Practicing medicine in less than ideal economic times is adding another element to a list of stressors that’s been growing for some time, state physician leaders say.
“We’ve been in tough times for a long time, and we’ve had to tighten our belts,” says Patrick Barrett, M.D., president of the Mississippi State Medical Association (MSMA). “We haven’t been practicing in the capitalistic system for a while.”
He and Randy Easterling, M.D., president elect of MSMA, cite the frozen formulas of reimbursements for Medicare and Medicaid programs among the chief reasons practitioners have been feeling an economic squeeze for more than 10 years. There’s been no increase in the percentage of reimbursements for seven years. That was coupled with a fight to keep reimbursements from being cut by 2 1/2%; something Easterling says came dangerously close to happening.
“The federal government has a crazy formula. Medicare has been devastating for years; it doesn’t pay the bills,” Barrett said. “Physicians have to make up the losses with paying patients, and insurance companies are clamping down.”
A Jackson orthopedic spine surgeon, Barrett says he started losing money 10 years ago as most medical specialties are poorly reimbursed. The country’s current financial crisis is making it worse.
He also sees another storm brewing with insurance companies wanting physicians to convert to electronic medical records, a conversion that will coast approximately $100,000. “We will have to do it under a federal mandate, but as a business deal it’s dismal,” he said, “and we can’t pass the cost along to our patients. Physicians are trained to treat patients, and that’s what they want to do.”
Easterling feels that few people know that reimbursements are frozen at pre-determined levels no matter what physicians charge.
“That’s at the same time all costs have gone up, including nurses’ pay, energy and other costs of operating a practice. We can’t tell a nurse there won’t be a cost-of-living pay increase, or the power company we won’t pay them,” he said. “In many situations, physicians are forced to be more selective in who they see. It’s not an issue of greed but simply one of survival.”
The Vicksburg family practitioner and addiction specialist says it’s not uncommon now for physicians to cut back on office personnel and/or office hours as the only way to cut losses is to cut overhead. When they’re only able to see 30 patients a day, some are cutting back on seeing Medicare and Medicaid patients.
“The important thing for the public to know is that this is an access to care issue, but that message is not getting out,” he said. “We don’t like things getting between us and our patients, but we continue to fight battles with the government. Almost everything we do is being scrutinized by someone who’s not trained in medicine.”
With people paying more for gasoline and groceries and in some cases losing jobs and insurance, the medical community is beginning to see the fallout. Choices are being made to put off preventive care, which sometimes leads to higher costing chronic care.
Still, Easterling says physicians see patients in their communities. “We’re the only profession that consistently gives away our services,” he said.
As physicians work harder and longer to maintain their practices, the burnout rate is growing says Gary Carr, M.D., medical director for the Mississippi Professionals Health Program. MSMA started the program in 1978 to treat physicians with potential impairing stressors, which includes addictions and depression.
“The medical community continues to be squeezed. All physicians are being asked to do more and more with less and less. There are mounting pressures and lots of nuisance paperwork,” he said. “It’s taking a huge strain on them and their families.”
The number one problem Carr, a Hattiesburg family physician and addictionologist, sees are serious addictions to drugs and alcohol. Those are followed by major depression and bi-polar disorder. He says stress and burnout are a huge problem, starting with medical students. Carr says studies show that 40% of medical students have burnout and more than half of practicing physicians.
“Economic issues will continue to add more burdens, although it’s probably too early to know what impact the latest financial issues will have,” he said. “Most physicians are savvy and, like the rest of society, we’re shrugging our shoulders and believing the economy will come back.”
Carr is most concerned with the group of physicians who are about to retire, which in some instances may have to be postponed. “It’s normal to feel grief, anger and depression in those cases,” he said. “I hope they will seek out help, but unfortunately we’re not well trained in taking care of ourselves. We would be quick to send our patients, but we won’t go.”
That reluctance to seek help, Carr believes, begins in medical school where the message is that doctors are not supposed to get sick. “That training to be a provider of care, not a receiver, starts early,” he says. “Medical students are told they need to suck it up and do the job.”
Barrett feels some physicians will solve some of their stress by rationing medical care. For instance, physicians who lose money making rounds at hospitals will have their hospitalized patients seen by hospitalists, medical specialists who are hired by hospitals.
“That’s disjointed care,” he said, “but the practitioner loses money while he’s out of the office at the hospital, and he can’t charge enough to pay for it.”
Then there are those physicians who aren’t treating Medicare and Medicaid patients or who are severely cutting back and not seeing new ones.
“That’s an access problem that’s hard to get a handle on,” he said.
Regarding calls for national mandated healthcare for all, the MSMA president said, “We’re drifting toward equality of inadequate care in this country. One solution is transparency, which means people would have to be responsible for their care and shop around. Most people do not want to do that.”
Contact MBJ contributing writer Lynn Lofton at firstname.lastname@example.org.