Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 6, 1993 TAG: 9306060212
SECTION: HORIZON PAGE: F1 EDITION: METRO
SOURCE: LISA BELKIN THE NEW YORK TIMES
DATELINE: LENGTH: Long
"People see you driving around in a little convertible with M.D. plates and they get hostile," said Elia, who practices at Lawrence Hospital in Bronxville. "It's just a $14,000 Miata, but people see the plates and assume its a $60,000 Porsche. There's such resentment against doctors; why make it worse?"
Across the country, doctors like Elia are coming to terms with the fact that they are losing in the battle for public opinion. While most doctors describe themselves as healers and advocates for the sick, a growing number of patients see them as the overpaid cause of the health-care crisis.
Doctors are reacting to their shifting status in ways large and small. Many say they do not use their title as often, are more conscious of appearing ostentatious, and do not expect the comfortable perquisites of the past, such as choice parking spaces and priority at restaurants.
Some doctors are even trying to fight back. One surgeon's wife, for instance, has formed a group to promote doctors as hard-working and devoted. And an association of Manhattan doctors is in the process of hiring a public relations firm to help polish their image.
That might not be a simple task. Polls show that while most Americans like their own doctor, they believe doctors in general earn far too much. The Clinton administration apparently feels the same way. Hillary Rodham Clinton has said that curbs on payments to doctors, insurers, hospitals and other health-care providers will be a major part of her proposals for change.
"Too many people have made too much money" providing health care and health insurance, Hillary Clinton said in a speech to hospital and nursing home workers. "The status quo exists because there are people who benefit from it. Talk to your friends and neighbors about what you see every day in terms of price gouging, cost shifting and unconscionable profiteering."
Those are particularly harsh words to doctors who entered medicine when it was a profession that brought automatic respect, along with a nice living.
The average primary-care doctor was paid $111,000 in 1991, according to the American Medical Association. The mean for all doctors, including higher-priced specialists such as Elia, who would not disclose his actual income, was $171,600. But, doctors say, their incomes are not the cause of the nation's skyrocketing health-care bill.
"It's shocking to realize how people see us," said Dr. Caryl G. Mussenden, an obstetrician-gynecologist in Washington. "We should have seen this coming. We were just going along, doing our jobs, and we didn't realize that the world was changing."
The hardening image of the doctor-as-bad-guy is all the more frustrating to doctors because, while the public has come to view them as the perpetrators, they have come to see themselves as victims.
First there was the consumer movement of the 1970s, when patients began questioning doctors' judgment - asking for second opinions and demanding to be involved in every facet of their care. Most doctors praised the theory of patient involvement, but believe it has gone too far, with patients often demanding care that they don't need.
The increased scrutiny came hand-in-hand with an explosion in malpractice suits and, consequently, insurance premiums. The 1980s brought the growth of managed care, where insurance companies can veto many treatment decisions.
"Here's what it means to be a doctor nowadays," said a Manhattan internist who asked not to be identified because he did not think it was professional to criticize his patients publicly. "A patient comes in and tells me to do a certain test because he read about it in the newspaper or because his neighbor had it done. The insurer tells me I can't do that test. The patient says, `Do it or I'll sue.' On top of all that, Hillary Clinton is saying I'm greedy. Is this why I went to medical school?"
A poll released last month by the Robert Wood Johnson Foundation found that while 89 percent of Americans are happy with the care they receive from their own doctors, 56 percent believe the health-care system needs a "complete overhaul."
When pollsters asked the causes of the health-care crisis, 35 percent listed doctors. They also blame malpractice attorneys (48 percent) and insurance companies (36 percent). Only 4 percent blame what health-care experts often cite as the main problem: an aging population, overdependence on high-tech equipment and the costs of such social ills as violence, poverty and drugs.
"It's clean and simple to blame doctors, but it's just not true," said Timothy B. Norbeck, executive director of the Connecticut State Medical Society. Nationwide, doctors' fees make up 19 cents of each health-care dollar, he said. Up to half of that goes for office overhead, Norbeck said, meaning that doctors receive less than 10 percent of the money spent on health.
In contrast, he said, 50 percent of all spending on health pays for the care of patients with preventable diseases brought on by lifestyle choices such as smoking, drinking and poor exercise.
Regardless of their protests, doctors are aware that they are not gaining much sympathy. "People don't look at the specifics," said Dr. Marvin F. Kraushar, an ophthalmologist with offices in Westfield and West Orange, N.J. "Whatever we make, they think we make too much."
He was in an elevator recently, telling a colleague how changes in reimbursement rates mean he earns 5 percent less for treating a Medicare patient than he did as a new practitioner 23 years ago, when a stranger interrupted the conversation.
"He said, `Who cares? You weren't so hard off 23 years ago,"' Kraushar said. "But in those same years, my malpractice went from $699 to $13,000 and the cost of a car went from $8,000 to $30,000."
Elia, the Westchester orthopedist, thinks the public has blind spots when it comes to criticizing how much doctors earn. Recently, he says, he calculated his hourly pay rate during 10 years of training and arrived at an average of $1.50 an hour. "No one envied me when I was paying $20,000 a year in tuition," he said, "or when I was working 100 hours a week as a resident. No one was bashing me then."
Some doctors compare their public image to that of plumbers - another line of work where the client often resents paying the bill. The comparison, they said, saddens them.
"We're being made into tradespeople and technicians," Kraushar said.
Of particular irritation to many doctors is the term "health-care providers," used by policymakers, politicians and insurance companies. The use of a single category that lumps physicians with nurses, therapists and home-care companions is seen as a slap in the face to doctors, who traditionally chafe at even sharing their title with Ph.D.'s and dentists.
"They call me a `provider,' as if this is just another service," said Dr. Peter S. Liebert, a pediatric surgeon in Westchester County. "If I'm a provider, I could just as well sell fish."
Many doctors concede that the profession brought some of this backlash on itself.
"For all those years, physicians had this kind of aura about them, and they took advantage of that," said Mussenden, the obstetrician-gynecologist. "They were condescending to patients. They didn't explain things. This is a reaction to that."
Agreed Dr. Ted Tyberg, a Manhattan cardiologist: "Doctors have been fiercely independent for many, many years. It's hard to tell them, after they've suffered and worked hard, to hide the fact that they're doing well in a recession. But they should have been more sensitive. When every penny is looked at, it may be ill-advised to be ostentatious."
by CNB