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Most Doctors Aren’t Using Electronic Medical Records: Part 2


Stanley Feld M.D.,FACP,MACE


The common impression is that physicians are resistant to the use of Electronic Medical Records. I believe there are important reasons adoption by physicians is slow.


Dr. Paul Feldan, one of three doctors in a New Jersey practice, said switching to electronic records did not make economic sense for his practice.

Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see fewer patients during the conversion from paper to computer, we don’t get paid.”

Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston hit the nail on the head.

“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay.”

“To fix the market, Dr. Middleton recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States.”

Wouldn’t it be simple if the government and healthcare insurance industry along with input from practicing physicians created the ideal electronic medical record? I believe adoption of an EMR would be rapid under certain circumstances.

I emphasize including practicing physicians of all specialties in creating an ideal EMR. If policy makers happen to ask for physician input it is usually from high profile academic physicians with little private practice experience. Academic physicians do not understand the practice problems of the private practice physicians.

The ideal EMR must contained strong patient privacy rules. Patients should have ownership of their EMR. Patients must have the exclusive decision making voice in how the information is distributed and used. This concept is totally opposite from the newly introduced HR6357 that is rapidly moving through the House of Representatives.

Private practices should be able download the EMR software for free. Customization of the generic EMR could be fitted to the physicians practice style. All measurable entries would be formatted as a relational database. Physicians would pay a minimal transaction fee for each click making the EMR affordable to physicians in all sized practices. All maintenance and upgrades would be web based and downloadable at no cost. (nomadic software as described in the Unfinished Revolution)

The saving to the government, the healthcare industry and the healthcare system would more than offset the cost of providing a uniform and upgradable electronic medical record to all the physicians in the U.S. The system must be easy to download and its use must be intuitive.

It is estimated that the healthcare system would save 5 billion dollars over five years alone if every physician used an e-prescription system. If would avoid many prescription errors due to handwriting misinterpretation.

For some reason government policy makers can not think about physicians needs. Someone must think innovatively. An EMR must be created that provides incentives to physicians to want to convert to an EMR. An EMR would not be used against physicians punitively but rather by physicians educationally.

Instead the government has just initiated a $150 million dollar long term pilot study that will fail because of its design.

“The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives ($58,000 over 5 years) to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.’

I believe the government is making another costly complicated mistake. Winston Churchill was correct. “Americans eventually get it right after they try everything else.” The intent of the study is to test the impact of incentives on the adoption of electronic health records. Wouldn’t it be easier if someone used some common sense and asked private physicians and patients what they need rather than create a study that is destined to failure? The physician incentive is too small and the dangers to the patients and physicians too great.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • John medical records

    It is better to use medical patient record which has good efforts but at the same time they have disadvantages that effects lot to patients as well as doctors.

  • Adam

    By obtaining a copy of immunization records, you can easily benefit in that you know exactly what diseases and conditions you have less of a chance of developing. It is important to also keep up with the updates in order to ensure proper defenses from various types of medical conditions, as well as infectious diseases. And nowadays EMR are becoming very popular among people.

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Most Doctors Aren’t Using Electronic Medical Records! : Part 1

Stanley Feld M.D.,FACP,MACE

Why do physicians seem resistant to the use of Electronic Medical Records (EMRs)? The answer is there are at least three barriers to adoption of EMRs that healthcare policy wonks seem to ignore that must be cured.

The New York Times reported on a survey published in the New England Journal of Medicine that less than 9% of physician in small physician office practices use EMRs? The major barrier is these small physician practices cannot afford to buy them and do not know which EMR to buy.


There are different sized medical practice groups in the United States. However, more than 50% of physicians practice in groups of one to three physicians. The survey points out that the smaller the group the less likely they are to have an EMR.

Dr. Paul Feldan, one of three doctors in a New Jersey practice, said switching to electronic records did not make economic sense.”

I have described the ideal electronic medical record. I have also emphasized that the patient should own the record. Its distribution should be exclusively in the hands of the patient. Technology exists to create a fabulous electronic medical record. The data generated could increase the quality of medical care and decrease medical errors. The result could be an enormous decrease in the costs to the healthcare system.

So why is the medical community slow to adopt the EMR? The government sponsored survey points to two contradictory conclusions.

The New England Journal of Medicine published survey found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care.

Dr. Peter Masucci, a pediatrician in Massachusetts, said shifting to computerized records helped improve his patient care.

The meaning of the concept of quality medical care should be obvious but is complex. The judgment of quality medical care by a computer program is frequently wrong. This, in my opinion, is the major problem with the present Pay for Performance fad. It is an attempt at a judgment of quality that results in a punitive action against the doctor rather than being an educational experience for him or her.

Physicians in private practice have been slow to adopt EMR’s for at least three reasons.

1. They do not have the financial resources to spend $25,000 to $80,000 per physicians to purchase an EMR. The range of cost for an EMR implies differences in quality and capability of the various EMRs on the market. Many physicians have made investments in EMRs only to find them to be deficient in many areas. The initial investment does not include a yearly maintenance service contracts or updates. Many EMRs lack adequate software support. Physicians do not have the skill or want to devote the time to figure out the best deal.

2. A second reason is the lack of financial incentives to purchase an EMR. The EMR might help the healthcare insurance and government accumulate data about physician practices and patients care. It might save money for these stakeholders but there are no assurances that the saving will be passed on to either physicians or patients. The promise of the EMR is it should increase productivity and decrease practice overhead. Physicians should be able to decrease the number of full time employees. In most cases this does not happen.

3. Patient privacy is the third barrier. In reality, at this moment patient privacy is non existent with paper records. If patients want to buy healthcare insurance complete medical histories are required by the healthcare insurance company. An EMR would make it easier for the healthcare insurance industry to evaluate a patient record and restrict a patient’s access to healthcare insurance. The element of mistrust by physicians and patients toward government and the healthcare insurance industry is difficult to erase.

The point of patient mistrust was expressed in late June when a House of Representatives committee introduced new healthcare privacy legislation that does not adequately protect patient privacy. The American Civil Liberties Union was the first to protest.

Leaders of the Energy & Commerce Committee introduced H.R. 6357 this week, and the health subcommittee approved it on June 26. The full committee, as well as two other House committees, now will consider the bill.”

“The legislation lacks provisions to enable patients to review their own files and make corrections, decide who has access to personal health information, or simply opt out, according to ACLU.”

Caroline Fredrickson, director of ACLU’s legislative office in Washington, said in a statement. “If this legislation gets approved, Americans’ medical secrets will be extremely vulnerable to being lost, stolen or sold to the highest bidder.”

I have stated previously that mistrust of the secondary stakeholders by the primary stakeholders in the healthcare system, physicians and patients, must be understood by healthcare policy makers. The issue of mistrust has to be resolved if any progress is to occur in accelerating physician adoption of the EMR.

Both the government and the healthcare insurance industry seem to encourage this mistrust unintentionally by introducing punitive measures to solve the healthcare systems’ problems. These measures simply heighten the primary stakeholders’ cynicism and mistrust.

More on EMRs to follow.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • Scott Smith

    I read your article on electronic medical records and would like to recommend that you and your readers test drive our unique solution. (MMR), a Patient Health Record, put a priority on two issues that are difficult to find together in most PHR programs and EMR systems. First is ease-of-use—all your healthcare providers need is a fax machine to put all your records into your account: each is turned into a PDF image using a proprietary process, which you then file. Second is privacy and security: we have such a bulletproof system that no hackers-for-hire have ever been able to penetrate it. You can share the account with up to 10 members of your family and each one would have secondary passwords to be sure privacy is protected. We also provide a special file that can be accessed by emergency personnel, which can have your critical information, like blood type and drug allergies. MMR is also by far the most feature-rich PHR on the market and is an Integrated Service Provider on Google Health—we have everything from a drug interaction database that red flags contraindications to calendar reminders for doctor appointments and prescription refills. If anyone wants to try this out for 30 days, just use the code TRYMMR.
    Scott Smith

  • Adam

    Yes, what Smith said is right.
    I too have heard about They are offering a good service…

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Herald Tribune Fresh Air Fund Summer Camp 1950

Stanley Feld M.D.,FACP,MACE

In 1950 there were a number of summer camps ringing New York City.The Herald Tribune Fresh Air Fund did great things for the kids in New York City. The Fresh Air Fund’s goal was to give kids the opportunity to get off the hot city streets and enjoy some fresh country air. The sole advertising vehicle was ‘posters in the neighborhood recreation center and police stations. On a hot summer day in June 1950, H.B and I went down to the police station to get applications for summer camp.

After studying the qualifications and dates, we took the applications home to our parents. My father said, “Absolutely not! Are you crazy? There are going to be kids in that camp from the toughest neighborhoods in New York City. You will never live to go to medical school.” My mother was a little more subdued although it was clear she did not want me to apply. ‘

Somehow I convinced them it would be a good learning experience. They proceeded to complete the application. I was accepted and scheduled for a physical examination at an address on 39th Street and 10th Avenue. The significance of that address might not mean much to readers of this blog but in 1950 39th and 10th was a war zone. I had traveled all over the city alone for years at that time but never dared to go to 39th and 10th Avenue.

About 150 kids showed up for physical examinations. Every race, color, and creed from every bad neighborhood in the city was represented. Outstanding were the 12 kids from the Red Hook District in Brooklyn. Their whole street gang was accepted to camp. There were only two kids from the Tremont section of the Bronx. H.B. and me.

My first impression of all the kids was they were big, muscular and mostly black. I was pubescent but scrawny at 5’6” and 118 lbs. H.B. was frightened. I told him not to worry but I was scared stiff. After an hour wait on the hot sidewalk they let us into the store. They told us all to strip. This was not my most favorite task at 12 years old in front of all these big pubescent black kids.They were better endowed than I was. I stripped and passed the physical.

We were told to meet at 10 am on Sunday with a camp trunk ready to depart for camp. They did not tell us the name of the camp. They said they would give the address of the camp to our parents at departure. My mother, father and brother drove me down to 39th and 10th. When my father saw the crew he decided to make a U-turn. My mother convinced him to let me go to the camp.

The bus ride to camp was terrifying. The bus was old. The kids were not well behaved. The counselors did not seem to have control of the crowd. All the 12 year olds were smoking the newly released Chesterfield Kings in order to be cool. I passed. I thought at that moment going to this camp was going to be mistake. It looked like I was going to have a very hard two weeks.

We arrived at camp about one and a half hours later. The camp was a brand new Herald Tribune Fresh Air Fund camp near Bear Mountain New York. Since there were only two of us from the Bronx, I was assigned to the Red Hook Section of Brooklyn’s bunk. I was terrified. The smallest kid in the group was at least 20 pounds heavier and two inches taller than me. The biggest kid was 50 pounds heavier and 6 inches taller. Every one of them talked Brooklyn tough.

Camp was set up so that each bunk competed with other bunks in categories such as baseball, basketball, football, rowing, bunk cleanliness, mess hall chores and a few others. I was a very good baseball and basketball player. I was a good football tight end. I gained the respect of my bunkmate quickly. After the first day, I found the kids in my bunk to be tough but great. We all stuck together, worked as a team to excel and beat the other bunks in almost every category. All my bunkmates cooperated with each other. There was none of the fighting between each other and with others that I had expected. At the end of the two weeks four of the twelve of us in the Red Hook bunk received honors. We were invited to be junior counselors for a group of 8-10 year olds coming in the next two weeks.

To my disappointment, I never made it because on the last day of camp I got pink eye a very contagious form of conjunctivitis. It disqualified me from being a junior counselor.

The moral of the story is never judge a book by its cover. The Herald Tribune Fresh Air Fund Camp was a very educational and rewarding experience. It taught me a very important lesson in team cooperation and leadership. I have retained this lesson my entire life.

Thank you Herald Tribune Fresh Air Fund.

The Fresh Air Fund established in 1877 is a worthy cause and a fabulous model for creating unforgettable memories and fresh possibilities for living.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • sb

    I sm now 64 years old. When I was about 10 years old my mom sent me to camp through the herrald tribune fresh air fund. We had a counselor named timmy who physicaly abused us daily.

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Politicians Are Hard To Trust: Part 3

Stanley Feld M.D.,FACP, MACE


Why would the Senate initially vote against S. 3101 and H 6331? Why would President Bush threaten to veto it?

Nine Republicans who had voted against cloture last week pivoted to produce a potentially veto-proof 69-30 vote in favor of linking another temporary physician-pay fix to Medicare Advantage (MA) modifications already passed in the House by a 355-59 margin.”

The answer is President Bush is committed to the transfer of Medicare to the healthcare insurance industry (privatization of Medicare). He is subsidizing the healthcare insurance industry through the Medicare Advantage program at the expense of physicians’ reimbursement and to the disadvantage of seniors. The reimbursement reductions are below cost. Seniors are one of the primary stakeholders in the healthcare system.

President Bush’s advisers have convinced him that he has to get rid of the Medicare entitlement program. Medicare was invented by the Democratic Party and initiated in 1965 by President Johnson. It has been pretty clear for a while that Medicare’s business model was faulty. It is predicted to result in a 100 trillion dollar deficit by the time today’s young children become eligible for Medicare at the present level of spending.Source: Social Security/Medicare Trustees Reports 2008. The Medicare payment structure is seriously flawed. The two biggest flaws are the DRG system and the payments to the healthcare insurance industry.


Rather than being innovative and repairing the healthcare system by, eliminating waste, inefficiencies, and adverse incentives in order to protect future seniors with guaranteed, effective healthcare coverage, President Bush and his administration have opted to subsidize the healthcare insurance industry, a very powerful secondary stakeholder in the healthcare system.

Unfortunately, Senator McCain is thinking like President Bush. He has pledged to eliminate entitlements. Senator Obama is focused on universal healthcare and a single party payer.Obama’s plan will simply expand the Medicare deficit and yield more profit for the healthcare industry. I have discussed constructive policies that are needed to change the paradigm of the healthcare system. Neither candidate has uttered a word about innovative solutions that provide hope for the healthcare system and the citizens using it.

President Bush is handing our healthcare system over the healthcare insurance industry. He is providing subsidies equal to at least three times the present cost of Medicare to the healthcare insurance industry to take the healthcare system off his hands.

With the White House ideologically committed to protecting MA, the outcome of a veto struggle remains uncertain. Republican senators who changed their votes will be under heavy pressure from the administration to support a veto.”

President Bush’s veto was overridden on July 12, 2008 simply by constituent outcry once they understood the consequences of his actions. Much of the healthcare insurance companys’ profits come from Medicare Advantage (≈10 billion dollars per year).

“As the juggernaut for Medicare privatization, the PFFS plans have been staunchly supported by the Bush administration despite per beneficiary costs that are an estimated 17 percent higher than those of traditional Medicare.

Does anyone think this helps anyone except the healthcare insurance industry? The budgeted money is shifted from physicians’ reimbursement to a healthcare insurance industry subsidy. When President Bush’s veto is rejected he will be decreasing the healthcare insurance industrys’ profit from the Medicare Advantage program. I think he is afraid the healthcare insurance industry will be upset and not want to take over Medicare.

Before Medicare bankrupts the country, it must be reformed. However, this is not the way to do it. By putting the healthcare insurance companies in charge will lead to disaster. The way to do it is to provide incentives to the primary stakeholders, not punish them to the advantage of the secondary stakeholders.

President Bush has not even mentioned medical care outcomes and impacts (i.e., is the nation getting what you pay for?). This is the point when it comes to evaluating whether a program that transfers money from the public sector to the private sector will accomplish a public mission.

All of the research says “NO.” Both types of MA plans provide no more care nor any better care than traditional Medicare does, in terms of health outcomes of seniors. There is no justification to continue this Medicare Advantage program, by any definition of “efficiency” or “effectiveness” that the “market-based” conservatives may use. The Congressional Budget Office points out; the current IME adjustment represents a double payment to MA plans, because Medicare’s fee-for-service hospital rates, on which MA benchmarks are partially based, already include an IME add-on.

President Bush has called himself a “compassionate conservative”. I think he is being an unthinking conservative bent on protecting the vested interests of secondary stakeholders and ignoring the perverse consequences to primary stakeholders…

  • texas medicare supplement

    “The answer is President Bush is committed to the transfer of Medicare to the healthcare insurance industry (privatization of Medicare). He is subsidizing the healthcare insurance industry through the Medicare Advantage program at the expense of physicians’ reimbursement and to the disadvantage of seniors. The reimbursement reductions are below cost. Seniors are one of the primary stakeholders in the healthcare system.”
    Obviously, the Medicare Advantage plan is controversial… at best. I can tell you as an agent who sells both plans (Part C and Medicare Supplements) that many of my clients are extremely happy to have the Med Adv plan. The program that’s popular here in North Texas features a $5 Doctor Visit and and $25 for specialists.
    I’m not saying it’s right… I’m just saying there’s not a whole lot of Sr’s using these programs who are complaining. They’re happy with it!

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McCain Non Health Plan: Part 2


Stanley Feld M.D.,FACP,MACE


Last week I listened to a speaker defending John McCain’s health plan. He defended the $5000 tax credit for a family of four. Most people know what a tax credit means but would be puzzled by its direct effect on healthcare. The tax credit means one can deduct $5000 dollars from one’s taxable income.

If the average insurance policy for a family of four is $12,000 a year, how does the tax credit translate into an effective healthcare reform? My answer is very poorly! The real message is abstract and can also be a trick to help employers abandon providing healthcare insurance for their employees.

The claim is the tax credit levels the playing field for the self employed and the employed whose employers provide healthcare insurance for them with pretax dollars. The employer pays for the employee’s healthcare insurance. The employee does not pay income tax on the money spent for healthcare insurance and the employer is able to deduct the premium cost from gross revenue. As healthcare premiums have increased rapidly many employers can not afford the benefit and either stop providing healthcare insurance or healthcare insurance that provides fewer benefits.

Presently if someone was self employed he would buy healthcare insurance with post tax dollars. Therefore, a healthcare premium of $12,000 year for healthcare insurance paid for with post tax dollars would require that he earn $17,142.85 in pre-tax dollars. (12000= 1x-.3x x =12000/.7= $5142.85) John McCain’s tax credit makes up the $5,000 difference. The consumer would have to pay the $12,000 premium with $7,000 post tax dollars or $10,000 pre tax dollars The fallacy in McCain’s tax credit plan is that consumers might not be able to afford the $12,000 per year to allocate that much money for healthcare insurance. The plan would be an advantage to employers and not employees. It would get employers out of providing healthcare insurance for their employees. Additionally, it would not level the pre tax and post tax difference that exists today.

Total pre-tax payment of the healthcare insurance dollar is only one step in the repair of the healthcare system. It is not a healthcare plan. Consumers must have control of the healthcare dollar not the healthcare insurance companies. My ideal medical savings account, real price transparency, support for chronic disease management,malpractice reform, patient and physician incentives to prevent chronic disease, and instant physician payment to eliminate non value added administrative cost must be added simultaneously for healthcare reform to make any progress. A consumer driven healthcare system is the only way to create a competitive marketplace.

John McCain’s plan opens the door for employers to abandon this important employee benefit without adding any value or efficiency to the healthcare system. It also eliminates the purchasing power of employers in negotiating healthcare insurance.

If Mr. McCain becomes president he might sneak in as a stand alone item of healthcare reform (an important element of the total package of health care reform), a law that will result in a disadvantage to employees covered with insurance by their employer. It will create an advantage the employer and the healthcare insurance industry.

A lot of smart people are thinking about the healthcare problem. It is time to think about it in terms of the constitution. We are a nation that whose government is chosen by the people for the people and not isolated vested interests. In the season that candidate are begging us for our vote we need to demand our needs be addressed.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • anonymous

    is it a tax credit or a tax deduction?

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Politicians Are Hard To Trust: Part 2 Patient Power Wins Again

Stanley Feld M.D.,FACP,MACE

When citizens understand an issue they are motivated to act. They can put enough pressure on politicians so they act for the citizens’ vested interest. After all, the United States government was created by the people for the people.

HR 6331 called for a stop to the 10.6% reduction in physicians’ reimbursement and continues current rates for the rest of this year, while providing an additional 1.1-percent increase in 2009 to physicians.

Resolution 6331 flew through the U.S. House of Representatives 355 to 59 last week. It was defeated in the Senate by one vote. Both my Texas senators voted against it initially. The resolution needed only one more vote in the Senate to win. Protests were voiced by citizens in Texas and the rest of the country. The citizen outcry resulted in Senators switching their vote from a one vote defeat to a nine vote victory for senior citizens and physicians. (69-30). Both Texas Senators switched their vote from no to yes.

I hope my quick blog entry about the difficulty contacting politicians helped. I intended to provoke an outcry from many readers. I did. Many showed me how easy it is to contact their politicians and let them know their feelings.

The citizen outcry plus Ted Kennedy showing up for the vote won the day for the citizens over 65 years old and physicians. Both were going to suffer from a negative vote. President Bush still threatens to veto the bill.

However, I believe if he does, his approval rating will sink further, and his veto will be overridden.

If physicians continued to see Medicare patients many would be seeing these patients at a loss. Seniors going to physicians who do not take Medicare would be paying huge out of pocket expenses. Medicare costs would escalate because more seniors would be hospitalized for illnesses they could not afford to have treated. They would wait until they had no choice but to be hospitalized for a costly complication of their chronic disease.

The Senate’s rejection of the bill would have also protected the healthcare insurance industry by adding items in the bill to help the Medicare Advantage program’s growth.


United Healthcare and Humana are betting on the lucrative Medicare Advantage part of their business. The Medicare Advantage program develops doctor networks that are managed by the insurers in contrast to regular Medicare in which members can choose virtually any doctor, who is paid directly by the government.

“One in five of the nation’s 43 million Medicare enrollees are now in the Medicare Advantage program, which the Bush administration says has brought more choices and better benefits to the federal health system.”

My question is, “who can you trust?” Is President Bush really protecting seniors and the U.S. federal treasury or the healthcare insurance industry?


“ Medicare Advantage has become a political target, because — whatever its vaunted enhancements — it costs the federal government 12 percent more for each enrollee, on average, than the regular Medicare system.” “The Congressional critics see the policies as an extravagance whose main beneficiaries are insurers like Humana and UnitedHealth.”

Wake up America! Physicians only receive 20% of the Medicare dollar. Physicians are the people providing medical care, not the healthcare insurance companies.

Americans made the Senate act positively in one week by their outcry. We should make Congress go after the stakeholders that add little value to the healthcare system. The healthcare insurance industry consumes at least 50% of the remaining 80% of the Medicare dollar.

“Under Medicare Advantage, the insurer provides coverage through a network of doctors, and the government pays the insurer a flat annual fee per enrollee. That federal payment varies from county to county, but it averages about $9,000 per enrollee nationwide.

In my blog: Medicare Insurance: It is Not Cheap-Part 1 the maximum an enrollee pays is $3408 per year. If Medicare Advantage is receiving $9000 a year per enrollee the difference is $5592 per enrollee more than the government collects from the seniors who pay the most. The healthcare insurance industry receives $8380.88 extra for an enrollee that pays the least premium for Medicare (1112.60 per year). The dollar difference is large and yields a nice profit for the healthcare insurance industry provider.

“UnitedHealth, in contrast, will get about 15 percent of this year’s projected pretax profit of $7.48 billion from Medicare.”

It is no wonder United Healthcare can afford to pay their former CEO 1.80 billion dollar in stock options over 8 years.

“And Humana is transforming itself into a big-time government contractor. It will get almost three-fourths of its projected $1.28 billion in pretax profit this year from Medicare, mainly from the Medicare Advantage program, according to analysts.”

Clearly a healthcare insurance company can make large profits from Medicare Advantage.

Patient Power works as long as citizens know what is going on. Politicians will act in the citizens’ vested interest if citizens demand it from them. Citizens must demand that Congress and the administration stop this disgraceful behavior.

The media reports most of the information but never connects the dots. I have connected the dots. What I see is not a pretty picture. In fact it is a terrible betrayal of senior citizens and taxpayers.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • Chrissy Dodman

    Hi Stanley,
    Sorry to contact you via comment but your email address failed.
    I work for a news distribution company and wondered if you would be interested in receiving free news releases on healthcare from us?
    If you have any questions just email me at the above address.

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It Is Not Only Older Physicians Who Are Discontent: Part 2


Stanley Feld M.D.,FACP,MACE


The administrative difficulties in the physicians’ work environment are increasing physician discontent.

In a survey last year of nearly 2,400 physicians conducted by a physician recruiting firm,, 97 percent said they were frustrated by nonclinical aspects of medicine. The level of frustration has increased with nearly every survey.”

The important point is that it is our younger physicians who are complaining about the burdens of medical practice.

“Dr. Bhupinder Singh, 42, a general internist in New York, sold his practice and went to work part time at a hospital in Queens. When he decided to work in a hospital, he figured that there would be more freedom to practice his specialty.”

Recently, he confessed, he has been thinking about quitting medicine altogether and opening a convenience store. “Ninety percent of doctors I know are fed up with medicine,” he said.

Many healthcare policy makers dismiss these complaints as the failure of managed care. Managed care was a system policy makers developed to manage costs. It is a system that has failed to manage care and manage costs as well.

“It is not just managed care. Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors’ lounges. Malpractice worries also remain at the forefront of many physicians’ minds, compounded by increasing liability premiums that have forced many into early retirement.’

Physicians are discouraging their children and their friends’ children from becoming physicians. The opposite was true in past generations.

In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession.

Practicing physicians are not stupid. They are adjusting their practice to decrease practice burdens. Some Ob-Gyn physicians have stopped delivering babies because of the malpractice burden and decrease in reimbursement. They are only practicing gynecology. The adjustments in medical practices are to the detriment of patient care.

“Doctors are working harder and faster to maintain income, even as staff salaries and costs of living continue to increase. Some have resorted to selling herbs and vitamins retail out of their offices to make up for decreasing revenue. Others are limiting their practices just to patients who can pay out of pocket.”

“There are serious consequences to this discontent, the most worrisome of which is that it is difficult for doctors who are so unhappy to provide good care.”

I have said over and over again that healthcare policy makers do not listen to or ask physicians for advice. The end result will be a severe physician shortage. Physician shortages are here already. The central problem is quality care for patients and not the healthcare insurance company’s bottom line. I hope policy makers are listening.

“Another is a looming shortage of doctors, especially in primary care, which has the lowest reimbursement of all the medical specialties and probably has the most dissatisfied practitioners.”

Last year, residency programs in family practice took only 1,096 graduating medical students, the fewest in the last two decades. The number increased just slightly this year. “For me it’s an endless amount of work that I can never get through to do it properly,” said Dr. Jeffrey Freilich, 38, a primary-care physician on Long Island. “I’m a bit compulsive. There is no time to do it all in a day.”

“On top of all that, there are all the colonoscopies and mammograms you have to arrange, and all the time on the phone getting preauthorizations. Then you have to track the patient down. And none of it is reimbursed.”

The only services primary care physician have to sell is their time and clinical judgment. Both services are undervalued in the present healthcare system.

Once a patient is hospitalized the primary care physician loses track of the patient. Hospitalists take over. Hospitalists call many specialists for consultation and advice.

“The upshot is that the doctor who knows a patient best is often uninvolved in her care when she is hospitalized. This contributes to the poor coordination and wanton consultation that is so common in hospitals today.”

“Years ago you had one or two doctors,” a hospitalized patient told me recently. “Now you’ve got so many people coming in it’s hard to know who’s who.”

Medicare is going to cut payments to physicians 10.6% in July. Why? It is easier to cut physicians who utilize 20% of the healthcare dollar than to cut the stakeholders that absorb 80% of the healthcare dollar. Why? Physicians are not organized! They are also cheapskates and do not support lobbyists. They do not have the powerful a lobbying infrastructure that the healthcare insurance industry and the American Hospital Association.

A 10.6 percent cut in Medicare payments to physicians is scheduled to take effect on July 1. Further cuts are planned in coming years. Many doctors have told lawmakers that if the cuts go through, they will stop seeing Medicare patients.

Unfortunately, politicians do not understand the problems physicians and patients have in the healthcare system. It is going to be up to patients and physicians make these problems clear to politicians in order to Repair the Healthcare System.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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Do You Think Politicians Want To Hear From You?

Stanley Feld M.D.,FACP,MACE

The answer is “NO”. Cecelia and I wanted to contact John Cornyn and Kay Baily Hutchison about their vote on HR 6331. Their two votes defeated the House of Representatives proposal to cancel the Medicare cuts.

It is an impossible task to send them an email. Just try to find an email address. We have concluded the best way to contact a congressperson is to send him or her a fax. Actually, many fax’s and break their fax machine. Maybe then you will get their attention.

The next time I hear that a politician wants to hear from his/her constituents, I know he/her wants to seduce us to vote for him/her. He/her has no intention of listening to us.

  • Mark

    I think you are right . . . they tell how much they want to do for us and then they pretty much do what they REALLY wanted to do all along.
    We need to pray for all of them because I believe that the Lord can get through to them better than we can.

  • Sandra Smith

    Dear U.S. Senator John Cornyn,
    I am writing to you because I am very fed up with Washington right now. I have spoken to many people in my area that feel the same way that I do. I have not spoken to anyone that is in favor of this health care bill.
    1. Where did the money come from for the bank bailouts???
    2. Where did the money come from for the auto bailouts???
    3. Where did the money come from for the aid to Haiti???
    4. Where did the money come from for the aid to Chile???
    5. Where is the money supposed to come from for the health care bill???
    I am (along with many people in my area) totally opposed to the health care bill. I hope you strongly oppose this bill. I also hope that you get as many congress people to also oppose this bill. Only our representatives can do as their constituent’s want, so I am counting on you and others to fight this bill every way that you can.

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It Is Not Only Older Physicians Who Are Discontent: Part 1

Stanley Feld M.D.,FACP,MACE

It has been said that the older physicians are the only physicians upset by the way they are being treated by the healthcare insurance industry. The claim is older physicians are spoiled by the golden days of medicine. My reply to that statement is nonsense. When a professional is treated as a commodity no matter what his age discontent is generated. The older physicians are products of the silent generation. When the younger physicians are pushed to the edge we will hear lots of noise and have lots of rebellion. The rumblings have started.

“I love being a doctor but I hate practicing medicine,” a friend, Saeed Siddiqui, told me recently. We were sitting in his office amid his many framed medical certificates.

Uwe Reihardt said it all to my surprise in a letter to the editor of the New York Times in May 2008.

“Any college graduate bright enough to get into medical school surely would be able to get a high-paying job on Wall Street. The obverse is not necessarily true. Against that benchmark, every American doctor can be said to be sorely underpaid.

Besides, cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.”

Many examples of discontent from younger physicians can be sited. As these physicians gain experience and understand that the healthcare system is a business to the facilitator stakeholders whose only concern is the bottom line the patient-physician rebellion will pick up steam. The facilitator stakeholders account for 80% of the healthcare dollar and add little value.

A doctor in his late 30s, he has been in practice for six years, mostly as a solo practitioner. But he told me he recently had decided to go into partnership with another cardiologist; “Your days aren’t busy enough already?” I asked.

The waiting room was packed. He had a full schedule of appointments, and after he was done with his office patients, he was going to round at two hospitals.

He smiled wanly. “Just look at my eyes.” They were bloodshot.“This whole week I haven’t slept more than about six hours a night.”I asked when his work usually got done. “It is never done,” he replied, shaking his head. “See this pile?” “He pointed to five large manila packages on a shelf above his desk.” “These are reports I still have to finish.”

“As a physician, I could empathize. I too often feel overwhelmed with paperwork. But my friend’s discontent seemed to run much deeper than that. Unfortunately, he is not alone. I have been hearing physician colleagues voice a level of dissatisfaction with medical practice that is alarming.”

The discontent is building. Physicians are fed up with what they perceived as a loss of professional autonomy. They can not stand the unwarranted restrictions on their medical judgment. As demand for physician services increase we are experiencing larger and larger physician shortages.

Another physician complained. “I’d write a prescription,” he told me, “and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.” Managed care is like a magnet attached to you.

A 42 year old physician complains that he continues to be frustrated by payment denials. “Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ”

The endless abuse on professional integrity amazes me. A high school graduate sits in front of a computer screen deciding on what a physician can or can not do. Another healthcare insurance company assistant sits in front of a computer billing screen reducing reimbursement on questionable computer programming decisions. The appeals process is difficult and time consuming for physicians.

Dr. Mark Linzer, an internist at the University of Wisconsin who has done extensive research on physician unhappiness, told me. “Fortunately, the data show that physicians are willing to put up with a lot before giving up.””

How long do you think young intelligent physicians will tolerate this abuse? How long do you think it will take to train another compliant work force? America has a physician shortage that is about to accelerate.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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