Letter from Dr. L in Illinois

Obamacare will lead to a U-turn in life expectancy. Hugh Hewitt gets a letter from an Illinois doctor, here's all of it: 
From Dr. L in Illinois:

Dear Hugh,

As a brief background, I am a board certified medical oncologist in private practice with a 22 physician group in Chicago and the adjacent suburbs. We see patients in ten hospitals, seven offices, and see nearly 5000 new patients per year. I finished training in 1993 and joined my practice that same year. I am a partner and practice manager, responsible for both patient care and 'nuts and bolts' financial and organizational management of the practice, along with our other officers.

This weekend, the American Society of Clinical Oncologists will hold their annual meeting in Orlando Florida. While it is directed at the American cancer treatment community, it has become the de facto World cancer meeting. Much of that stems from the plethora of companies based in the US that have brought to the market a multitude of groundbreaking drugs, developed in US academic centers and thereafter applied to the American population at large who suffer from cancer.

Reading the Meeting Proceedings between [visits with] patients in my office (not my turn to go this year), I've rarely seen an annual report that held such promise. There are a multitude of both new drugs, and new applications of established drugs that promise to accelerate the 1-2% annual drop in cancer mortality that we've seen since the late 90's. It's a better time to have cancer than ever before---if, of course there was ever a good time for such misfortune.

Alas, I think many of these advances will be stillborn. And yes, I expect the Obama administration to be the instrument of its destruction.
I will be the first to point out that there is enormous waste in American medical care. There's plenty of blame to go around; physicians are rarely capable economists, and rarely consider the cost:benefit ration of that extra test or that extra day in the hospital; "Nothing's too good for my patient" is laudable, but is also a screen behind which too many of my colleagues hide their intransigence. Greed is hardly unknown, though I believe far less widespread among physicians than their various suppliers. I admit to something less than objectivity on this. Medicare guidelines are often the perfect example of the adage "there's no problem that government can't make worse and more expensive".

Despite the fact that perhaps 15% of healthcare expenditures go to physician compensation, it's the convenient target. Hospitals, private payors and Pharma are very effective in the political arena. The AMA, looked upon by the uninitiated as the'voice of American medicine' is nothing of the kind. We, frankly haven't the time, nor often the inclination to participate in the political wrangling; many of the 'thought leaders' in medicine are academics, whose goals are often diametrically opposite the more than 80% of physicians who practice in the private, nonuniversity sector.

Every analysis of oncology suggests that we have a 10-30% deficit of trained physicians staring us in the face by 2020. Every academic analysis suggests one or another program, and bemoans the difficulty in attracting qualified medical students and residents to oncology. It's quite simple, really: very hard work, and declining income. Private practice physicians have seen a fall of approximately 30% since 2004. Worsening economics are right around the corner. Given the extraordinary expense of chemotherapy and supportive therapies, combined with reimbursements that just exceed a wash, it will become impossible to deliver outpatient care in more than half the venues in the United States quite soon. And then, simply put, the senior physicians will quit.

Make no mistake: most of us enjoy the opportunity to do what we do. After all, we cure cancer for a living. Hard to top that on the "Useful Professions" scale.
We also, however endure just the stressors and personal strains that you might imagine. We trade time, and inconvenience, for money. Just like everyone else in the private sector, only more so---after ten years of training after college. With the prospect staring us in the face of working harder than the average internist, and earning less: well, if I were 58, and my kids were grown and my mortgage paid: well, I'd call it a day. At 48, I'm already working on an exit strategy by 55 in anticipation of this scenario.

I could go on, but this note is far too long already. Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They'll scarcely need to ration care: there just won't be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.

Sincerely,
Dr. L. MD FACP