Mark J. Lema, M.D., Ph.D. Editor

A Potpourri of Pesky Professional Problems

There are a number of recent newsworthy events that should be brought to your attention. Each subject, however, may not require the few pages I devote to editorials. So I will introduce a few interesting developments and provide my usual noncontroversial opinion. Your thoughts, as always, are encouraged.

Boutique Care by Anesthesiologists?
A recent article in American Medical News highlighted the practice of a Seattle emergency physician who charged a little extra to spend more time with middle-class patients.¹ For $99 per month (notice the marketing ploy of keeping it under three figures), this doctor offers an extended period of contact time, same-day appointments, e-mail and telephone access, routine (noncovered) check-ups, a wellness program and, of course, a monthly newsletter. He also will make house calls for a surcharge. Not bad! This practice is becoming mainstream for middle-class Americans who can easily afford $1,000 to $1,500 over a year’s time for this special care. At $1,000 per year, a primary care physician would need only 100 subscribing patients to make an additional $100,000 over his/her usual billings.

It seems that anesthesiologists also could be heading down the “boutique care” track as more office-based and ambulatory centers lure patients away from the monolithic hospital arrangements. Fast-in, fast-out care with free parking and coffee sure beats driving into the city and waiting all day for one’s arthroscopy. Could anesthesiologists actually become suppliers of boutique medical care? Would families pay a retainer to have a particular anesthesiologist or small group perform anesthetics on their members whenever it is required? Would anesthesiologists opt to be “on-call” for boutique customers 24-7? My crystal ball says “probably not.” However, it may already be happening and just not discussed at the ASA Annual Meeting.

Medical Tribunals Instead of Tort System
“If you were an American surgeon, could you really trust yourself to operate on a lawyer?” A recent editorial calling for a complete change in handling adverse events started with this question²: How would you feel when delivering the anesthetic to one of the lawyers in the local “Dewey, Cheatam and Howe” medical malpractice group? With the typical award now at $1 million (three times larger than in 1994) being rendered by conditioned, sympathetic, “expert” jurors, collapse of health care and every other moderate-risk industry is inevitable. Two separate studies retrospectively reviewing closed malpractice claims ruled the 78 percent and 83 percent, respectively, did not involve negligence. Moreover about 3 percent of the legitimate cases ever have claims filed.

Senator Michael B. Enzi (R-WY) has introduced a radical bill calling for a medical court system where judges, not jurors, can levy awards, expediting the process and markedly reducing costs. You can count on trial lawyers and Democrats to be vociferously opposed to this concept. Along with closing a few hundred law schools and requiring lawyers to recertify, I think it is a great start to curbing the tort lottery frenzy.

National Health Care Insurance or… Step into My Web, Said the Spider to the Fly
The Physicians’ Working Group for Single-Payer Health Insurance issued a special communication in JAMA proposing a single-payer socialized medicine concept amounting to an expanded Medicare system.³ This eight-page document, along with the accompanying editorial, states the obvious problem: Health care is so broken that it requires a new paradigm of a “simpler and better way.” While the effort is laudable, it is, as always, directed by liberal internists who may not understand the “equitable” nature of medical specialty efforts and reimbursements. Moreover how can we trust the U.S. government to fairly administer a program that virtually places all physicians in their employment? Their handling of Medicare fraud, medical school support and Medicare physicians’ payments are horrific from the physicians’ perspectives.

Big business’ attempts at managed care, however, have dealt a near death blow to medicine.

There must be a simple and better way for patients, businesses and debt-laden young physicians to receive, pay for and administer health services. Let the discourse continue but with the specialty medical groups playing an integral role this time.

Mid-Career Burnout May Be Coming to an Operating Theater near You
Two articles appearing in JAMA dealt with burnout issues for generalists and specialists.^4,5 The authors defined burnout as a syndrome where physicians “are frequently overloaded with demands of caring for sick patients within constraints of fewer organizational resources. The symptoms and signs… include emotional exhaustion, cynicism and perceived clinical ineffectiveness and a sense of depersonalization in relationships with coworkers, patients or both.”

These articles discuss the childhood development psychology, gender and personality issues and a few ideas for preventing or delaying burnout (“spend time with family and friends”). Of note, anesthesiologists were mentioned as one of the diverse groups affected by burnout.

Overall this topic is critically important for our specialty to address, especially in view of current workforce shortages and increasing clinical demand. These articles suggest that medical organizations, through the “Medical Professionalism” campaign, deal with impending physician burnout. In my opinion, the quicker we develop educational and proactive programs, the better the chance we have of retaining our highly trained members to participate in anesthetic care.

– M.J.L.

References:

1. Norbut M. Boutique care goes mainstream. Am Med News. 2003; 46(29):18-19

2. Doctors v. Lawyers. An end of the nuisance. Editorial. The Economist. July 31, 2003.

3. Woolhandler S, Himmelstein DU, Angell M, et al. Proposal of the Physician’s Working Group for Single-Payer Health Insurance. JAMA. 2003; 290(6):798-805.

4. Spickard A., Jr. Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2003; 288;1447-1450.

5. Mechanic D. Physician discontentment. challenges and opportunities. JAMA. 2003; 290:941-946.

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