Study: Fewer Doctors Offer Charity Care (down from mid-1990s)

http://www.ksat.com/health/8208472/detail.html?rss=ant&psp=health

WASHINGTON -- The percentage of physicians who provide free care to the poor has dropped over the past decade, signaling a growing problem for the uninsured, a survey suggests.

About three-quarters of physicians provided charity care in the mid-1990s, compared with about two-thirds now, according to a study being released Thursday by the Center for Studying Health System Change.

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"Charity care is not the solution to our health coverage problems in this country," Hill said. "Maybe this will help wake up everybody so they understand we've got to solve the problem of almost 46 million people without (insurance) coverage."

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The study said 81 percent of doctors with their own practice or with a two-person office provide some charity care.

The percentage of doctors providing charity care drops to 66 percent when they practice with 11 to 50 other physicians. It drops even further, to 62 percent, when physicians practice in a group of more than 50 physicians.

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Medicare and insurance reimbursements are down so low that it becoming damned near impossible to run a practice with "regular" patients. There are only so many hours in a day. When doctors have to cram in half a dozen more patients to make up for the income they were making just a couple of years ago, the poor simply don't fit into the schedule anymore.

Charity isn't the solution. A modern, inclusive health care system is.

how do you expect them to maintain their lifestyles with their super-sized mac mansions and excess-mobiles. Anybody that has seen their doctors bills won't understand why there isn't room for some pro bono doctoring to the less fortunate. Those that have the most are usually the biggest whiners.

I can't recall meeting anyone who didn't care for charity patients when called upon to do so.

I already have one OB/GYN clinic that I refuse to refer to -- they won't do anything charity wise (inc Medicaid & MSDHS program for cervical cancer which pays MC rates). This is after 2 pos paps with prominent legions.

The neurosurgeons won't accept any charity, Medicaid, or Medicare cases here either outside of an ER (on-call).

I take care of an elderly couple. She has medicare, and I always write off the co-payment. He is not medicare age yet, and they have no money and no insurance. I have never charged him up until today. Nothing was ever said-they knew that I knew their predicament, and handled his case within the confines of my own office at my own expense. Lab, meds-free gratis. Today, he came in with neck and shoulder pain, always a red flag in a two pack a day smoker. His wife, knowing my party affiliation, immediately jumped on my case regarding Bush's low approval, what a bitch Hillary Clinton is, and what a fool I am. I did not rise to the bait, but finished my exam. Mr. S then told me that I would have different opinions if I only knew the facts. So, I gave him a prescription for some muscle relaxer, gave him an instruction sheet for neck therapy, and asked him to return in four or five days if he wasn't markedly improved. I am concerned that he has a lesion in his cervical spine. Tuesday, I will send him to a free-standing xray facility for a chest and cervical spine films, probably about four hundred dollars worth of xrays. Then, I will have to send him for an MRI of the spine-about two grand. Then, I will have to send him to a neurosurgeon-anywhere from three hundred to seventyfive thousand dollars. If he has a left upper lobe tumor, he will go to a pulmonologist ($300) and then for a bronchoscopy ($1500) and then for a ct guided biopsy ($800). Then, if it is resectable, he will go to a thoracic surgeon (another thirty thousand dollars) and then for radiation and chemo. (another twenty thousand dollars) The doctor's fees will eventually all be waived-that is the easy part. Since he is a county resident, eventually his hospital fees will be waived. Still, they will be ruined financially and his days of active living are over.

Perhaps none of this will come to fruition-he may, after all, just have a kink in his c-spine. But if not him, somebody else, someday really soon, will have a similarly devastating problem. God willing, Mr. S will be fine. Oh-the horse's ass part? I billed him for an office visit today, just for listening to their right wing diatribe. Let's see how they like proprietary medicine now.

Tough one -- although it seems like you might have better resources than we do.

Here, if I couldn't get him SS Disability (and thus Medicaid), he would get no chemo and no elective admissions / procedures. Males (and non-pregnant females) here aren't eligible for Medicaid on the basis poverty.

I have one radiologist who owns an imaging center that will take the Breast & Cervical Cancer program (for state paid mammograms), but the other group won't. He will take a charity case occassionally if I beg a lot -- but the other group (which is hospital affiliated) will not.

BTW -- Family physicians currently make less than teachers in a fair number of states when you factor in benefits, tuition, and time out of the workforce training. There is a reason that 50% of residency spots are unfilled, and a majority of those that are are FMG's. Certainly less than many professors in the sciences.

I'm fifty one. If I had to do it all over again, I wouldn't. I still see myself as a college professor like my old man.

My husband is a family physician with his own practice. Did someone steal my mansion? I live in a modest two bedroom house. The cost to run a practice is enormous and the payments are dropping while the malpractice insurance fees are skyrocketing.
He sees a lot of people for free but we surely are not rich. He also is on call 24/7. Don't paint with such a large brush.

have you seen the student loans they have to pay off. When you figure the hours they work and their overhead...they aren't doing so well. Eight to ten years of extra schooling only to come out and be in debt for 10-20 years. Sounds like a bargin to me. Talk about a postponed life. I work around them and more and more of them are fed up and leaving. and I can't EVEN tell you the number that tell me if they had to do it over again, they be in another field. In some areas of the country you can't get a Doc without a couple of hours drive. And many do give as much charity care as they can afford, they just can't afford much these days.

to have to ask doctors until they find one who agrees to treat them free? How is this different to telling a sick person to beg on the street for the money to pay the doctor?

I don't care how rich or poor doctors are, that should not be the issue. The more money they make, the more taxes they should be paying, and these taxes should be used, in part, to look after those who genuinely can't look after themselves.

That is what we like to imagine separates society from savages. But the sad fact is, you would be more likely to get looked after by "savages" than by our modern societies.

We need doctors, yes. They work very long hours, yes. They are mercilessly exploited by the insurance industry, yes.

But, darn it, they led the charge against Clinton's attempt to solve this crisis in the early 1990s. They helped give us the 1994 Repuke Revolution and the Contract on America. I remain quite bitter about all of that.

-Laelth