Letter to the Editor

Where have all the doctors gone?

Tuesday, September 9, 2008

Dear Editor,

I'm sitting here abashed at how perturbed I recently was when I had occasion to visit a doctor.

I guess we can be thankful we live in McCook or perhaps a smaller nearby town which has general practice doctors to serve them.

My experience was that I had such a short visit with the doctor and he left the room and the nurse came in telling me my visit was ended, whereas I wanted to ask a couple of more questions. I was told all I could ask was two things; if I wanted to know more, I had to make another appointment. I had spent less than 15 minutes with the doctor. Why? I was a very "unhappy camper."

I just received my AARP bulletin, which gave some insights to the "why." I'd like to share a few things in the article, if I may.

First off, the number of doctors going into primary (family practice) medicine has fallen by half. The findings are particularly related to older people; however, the principle still applies. As the population ages with the first wave of 78 million boomers due in 2011, the experts say we are already in a crisis for doctors for primary care. Let's expand on that a bit.

The president of the American College of Physicians reports as follows: "The reasons why primary care doctors are retiring early and new ones aren't replacing them is pretty much the same. Their earnings on average are half or a third of those of doctors in many specialities, yet their workdays are longer and overhead higher. Hours spent on paperwork and phone calls for authorizations demanded by insurance companies reduce time spent with individual patients -- so does the pressure to take on as many patients -- so does the pressure to stay in business. New medical school graduates realize this. The number going into family medicine declined by more than half from 1997 to 2005. By 2006, only 13 percent of first-year residents in internal medicine said they intended to pursue it in general practice.

One internist tells a little as to the situation. He says that when his father was in medical practice, there were plenty of physicians and they had time to see and get good relationships with patients. There was little paperwork and overhead was less than 40 percent of every dollar they took in. Now it's about 65 percent, of which 40 percent is spent dealing with insurance companies.

He says he doesn't blame doctors for choosing other specialities with defined hours, higher salaries and less hassle. Hence his quotation, "Because fees are fixed by Medicare and insurers, the only way primary care doctors can generate more revenue is to take on more patients, which means spending less time with each ... often no more than 15 minutes. The commonest complaint you hear from patients is: 'I don't have enough time with the doctor.' They're right. You can't take good care of your people with chronic conditions in 15 minutes."

Enough comments from the Bulletin. I must admit again, I was one of the complainants. Sorry, I'll be more patient next time. Again, be thankful we have the care that we have. They say some people in cities have had to wait two years to see a specialist due to having to have a referral from a primary care doctor, which sometimes they do not have. Some doctors have refused to attend medicare patients.

Hats off to our family practice doctors.

Esther Wissbaum,


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