Physicians pay price for defying convention

Colorado Springs Business Journal, Oct 7, 2005 by Marylou Doehrman

There is art to medicine as well as science, and - warmth, sympathy and understanding may outweigh the surgeon's knife or the chemist's drug.

-Louis Lasagna's 1964 translation of the Hippocratic Oath

The median income for family doctors in the United States in 2003 was $145, 541, according to the American Academy of Family Physicians. Drs. Susan McMaster and Joel Klein take home about a quarter of that amount.

The academy deems the number of patient visits as the strongest influence on physician income. An AAFP survey of family doctors nationwide in 2004 showed that high earners saw an average of 122 patients per week; low earners saw 84.

Revenue is the trade off for doctors who spend time practicing warmth, sympathy and understanding.

McMaster, who is board certified in family practice and the owner of Fore Seasons Wellness Center, sees about 30 to 50 patients per week. Klein, who is board certified in family practice and holistic medicine, owns the Klein Center for Holistic Medicine, and averages about 30 to 35 patients a week.

McMaster spends about 45 minutes to an hour with new patients; Klein about 60 to 90 minutes. Klein spends an average of 30 minutes on follow-up visits with patients, and McMaster estimated her follow- up visits run 40 to 60 minutes.

The average time doctors spend with patients increased from 16.3 minutes in 1989 to 18 to 21minutes in 1999, according to the latest statistics published by the New England Journal of Medicine, said Jason Pitts, practice administrator for the Family Medicine Center.

Pitts questions the actual face-to-face time. The codes for billing include time spent on the paper trail.

I would assume a larger part of those 21 minutes is spent on administrative work, Pitts said. I am assuming the administrative burden on physicians changed with managed care.

The administrative burden of managed health care is about a complex world and a need for documentation, much the same as Medicaid or Medicare, and especially in relation to potential malpractice suits, said Daryl Edmonds, president and general manager of CIGNA Health Care of Colorado.

CIGNA has been recognized by the National Committee for Quality Assurance as one of America's Best Health Plans.

I (believe) what CIGNA has done is document improvement year after year when it comes to quality care, Edmonds said.

Others say quality care is compromised with overbooking practices, a result of a managed care system.

McMaster and Klein agree: Overbooking patients and hurried patient/doctor visits have become industry standards.

Dr. Kenneth Ludmerer, who wrote Time to Heal in 1999, cites capped payment systems and productivity requirements as reasons why doctors overbook to fulfill salary needs.

Most doctors schedule in 10- or 15-minute increments, McMaster said. But they don't book accordingly. If true to the 10-to-15- minutes time frames, the staff would book between four and six patients per hour, she said. Instead, they book 12 people in one hour.

Overbooking patients is getting worse, Klein said. It's a self- perpetuating cycle, while insurance companies cut reimbursement rates.

Klein's goal is to bid farewell to the four insurance plans he accepts in favor of a cash-only practice.

I've made a conscious choice to opt out of the rat race, and it means making a lot less money. He said his income will increase this year to about a third of the national median.

His practice is concentrated on blending alternative and conventional modes of treatment. He supplements his income by selling good, quality vitamin supplements that aren't available off the shelf.

McMaster also is supplementing her income, which is lower than the average Wal-Mart worker, by offering on-site alternative therapies, such as massage, acupuncture, reflexology, facial treatments and Consegrity medicine, which focuses on an individual's energies, affecting cause as opposed to symptom.

McMaster also has narrowed her practice to 50 percent female health and 50 percent geriatrics.

Klein and McMaster have been practicing medicine for more than 20 years. Both say they pay a price for doing it their way.

Their way, Klein said, is being a healer and not a biomedical technician. Conventional medicine can become the ultimate enabling system - protecting people from the consequences of their own behavior. Most of the money (in health care) is made from people being sick.

-Marylou.doehrman@csbj.com