Surprise! You're on a discount panel, Present at a protest against low payments, Why are doctors reluctant to show their emotions?, What a rush! Medicine at 40,000 feet, Seniors should demand prescription drug coverage, When peer review goes awry
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I identified with the doctors whose experiences were described in "Caveat doctor! Medical discount cards could burn you" [Feb. 19]. I, too, have often wondered how to respond when a patient presents an insurance card and insists that her new insurance book lists us as a providerbut we have never heard of the company.
I think that the least an insurance company should be required to do is notify all physicians listed in their provider books.
Peter Imber, MDPanama City Beach, FL
In "Has capitation reached its high-water mark?" [Feb. 19], Ken Terry said that I "wasn't one of those protesters" at the San Diego County Medical Society's October rally to protest the deplorable condition of the area's health care industry. In fact, as president-elect of the society, I was one of the key planners of the event and an active participant.
As Terry's article indicates, an increase in capitation rates improved my medical group's fiscal status last year, but in Californiaparticularly in southern Californiareimbursement from health plans still stands well below actuarially sound levels needed to provide quality medical care.
This needs to change, which was the point of the San Diego rallyand the reason I was willing to be interviewed for this article. I very much regret that the membership of our medical society has been told that I did not participate in their rally.
James T. Hay, MDSan Diego
Editor's Note: We apologize to Dr. Hay. Editing changed the intent of the author's language, which was to indicate that Dr. Hay had not suffered financially from the change in capitation rates. We also apologize to FP Sam Ho, who was identified in the article as a "former chief medical officer" of PacifiCare. Ho remains with Pacificare; his title is vice president, corporate medical director.
FP Robert M. Hunter Jr.'s poignant account of his father's battle with a terminal illness, "We let Dad end his sufferingand ours" [online exclusive, Feb. 19], struck a chord. I had a similar experience with my dying father-in-law.
I wish that my colleagues were more willing to express emotional torment, especially to fellow physicians, instead of closing themselves up to protect their image.
Barry Rabin, MD, MPHSyracuse
Editor's Note: To read Dr. Hunter's article and other online exclusives, go to www.memag.com, then click on Memag.com Exclusives under the "Medical Economics Library" heading on the left side of the home page. Web articles are listed by title and date of issue.
I read with interest the article "Stuck midstream? Change horses" in your Career Guide [Jan. 22]. Some of the scenarios presented, however, seem to be opportune for only a select number of physicians. I found no mention of military medicine or locum tenens work, two options worth considering.
I have met physicians who work exclusively as locum tenens, traveling across the United States wherever their desires and the need for coverage take them.
As for me, I became a flight surgeon four years ago, and have been able to apply my skills in interesting ways and unique settings. While assisting with the evacuation of a patient stricken with a terminal malignancy in the Persian Gulf, I had a few hours to discuss issues of death and dying while awaiting customs clearance in the back of an un-air-conditioned C-130 on a 140-degree flightline. Not your typical home or office counseling session.
I have learned new skills and relearned old ones, and I get a chance to practice preventive medicine with every physical performed. While I practice in a managed care environment, the folks I need to deal with for approvals are just down the hall, and they salute me! My debt load has been dramatically reduced, and I have much more time with my family, even factoring in deployments overseas. Oh, and it's really cool to find out what happens to your body at 9 Gs, or at 40,000 feet when you remove your oxygen mask. Plus, I get paid to do this.
Kudos for your concerns about Medicare patients not being able to get the drugs they need ["Can physicians order wholesale drugs and resell them to patients?" Practice Management, March 19]. This is a national disgrace. Doctors should tell their older and soon-to-be-older patients to write their congressional representatives and demand passage of a Medicare coverage plan.
Of course, before this happens we have to find a way to prevent drug companies from bribing our representatives to forestall such legislation. In the alternative, seniors should demand that Congress give them the same health care benefitsincluding drug coveragethat it gives itself!
The scarcity of articles in medical publications about bad-faith peer review suggests that the topic is a political hot potato.
I share my colleagues' concerns that in today's difficult medical economic climate, bad-faith peer review is used by competitors to disenfranchise a physician from practice. Immune bad-faith peer review provides an almost foolproof way for competitors to unjustifiably remove a doctor from a hospital or clinic staff without any significant repercussions to the party perpetuating the fraud.
That's why I support the work of The Semmelweis Society, a group of physicians that upholds the integrity of peer review. Founded by a California physician, the society is named after a 19th-century Hungarian obstetrician who was scorned by his peers for arguing that doctors spread infection by not washing up between patients. Sadly, the organization still gets calls from excellent physicians who, having been subjected to sham peer review, are deprived of their hospital privileges for economic and political reasons.
We're alarmed at the proliferation of so-called "external" commercial peer review firms, some of which exist solely to generate purchasable opinions for use by the hospital in its actions against a medical staff member.
It's our aim to assist medical societies in making peer review stronger, better, and fairer.
Edwin A. Day, MDThe Semmelweis SocietyLafayette, LA
Address correspondence to Letters Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to email@example.com, or fax them to 201-722-2688. Include your address and daytime phone number. Letters may be edited for length and style. Unless you specify otherwise, we'll assume your letter is for publication. Also, let us know if you don't want your e-mail address printed with your letter.
Gail Weiss. Letters to the Editors. Medical Economics 2001;8:19.