Dr Allen, an internist, who had a successful practice for over 10 years and even owned his own office building, was getting tired of all the hassles of private practice. He was tired of running an office, supervising personnel, doing medical billing, and a host of other things required to run an efficient office. He was tired of the HMOs telling him what to do. One day he was approached by an HMO who offered to buy his practice. He could then just practice medicine and not worry about all the things he did not want to worry about. They offered him a two-year contract at three-fourths of his previous income to be re-negotiated at that time. Since he didn’t have to worry about the administrative problems after hours, he thought this was a good deal.
Dr Allen was so elated with his new position he told all the tenants in the office building he owned that he was leaving his practice for the security of working for a very profitable insurance company. He advised them to do likewise. He assumed they could do that in his building.
Last month, rather than renegotiate a new contract, the HMO gave Dr Allen and 19 other of his associate doctors a notice of termination. Dr Allen, who felt he had lifetime security two years prior is without a job or income and has no practice assets. He has been treated like any blue collar worker. Would he go back to the bank and obtain another $50,000 practice loan to start again? Or would he just get a “job?”
This story is being repeated across the country every day. The once noble professional, which should never become beholden to anyone beside the patients we serve, is now beholden to an insurance company or HMO or hospital that looks at the bottom of the financial line and never at the patient’s health.
There is only one security for a physician and that is owning his own practice. In a free society, we should have no fear for we will always be able to attract patients. Now patients have to go to a specific doctor for reasons unrelated to their medical skills because their HMO has a contract with that particular physician.
Last week I had my annual physical examination. My doctor confided in me that he had just finished with a patient who needed an operation. After much soul searching, he felt his obligation to his patient exceeded that to his HMO. He told the patient that she needed an operation but he could not in good faith recommend any surgeon on her HMO panel. She would have to make her own choice. He understood the risk that could eliminate the 25% of his patients from that HMO should she inform them of his statement.
We have too few good men and women who still feel the obligation to those that seek their care rather than to society. When we are responsible to society and not to our patients, we will be no different than Napoleon III or Otto von Bismarck in the nineteenth century who used state control of patients to bolster their regimes, or Hitler who used physicians to choose which patients had lives worth living.