Memo From The Editor

"Doctor Rage"

Marianne Dekker Mattera

Those words screamed from the cover of the Aug. 6 issue of New York Magazine. The image—a scowling physician, teeth bared, tie askew, and smoke shooting out of both ears—could have left little doubt that doctors are angry. The cover line provided more detail: "Think you're sick of HMO hassles? With their incomes slipping and their status shrinking, M.D.'s are mad as hell. And there's no cure in sight."

Frankly, when I saw that cover, I was delighted that the plight of doctors was finally being trumpeted in the lay press. At least, I figured, the nearly 434,000 readers of New York Magazine would learn what doctors are up against these days.

The six-page article inside, however, didn't quite live up to my expectations. It did present the basics:

• The twin economic spears launched by managed care—lower reimbursements and increased expenses.

• The loss of power so clearly conveyed by the new jargon—all who care for patients in any way, including the doctor, are "health care providers" and members of the "health care team."

• The loss of autonomy—as evidenced by both the trend toward salaried practice and the fact that insurance clerks can countermand a doctor's care decision.

• The devaluation of the physician-patient relationship as changes in insurance companies dictate changes of physician and the $10 copay puts a price on the value of a visit.

But the overall tone of the piece was not sympathetic at all. There were too many references to Mercedes, Cadillacs, and Beemers. Too many cute cartoons portraying the doctor as a rich man who thinks himself maligned. I finished the article wondering whose side the magazine was on.

Maybe hip New Yorkers need an article with a tone like that, but most of the country would be better served by a less jaded picture. And it's up to you to give it to them.

It won't be easy. Most patients think of doctors as people who breeze in and out of exam rooms and make a lot of money. They don't know what you do before you get to the office. They don't know that insurance pays just a fraction of your fees. They don't know that you've had to hire two extra staffers just to take care of the paperwork for the 64 different insurance plans you take.

And they don't know that the typical primary care physician earns less than he did in 1998. (That's what the results of our latest Continuing Survey show.) I'm willing to bet that few of your patients earn less now than they did three years ago. Anyone who did would be looking for another job. And he'd understand why you're unhappy.

Patients are already unhappy with managed care. They can help you fight what it's done to the practice of medicine—if they understand.

Explain it to them. Get a panel of your colleagues together to tell the doctors' story at Rotary Club luncheons or PTA meetings or before the editorial board of your local newspaper or on a local cable TV channel.

Don't talk in terms of lost control and lost autonomy. Talk in terms ordinary folks can relate to. Tell them you haven't had a raise in two years. Tell them you haven't been able to take any time off in three years. Tell them you work 12 hours a day. Ask them what they think it's like to be a doctor, and then tell them.

The message won't get across if it's told by the AMA or even by your state or local medical society. The people who need to understand consider organized medicine as corrupt as big government. But the message will get across if real doctors deliver it.

Is there doctor rage? Yes, but you must be angry enough to let it out—in measured tones and in front of the right people—before you can let it go and use it to do some good.

 

Marianne Mattera. Memo from the Editor: "Doctor Rage". Medical Economics 2001;18:6.