Stem cell transplants. Human genomics. Nanotechnology. Virtual surgery.
Today’s triumphs of medical science are outshined only by the glittering promise of tomorrow’s breakthroughs, many of them developed right here in San Diego, where world-class research institutes like UCSD, Salk, the Scripps Research Institute and the Neuroscience Institute dot our coastline like strewn jewels.
Yet even while unimaginably promising vistas open up before us, the foundations of medicine have been systematically eaten away by the destructive forces of managed care. At a time when California physicians should be exulting in our newfound ability to help our patients, we feel powerless, depressed and ready to leave the state, as shown in a new survey of California physicians powerfully titled “And Then There Were None,” just released by the California Medical Association.
Among its findings, this survey shows 42 percent of respondents plan to leave medical practice in the next three years. Another 12 percent plan to reduce time spent in patient care. Some 58 percent report trouble recruiting new physicians to join their practices. Physicians still get pleasure from helping patients , some 67 percent in this survey , yet 75 percent of respondents are unsatisfied with medical practice. Two-thirds of us advise our children not to choose medicine as a career.
Where did this gloom come from? California has one of the highest rates of penetration by for-profit HMOs in the country. These for-profit insurers function like a Ponzi scheme, promising high rates of return in health and well-being, while siphoning off cash to pay outrageous executive salaries, ever-growing administrative costs and stockholder profits. “PonziCare” providers survive by shortchanging doctors, hospitals and nurses for their own financial gain while federal anti-trust laws make individual doctors powerless before the cartel of for-profit insurers.
Difficulty Recruiting New Doctors
My friends in anesthesiology tell me that the only good doctors they can recruit to San Diego are either people with family ties to the area, or else people who already have made their fortunes elsewhere and want to “semi-retire” to San Diego.
Dr. Phil Wise, a highly respected local urologist, recently noted his anesthesiologist had been on call for 30 hours straight, then had another exhausted anesthesiologist while he covered the operating room on July 4. But don’t take long to ask Phil about it; he’s moving to Michigan, where urologists make five times the average urologist’s salary in San Diego and, more importantly, have some quality time with their families, freed from managed care hassle and the marathon schedules it produces.
In recent years, San Diegans have seen hospital closures (Mission Bay, Harborview, Scripps-East County, Sharp-Cabrillo, Clairemont, Physicians and Surgeons, Vista Hill, Southwood) and major doctor groups go bankrupt (Palomar-Pomerado IPA, Paradise Valley IPA, Family Health Network, Family Practice Associates).
‘Prescription For Change’
What can be done to save San Diego health care? The San Diego County Medical Society has proposed an eight-point plan for transforming health care called “The Prescription for Change.” This effort was spearheaded by SDCMS secretary Dr. Jim Knight.
“The Prescription for Change” offers a new, consumer-oriented approach to health care, where people will own their own insurance instead of having it owned by their employers. This will require changes in federal tax law, which currently favors employer ownership, but would result in improved efficiency and better control by the consumer of their own health destiny. By cutting out administrative fat from the for-profit HMOs, this new plan would leave enough dollars to cover the uninsured, in a model that would permit small doctor groups and vertically integrated plans like Kaiser Permanente to survive side-by-side.
Here in San Diego, we have seen the health care system begin to unravel. As more hospitals close, remaining emergency departments are overwhelmed, and intensive care beds are now at a premium. The nursing shortage is now becoming a doctor shortage. Morale hangs by a heartstring. Quality health care also hangs in the balance, and with it the San Diego economy, which requires a healthy, productive work force.
Grisolia is the current editor of San Diego Physician and is a neurologist in private practice.
