, and expertise.  I supervise interns who are coming out of school with six-figures in student loans.  They should earn a wage that can at least help them pay off their educations.  They won’t be.  Robbing my patients blind or padding insurance claims is unacceptable, but so is a doctor who can’t afford to save for his child’s college education.   If I make a mistake a patient could attempt suicide, fall off the wagon, or act out dangerously.  If your surgeon makes a mistake, you could die.  If you are misdiagnosed, you can get the wrong treatment.  These things happen, unfortunately, not because of incompetence (although there are incompetent people in every profession) but because we cannot maintain the workloads required to sustain ourselves financially so human error is increased.

Last year I quit the major insurance panels and went back to setting my own fee.  This allows me to see a few people at a lower fee or through charitable organizations, because I can afford to.  I work a little less now, and volunteer more, helping nurture service dogs and visiting nursing homes with my own pooch.  I’m teaching a class, something I enjoy, but doesn’t add much to my income.  I don’t work as many late nights and weekends, so I can take better care of myself and give more time to my patients since 12-hour days are rarer for me now.  Would I have gone to business school if I could do it all over?  Probably not.  But will many bright, promising kids take that route, leaving medicine to mediocre students?  Maybe.  And that should have us ALL very worried.   ©

Barbara Kapetanakes, Psy.D., practices child, adult, and

family psychotherapy in

Sleepy Hollow.

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