The Destruction of American Medicine

By Greg Scandlen

The New York Times has published a sobering article by Gardiner Harris  which describes how quickly we have allowed the best health care system in the world to slip through our fingers.

The story keys off Dr. Ronald Sroka, a family practice physician in Crofton, MD. It says,

Handsome, silver-haired and likable, Dr. Sroka is indeed a modern-day Marcus Welby, his idol. He holds ailing patients’ hands, pats their thickening bellies, and has a talent for diagnosing and explaining complex health problems. Many of his patients adore him.

But he is being pushed into extinction by academics like David J. Rothman, president of the Institute on Medicine as a Profession at Columbia University who is quoted:

Those of us who think about medical errors and cost have no nostalgia — in fact, we have outright disdain — for the single practitioner like Marcus Welby.

Mr. Rothman’s disdain and his allies in the insurance industry and government bureaucracies are winning the war. The article explains:

The share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970.

It’s enough to make you weep, but there is perhaps a sliver of good news. A friend sent the following e-mail to one of my discussion lists:

Last week, Senator Whitehouse came to northern Rhode Island to speak to his home community. He had largely an elderly and retired audience of about 300. His comments were focused on them as he spoke of how he would fight to retain Social Security and Medicare. The audience clapped politely. Whitehouse continued to discuss healthcare. He eventually came to speak about physicians, lighting upon the topic as to how our actual charge per service differs depending upon what insurance each person has. “Go ahead,” he said, “call a doctor and ask what they charge for a certain visit or procedure. They’ll ask what insurance you have.”

I rose and said “$50.” I introduced myself to the audience and said that I charge $50 for an office visit, that I don’t take insurance, and that as a result of the massive cost savings by not having a coding specialist, collections specialist, or billing overhead, and by not having to rent an office big enough to house all those people, I can charge a reasonable fee while each patient retains the confidence of knowing that no third party will have any of their private medical information, of knowing that there are really only two people in the room when we talk, and of trusting that I’m going to provide the treatment that they really need rather than the treatment some third party tells me I should be providing.

I expected that this largely Medicare-covered audience would shake their heads and whisper “dinosaur” under their breath. Instead, I received applause and a few dozen new patients the next day. Each said roughly the same: “I’d rather pay for the care I want than have insurance cover me for care I don’t want.”

If indeed most new physicians choose to look toward the type of practices described in the Times article, that will allow all the physicians who want to run their own lives to do so without worrying about whether they’ll have enough patients. There will always be patients willing to pay a reasonable fee out of pocket for the kind of care that can be delivered by doctors like Dr. Sroka.

While the bulk of American medicine may accept becoming little bureaucrats, doing the bidding of their masters in Washington, a sliver will simply offer their services to patients on a cash or concierge basis. These few may grow until medicine becomes once again the noble profession it once was.


5 Responses

  1. Dr. Sroka’s ideal personalized family practice is in decline because we have bought the lie that we need insurance companies and government to be involved in the smallest transactions between patient and physician. The third party first-dollar coverage system and massive government involvement are the two culprits that have driven up costs and reduced the human element in medicine.

    90% of medical decisions should be made between the doctor and patient, with the patient paying his own bills. Insurance should be reserved for the unforeseen big-ticket medical events. Less administration equals lower costs.

    The poor should be seen in free clinics, apart from tax-payer funding– again with little third party interference. The NJ Volunteer Physicians Protection Act is being developed in NJ, where the state would provide free medical malpractice coverage to the entire practices of physicians who volunteer. Eliminate the middle man and lower costs for all.

  2. I sent the following letter to the editor of the Times and also sent it to the Public Editor . Of course, there was no response.

    Since when does a Professor of History – David Rothman – become an expert on the quality of care Dr. Sroka or any other physician delivers to his or her patients? Rothman has no idea about either the processes or outcomes of care that Dr. Sroka provides his patients. Neither does journalist Gardiner Harris. Harris –with no citations whatsoever — proclaims the small private practice rife with poor cardiac advice, less preventive care and more unnecessary tests than “larger practices.” Dr. Sroka should get a good lawyer to sue you guys for defamation.
    As for those larger practices, you must be referring to HMO or managed care practices. They do little or nothing to coordinate care and manage chronic diseases the way their advertises promises. I know that from inside looks at their practices, through investigative reporting efforts, litigation, and work as an expert witness. But curiously, the Times never wanted to see any of that evidence.
    Instead, you prefer to engage magical thinking about managed care, informed by your conversations with professors of history from the elite colleges.
    This is bad reporting, and as I have pointed out to you before, needs an editor with actual knowledge of the practice of medicine. And this piece is also an editorial disguised as news.
    But it’s your paper. Go ahead and keep misinforming the world.
    Is it any wonder that poor Dr. Sroka can’t give away his practice?

  3. Insurance should never be used to pay for small losses. As a 28 year insurance agent and a student of insurance I believe that what we call health insurance is no longer insurance. It is prepaid healthcare. And it is inefficient and expensive to prepay for services we may not need or that we can pay for ourselves if the need arises. Unfortunately, the general public has been trained to believe that they should pay nothing or very little for health care. My son-in-law had to get a small cut stiched the other day and had to pay $70. He was ready to vote for national healthcare. I am not sure that this type of thinking can be turned around, especially with policians that will be willing to demagogue the system.

  4. David Rothman posted a statement on the IMAP website saying he was misquoted or at least misconstrued:

  5. Thank you for posting that clarification. This happens to me from time to time as well. I describe a certain mind set people may have and the reporter ascribes it to me. Alas.


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