Internist Brian Jacobs discovered what the doctors who went into practice before 1993 knew almost intuitively: Solo and small group private practice is more profitable ["Going solo: My leap of faith paid off," Apr. 12].
An entrepreneur like Jacobs realizes all the profit from his efforts. He does not have to carry the burden of an administrative bureaucracy or less productive partners. Over the next several years, many physicians will return to this more profitable model. It's smarter for a doctor to be in a low overhead setting, something only possible in a small practice.
David C. Scroggins
Clayton L. Scroggins Associates
I wish the importance of the economic issues Brian Jacobs faced could be emphasized to medical students and residents.
Although no one is obligated to spend more money than he makes, there's tremendous pressure in medical professional circles to do just that. When I was starting up in practice, I believed that line, and ended up paying for itand I'm still paying for it, every month.
Also, as Jacobs says, no one has to accept insurance or capitation. The insurance business, as a middleman in the health care industry, has done everyone a terrible wrong.
Mark A. Pearson, MD
Why do some insurance carriersdespite instructions from their insureds to assign benefits to their doctorrefuse to send payment to us? Several carriers that we do not participate with send the money directly to our patients.
Many patients simply cash the checks. Some even have the guts to tell us that they need the money for more important things like vacations, furniture, and school fees.
Not only is this stealing, it prevents us from collecting payment for services in a timely manner. The delay adds to the cost of doing business, and thereby harms those patients who do forward their checks to us promptly.
I'd like to see medical associations or state authorities look into this everyday practice problem that affects all of us. If they can't resolve the major problems affecting the health care system, perhaps they can fix the small dents.
Kishan C. Agarwal, MD
As a pediatrician I frequently have to face the dilemma of child abuse that family physician Thomas J. Richards wrote so compellingly about in "Sarah's last visit" [Feb. 22]. There were other things Richards could have done. For instance, he might have confirmed his suspicions of abuse by ordering a skeletal series to look for old injuries. The real issue, though, was allowing Sarah to leave the hospital, not knowing who the perpetrator was. In Connecticut, where I practice, a 96-hour hold can be implemented until a safe environment for the child can be assured.
Some people will probably blame the professionals involved for Sarah's death, and maybe there's something to that point of view. But for me, the hardest part of dealing with child abuse is believing that human beings are capable of injuringor even murderingdefenseless children.
Jerome E. Lahman, MD
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Letters to the Editors. Medical Economics 2002;11:8.