(c) Arizona Capitol Times. Reprinted with permission.
A medical professor says bureaucracies - not physicians - are practicing medicine in Arizona, and a state physicians' organization says it will propose legislation to help doctors deal with health insurers.
"Government and insurance companies dictate every part of medical care now," said Dr. Michael Sborov, associate professor of clinical anesthesiology at the University of Arizona College of Medicine, "and their influence and policies have resulted in bureaucracies that are out of control ?"
He said physicians are leaving Arizona because HMOs and other forms of managed care have destroyed the doctor-patient relationship, doubled the time a physician spends on paperwork and significantly increased the costs of running a medical practice, shoving many doctors into bankruptcy.
Meanwhile, Tom Economidis, executive director of Arizona State Physicians Association, said in a letter published in the Tucson Citizen on Dec. 27 that the association plans to seek passage of a "providers' Bill of Rights."
"Although this action may not significantly change the system, it will help inform physicians of the inequities that currently exist in contracting with health insurers," Mr. Economidis wrote. He was not available for an interview.
Chic Older, executive director of the Arizona Medical Association, said several factors, including poor reimbursement from insurance companies, have led to a shortage of physicians in the state.
"They're not coming here" because of the increasing number of underinsured, uninsured and illegal immigrant patients, he said. Mr. Older's position is supported by a 2001 Goldwater Institute study, which found Arizona's adjusted ratio of physicians to population in 2000 - 185 doctors per 100,000 people - to be lower than recommended by The Bureau of Health Professionals and the Graduate Medical Education National Advisory Committee.
The study concluded Arizona is unattractive to physicians.
"The [physician-patient] ratio is lower in Arizona because of factors that are outside the control of patients, physicians, insurance companies and even the state government," the study concluded.
"All physicians in all states are being treated like indentured servants, having to provide uncompensated care for the uninsured and having to work in emergency rooms without recompense because of federal regulations," the study said. "But in Arizona, these factors are exacerbated by the state's high percentage of uninsured patients, which is primarily the result federal immigration policy. In a very real sense, federal policy has put a hidden tax on physicians. This, in turn, results in fewer physicians being attracted to the state."
Gov.-elect Janet Napolitano has called for the federal government to help with the state's expenses for emergency room services for the uninsured and medical care for illegal immigrants from Mexico. She said she would work to attract all types of health care workers to Arizona, especially nurses.
Doctors Retiring Sooner
Adding to Arizona's doctor shortage, Mr. Older said, is the trend toward physicians retiring much sooner that their counterparts 20 years ago because there are no incentives to remain in practice. Physicians used to work into their mid-60s or early 70s because they felt they were "doing something for mankind," he said.
"That's not our society anymore," Mr. Older said. "Second opinions are standard. The business aspects of medicine overshadow the medical aspects," including high malpractice costs for many specialties.
Dr. Sborov said retired physicians could still do something more for mankind - reform the health care system.
"As a group, retired physicians have nothing to gain financially from reform of this mess," he said.
Dr. Gonzalo Sanchez of Tucson, a retired neurosurgeon, agreed. "As retired physicians, we can contribute and play in the political arena, like anyone else. We are no longer indispensable. It is the practicing physician who is, and that is where the real power and leverage are," he wrote.
State Sen.-elect Carolyn Allen, R-Dist. 8, said the health care system is in crisis, and HMOs "have failed to deliver."
"The capitation of [doctors' fees]-they're ultimately paid not to see you-has harmed the patient," said Ms. Allen, who will chair the Senate Health Committee. She recently underwent $700,000 worth of medical treatment and said Dr. Sborov's description of the health care system "hit the nail right on the head."
"I don't have the answer," Ms. Allen said, [but] "the American public will rise up, and it will take a political toll."
Managed Care A 'Parasite'
Historically, managed care began replacing fee-for-service medicine 20 years ago because national health care costs were rapidly increasing. Dr. Sborov calls managed care a "parasite" and said everyone's health care premiums go to support a bureaucracy designed to deny care and maximize profits.
The nation's HMOs and health insurers reported a 25 per cent increase in profits in 2001, earning $4.1 billion for the year, according to Weiss Ratings, an independent provider of financial ratings and analyses. The research firm also reported HMO profits for the first quarter of 2002 were up 162 per cent.
"Premium rate increases, insurer consolidation and elimination of unprofitable subsidiaries continue to boost industry earnings," said Melissa Gannon, vice president of Weiss Ratings. "The other side of the coin is that consumers have been straddled with rising health care costs and, in many cases, reduced services, a trend likely to continue."
With 172,000 members in Arizona, Aetna Health showed the largest recent increase in earnings among HMOs in the state. The insurer reported $14 million in net income for the first three months of 2002, compared to $400,000 for the first quarter in 2001.
Aetna spokesman Rochelle Cunningham said the company has taken a number of steps to improve relations with physicians, including elimination of pre-approval requirements for many common procedures and an electronic claims payment system. She said Aetna also removed requirements that physicians be members of all the company's managed care programs, and it has revamped its case management program to make it easier for physicians to work with the company.
"I certainly don't think you can lump commercial managed care with AHCCCS managed care, said Frank Lopez, spokesman for Arizona's AHCCCS program. "Our system, we believe, is much more effective, both in cost, in the services we offer and in the way we run the program."
AHCCCS is the state's managed care Medicaid program for residents at or below the federal poverty level.
Dr. Sborov said health care financial problems began with the advent of Medicare in 1965. "That cost-plus system resulted in a disconnection of supply-demand balances and literally doubled the number of hospitals over the ensuing 10 years, more than quadrupling the costs to the country," he said.
John Rivers, president and CEO of the Arizona Hospital and Healthcare Association, said the health care system is flawed, but still the best in the world.
Anger and Solutions
"Dr. Sborov is unquestionably expressing the frustration and anger of many physicians today," Mr. Rivers said. "But I don't think that lashing out in anger is going to help bring about solutions. We need to dedicate our energies to thoughtful problem solving, aimed at each of these flaws in our present system.
"It's important that we not lose sight of our ability to be a constructive instrument for change, rather than just throw in the towel and walk away from what is still the finest health care system in the world."
Dr. Sborov said, however, "I feel I have to apologize to the next generation of doctors for the mess that my generation of physicians has left as a legacy for our patients and colleagues.
"It is clear that health care in this country is an abysmal mess," he said.