I appreciated your August editorial on mounting student debt (“A difficult beginning: Starting out with disabling student debt”). Student debt is even more of a burden in the first 4 to 5 months after completing training, when students must wait for a Medicare number. During that time, their ability to make money is significantly impaired because, without this number, they are unlikely to be accepted into managed-care programs. Then, when they are accepted, their ability to set their own fees is substantially limited, since managed-care fees are about 25% of what they were in the late 1980s.
I fear that the assault on physician fees that has occurred over the past 10 to 15 years will decrease the number of people going into medicine. It has certainly harmed our specialty. The outrageously low reimbursements for obstetrics and, worse yet, gynecology, have made it impossible to earn a living. I speak from experience, as I had a large, busy practice in Florida but was unable to pay my bills.
If the medical field in general, and obstetrics and gynecology in particular, are to be resurrected, our national leaders must demand an end to the price-fixing of managed care, and physicians in the trenches must push for that demand.
Jesse A. Kane, MD
Jacksonville, Ark
Dr. Barbieri responds:
Many authorities believe “price fixing” by government agencies (RVU and RBRVS system) and health insurers is partially responsible for rapidly increasing costs and flat/decreasing revenues. This will likely create spot shortages of the most poorly reimbursed services. Two current examples: obstetrics and mammography.