To the Editor:
Re “More Doctors Giving Up Private Clinics” (Business Day, March 26):
I differ with the assumption that a large health care organization ensures a “higher quality” of care. As the article observed, “the intimacy of longstanding doctor-patient relationships” is disappearing. In institutional settings, “people” become “patients,” waiting long hours to see their doctors and, when finally seen, are examined by physicians who barely know their names.
To “patients,” quality means being seen and heard as a person. It’s when a doctor sits down and listens to their complaints, and has time to palpate a tender belly, to listen to a heart, to check the pallor under the eyelids and, only then, refer them for tests.
As a midwife who provides home birth services, I see women who want to feel respected in health care. Many have had birth experiences in hospitals managed by physicians in large groups, who use a by-the-clock approach to labor management, leading to labor inductions and frequent Caesarean sections.
Our health care innovators need to find a way to support a system that is financially viable without resorting to an assembly-line approach. People who feel respected are less apt to sue. Keep “the human” in the equation, and I believe that malpractice suits will decline, reducing the fear-based style of health care.
Marcy Tardio
Brooklyn, March 26, 2010
•
To the Editor:
“More Doctors Giving Up Private Clinics” is a sad commentary on the state of medicine in 21st-century America. While it’s true that there can be great economies of scale when physicians merge their private practices into large hospitals and health systems, many of my colleagues have had quite negative experiences in such systems.
The primary-care physician is often the “low man on the totem pole.” His or her practice needs are frequently left to languish as administrators cater to the highly paid specialists who bring their reputations, not to mention highly reimbursed procedures. This is despite numerous studies that demonstrate that those patients who are cared for by a primary-care physician have lower health care costs, fewer hospitalizations and a healthier life.
Rather than sublimate the very “primacy” of primary care by selling ourselves to a large health maintenance organization or hospital system, my partners and I have charted another course by forming the pediatrician-owned and pediatrician-run Allied Pediatrics of New York. Most of us continue to operate in our original 18 neighborhood offices. Now a group of 75 pediatricians, we have been able to use our size to lower our costs for claims processing and medical and office supplies.
We’ve done this in order to preserve our physician-owned, private practice of medicine.
Gary S. Mirkin
Chief Executive
Allied Pediatrics of
New York
Great Neck, N.Y., March 27, 2010
•
To the Editor:
As a practicing physician in central Vermont, I work in a small practice owned by the local community hospital. I enjoy the benefits that come with the use of a hospital system; being on call is restricted to out-of-hospital telephone consultation.
In no way does this compromise the quality of health care I provide. I provide individualized care and even make house calls on a regular basis.
While big is often not better, the distinction between private and hospital-owned practices misses the point. Quality care is provided, or avoided, within either setting.
Bob Schwartz
Chester, Vt., March 26, 2010
•
To the Editor:
In “More Doctors Giving Up Private Clinics,” the chairman of the board of trustees of the Indiana State Medical Association is quoted as saying: “When I was young, you didn’t blink an eye at being on call all the time, going to the hospital, being up all night. But the young people coming out of training now don’t want to do much call and don’t want the risk of buying into a practice, but they still want a good lifestyle and a big salary. You can’t have it both ways.”
It is unfair to publicly question the ethics and expectations of resident trainees without acknowledging the dynamics of medical training today: the huge loan burden of recent medical graduates, the exponential increase in hours spent on medical administration over actual medical care, and the ever-shrinking payments that have forced private practitioners to close shop out of necessity rather than choice.
And besides, the simple lack of desire to work 80 hours a week — many of those hours on 30-hour shifts without days off — for barely more than minimum wage is reasonable enough in and of itself.
After all, medical residents — just like patients — are people, too.
If the association’s chairman were starting over as a resident today, these modern complications would undoubtedly make him “blink,” if not reconsider his career altogether.
Jotin Marango
San Francisco, March 26, 2010
The writer is a doctor.