Another One Bites the Dust: Dr. T. Leaves Primary Care

I received a disturbing email from one of the doctors in my group, Dr T.  My group is made up of internists and family practice physicians that fill in locally through out the large city we live in.  All the physicians are board certified and have been out of residency for five years or more.  Several of them have private practices and work with ExtraMD as a local locums to augment their salaries.

Dr. T. is one of my favorites.  He is in solo practice in a lower income area.  His office is comfortable, his receptionist kind and the atmosphere is homey.    He works with ExtraMD on his days and weekends off.   Dr. T. is leaving private practice.  He has been trying to make it for 5 years now, getting by with a single receptionist and his wife doing the books.  He just can’t make it work anymore. 

But why?  He has tried mightily to serve the working class poor in his area.  He does most procedures himself, runs a tight ship and economizes where he can.  He bought his equipment second hand, takes little time off and spends nothing on frills.  While working, he developed acute cholecystitis and was hospitalized.  His first thought was to let his patients know he wouldn’t be in and his second was to call me because he had a shift scheduled.  Not one word about how he was hurting.  In addition, his wife followed up with a call just to make sure I had gotten the word.  Sheesh, how many of us care that much?

He is leaving because he can’t deal with the constant financial hardship, of fighting with insurance companies, figuring out how to make the cash go further when the payers are late, and how to break even.  He takes medicare and medicaid, because in his neck of the woods, they are some of the best payers.  He is leaving because he can’t keep up with the endless fighting over claims, and can’t afford to hire someone to do it for him.  He is leaving because he can’t afford to hire someone else to beg insurance companies for pre-authorizations.  He can’t afford the mandated EMR, can’t afford the “team” approach required for the patient centered home, and he fears he will go bankrupt trying to follow other of  the latest government mandates. He can’t keep up with ICD-10.  He doesn’t want to be a manager of a ‘physician extenders’ but wants to practice medicine and help people. Dr. T feels as if physicians have “sold out.”

He is leaving, he says because of “the realization that there is no future for the kind of medicine I practice.”

Dr. T, you will be missed.  I will miss your honesty, integrity and caring.  Your patients will miss a force for good, a comforting presence, and a kind and competent physician.  We all mourn the passing of primary care into the hands of those that DON’T care.

Score: Medical Insurance Companies/Government Regulations: 1  Patients/Physicians: 0.

Good bye, Dr. T and Godspeed.

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4 Responses

  1. How about the latest intrusion? E-prescribing. Medicare giving a bonus for using it now, but in a few years you will be hit with a 2% penalty for NOT using it.

    By the way, where if Dr. T going or did he retire?
    How old is he?

  2. From PookieMD:
    Dr. T is in his 40s. He is thinking about becoming a hospitalist, but hasn’t decided. He will not be retiring.

  3. I totally understand what Dr. T has gone through and his sadness at not being able to practice primary care in the way he was trained to do. Every time one of my patients turns 65 and goes on Medicare, I realize I will not make enough on that patient to cover my costs. With the aging of America and the low rates paid to primary care, it is only a matter of time until everyone goes the way of Dr. T. Doctors are hanging on now because they are going into concierge medicine or dropping insurance. I do not see how anyone could make it on Medicare/Medicaid rates and to think that is his best payer shows just how disadvantaged primary care doctors are. Patients are in for a rude awakening when they find all the doctor are gone. Watch the price of health care in America sky rocket.

  4. That’s a sad story. Here’s a simple question for those in the industry though. Why don’t more of you, including Dr T, open cash-based practices? When the overhead is as low as a single receptionist, and Dr T can have a full patient load, would a cash based, non-insurance practice not do well? Here in Canada we have socialized medicine but there are many doctors opening up cash based practices for services such as laser therapy. I know its not the same in a poor neighborhood, but I see cash based alternative docs like chiropractors or optometrists doing very well with cash based services.

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