This is the first letter I’ve ever written to a political figure, and I pray that someone on your staff will bring this letter to your attention. I have been a physician for close to 30 years. I am a second-generation pediatrician struggling to keep an independent solo practice alive. Not one politician has addressed what I feel is the major threat to health care: the physician-patient relationship. Without this, there is no quality of care no matter what you do. Physician-patient relationships require time with the patient.
Most of my diagnosis is derived from my patient-parent interview and a hands-on exam of the child. You cannot possibly read a cookbook of medical questions and treatments and have the same result. The current insurance treadmill model of primary care makes this impossible. There is a hemorrhaging exodus of well-trained physicians unwilling to jeopardize this patient relationship. Insurance companies are pushing the small man (or woman), like myself, out and replacing us with “health care extenders,” or whomever they can place in a white coat for less money. This is at the expense of the patient and the profit of the insurance company.
I have done everything by the book. During my 12 years of postgraduate training, I earned a degree in chemistry and biology, a masters degree in microbiology, and MD degree from Georgetown University Medical School where I also completed my pediatric residency. I am board-certified and recertified. I have a spotless record and a loyal patient following. I am not saying this to fluff my feathers but to emphasize my dedication to my calling. It is not just a job to me. This is what I was meant to do, and I will only do it the correct way.
Coming from generations of physicians, I take my job very seriously. My father was also a pediatrician and started his office in the basement of our home. I know what quality care is, and what it is not. I grew up knowing that medicine can exist without the interference of insurance companies. At that time, people paid a fair price for an office visit and had catastrophic hospital coverage for hospitalization and procedures. (My father was the physician who saved John F. Kennedy’s son, John John. His name is Dr. Ira Seiler, MD. It is a true story accessible through the archives. He also attended John F. Kennedy’s inaugural ball and parade.)
My father instilled in me a respect for the patient-physician relationship without which there is no quality care. Insurance companies have continued to decrease our payments knowing that we will need to see more patients in a shorter amount of time to make up for the decreasing reimbursement rates. You do not have time to foster a relationship. This may result in more medical mistakes but ultimately bring in more money to the pockets of the insurance company. This is a very dangerous game, and I have refused to play it. For that, I have been threatened and penalized.
I am trying desperately to keep my small practice alive. I spend at least 30 minutes with each patient; they have access to me via my personal cell phone 24/7. I have no wait times, will always see a sick patient that day, try to avoid ER/urgent care visits by seeing the patient after hours myself (to avoid medical mistakes since after hours clinics usually are not staffed by pediatricians and I end up correcting the mistakes at 3 a.m. for free anyway). Many times I’ll bring a chart home and research a condition and if I don’t know something I will find out. And for this, I am listed as a physician that is not cost effective, or in other words, I spend too much time per patient, which results in less revenue to the insurance company.
Medicine is not a 9 to 5 job; it is a calling, and my greatest fear is that no one is going to want to do this job for a salary of $6,000 a year, which after all my office expenses, I earned. And that is not from poor business skills or lack of patients. It is from decreasing reimbursement rates and higher overhead. This is why most physicians have left private practice to join hospital settings or larger groups. Many people don’t know that I have to pay not one but two malpractice payments in the state of Pennsylvania, licensing and board fees, rising medical and office supply fees which total $15,000 a month. I have one nurse, a receptionist, myself and one part-time relief doctor who is amazing, having trained at both Duke and Northwestern. I have not taken a paycheck in 8 months.
I continue to do this job because that’s what I was meant to do and I don’t want to give up on my patients. I should not be subject to prejudice for practicing good medicine. I am scared who will take care of these children or my family when those like me are finally forced out completely.
I am not a health care provider. I am a physician, and there is a very big difference. I hope that you will think about this in your fight to fix the problems in health care, because it’s more than just repealing Obamacare. It is putting medicine back into the hands of the patient, consumer, and the physician. Insurance companies are for-profit companies, parasitizing my expertise and exploiting your savings. If they are getting paid for my expertise and training, maybe the CEO’s of these insurance companies should try doing the surgeries and treating the patients themselves.
Sharon S. Jellinek, MD
Sharon S. Jellinek is a pediatrician who blogs at Rebel.MD.
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