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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

My Photo
Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Friday, February 23, 2007

Dear congressperson

I'll be up front with you. I neither like nor respect you at all. You beat out one of hardest working, most competent congresspersonages this last election, based on you personal wealth and name recognition. Too bad for the district, I say.

Nonetheless I'm sucking up to you to give us doctors a break. I don't know how I distrust more, the Republicans with their glib talk of improving health care access while they cut the budget for Medicare and the VA hospitals, or the Democrats with their glib talk of improving health care access while they do their best to criminalize the practice of medicine.

Anyway, I appreciate all the lip service everyone is making for colorectal cancer screening. I think folks get a little carried away with it - I was recently referred a 91 year old gentleman for screening - but generally speaking the yield is high enough to make it worthwhile.

However, in order to balance the books, the reimbursement for colonoscopy has been in a free-fall over the past 15 years. I'm now getting 25-30% of what I received for this procedure in 1991, and this is not adjusting for inflation. The reimbursements for 2007 look even worse. The private carriers base our reimbursements on Medicare, so every time you folks lower the reimbursements, they do too. Except for (would I get in trouble for mentioning the company's name?), who now is reimbursing me for less than Medicare does.

A recent article in the NEJM demonstrated that when colonoscopists are in a hurry, they miss stuff. A lot. It has always been a temptation for docs to turn their practice into an assembly-line. Now I think it will be inevitable.

This is not an issue of me not being able to afford that beach house or making my Porsche payments. I'm having trouble making payroll right now, between taxes (I appreciate your pledge to raise taxes as one of your campaign promises. The voters in this district must have lost their minds on Election Day), health insurance which paradoxically has become almost prohibitively expensive, malpractice insurance, and employees who expect merit and longevity raises right on schedule in spite of the fact that it's getting tougher for me to make a living. Plus, I had to update my phones, my computer software, my computer memory, and replace my fax machine that died a violent and painful death about two weeks ago.

I'm reexamining the way I practice medicine right now. I've prided myself in taking time with my patients right up to the present. If I can make a living, or if I could do better selling Amway or something, I'll have to do what's necessary. Right now I'm working for the health insurance.

By the way, if you and/or Hillary and/or Obama want to nationalize health care, now would be a pretty good time to do it. I feel less than no sympathy or loyalty for the health insurance industry. They can all go to blazes.

Anyway, I worked in the military during the 80's and have a good idea how health care rationing works. I can get used to it again if I have to. Just let me make a living at it. I'm getting too old to be retrained.

Yours truly,


Anonymous Anonymous said...

Did you send this to him?
If not, you should.

8:44 AM  

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