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doctor's response to columnist's medicare allegations

by seymour herschberg

susan braudy's photo and prior columns suggest that she is not old enough to be enrolled in medicare. i assume, therefore, that her first-person column "fired by my doctor" (june 10) is literary license and that her statements are based on journalistic research. however, she has not been fair. she gives only one perspective.

first, let me state that although i am a retired primary care physician, my entire career was as a salaried employee of a non-profit organization. thus, i never had to worry about medicare or insurer fees-or any fee for service-income.

but i would like to comment on the physician's side of the story, which applies not only to medicare, but to many other insurance reimbursements. there are many reasons why physicians object to and decline to accept various insurance reimbursements. i base my comments, which follow, on my reading of medical articles, discussions with other physicians and personal opinion.

? many fees are less than the cost of operating a practice. i just read losing my patience, by mickey lebowitz, m.d., who left private practice for a salaried position because income, largely from insurance fees, did not enable him to meet his expenses. if medicare fees are indeed less than that of other insurers, and lebowitz could not make ends meet with the relatively higher fees, how can one expect physicians to make ends meet with the relatively lower medicare fees?

? medicare fees can be unpredictable as the fiscal year progresses, although i believe congress has always stepped in at the last moment to prevent this. in theory at least, a medicare budget is set using fees based on the predicted total and combination of services. to maintain budget neutrality, medicare may reduce fees toward the end of the year if the rate of expenditure is greater than predicted.

? although most insurance fees may be higher than medicare fees, some managed care insurance fees are lower than medicare fees; a factual error in ms. braudy's column.

? if one can exclude the emotions related to health and healthcare, as well as the tradition which has tended to make healthcare a right, is it fair for physicians be the only professionals whose service value is dictated or controlled by others, rather than by supply and demand? our constitution and laws guarantee us legal rights; however, there is no control of attorney fees in order to provide similar access to legal care. if one cannot afford the high-priced attorney, then tough luck.

? is it really fair to control or cap the income of one group of individuals while not controlling their expenses? to the best of my knowledge, the only other situation in which this occurs is rent control/stabilization-another emotionally charged issue.

? physicians typically spend seven or eight years (and more in some cases) training beyond college, while attorneys spend three or maybe four years. when one considers these costs, which include forgone income, why shouldn't physicians be reimbursed at the same rate as attorneys? my attorney charges $400/hour and his overhead is less than that of a typical physician. in addition to very costly professional liability insurance for the physician versus the attorney, supply costs for the physician undoubtedly far exceed that for the attorney. both have the expense of utilities, paper, etc., but physicians use a considerable amount of disposable equipment, such as dressing gowns, needles, syringes, tongue depressors, etc.

? physicians' fees should also be higher to compensate for services (time) that is not considered reimbursable, but for which attorneys would charge. fees paid to physicians do not compensate for services that do not involve direct face-to-face contact. these services are phone conversations, record reviews, calls to pharmacies, discussion with consultants, etc. attorneys, on the other hand, typically charge for these services. an attorney once billed me for time spent researching the law and consulting with his partners. a physician, on the other hand, cannot charge for time spent researching a case-related matter of therapy.

? is it fair that starting salaries for recent graduates with mbas (perhaps two years of schooling beyond college) in law, finance and information technology exceed by far starting salaries for starting physicians, with seven or more years of post-college training? these other professions' salaries equal and often exceed the income of established physicians at the peak of their careers.


seymour herschberg, m.d., is certified in internal medicine and geriatric medicine, and received a certificate of advanced achievements in internal medicine in 1987. he is based on west end avenue.

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