Dire Straits: Letter From An Emergency Room Doctor

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Consider that in 2006, there were 120 million ER visits; about 30% were uninsured patients. ER visits have escalated 26% over the last decade costing billions a year. Since there aren’t enough primary care doctors, wait times grow and patients are frustrated.

[HealthCare Reform: Op-Ed]

Recently, President Barack Obama finally hosted a group of doctors at the White House to discuss healthcare reform and said, “nobody has more credibility with the American people on this issue than you do.”

I’ve been meaning to tell him this for months.

As an emergency room doctor I feel like I’m in a daily war zone. As 14,000 people lose their healthcare daily and more job losses loom, many of these casualties of the “great recession” head to ER if they lack coverage; they need primary care, prescription refills, and sometimes emergency care.

ER physicians daily observe the devastating effects of healthcare costs escalation. We see people who may not have suffered strokes had they been able to afford their medications or see a primary care doctor.

It’s about time the president reached out to doctors. He once claimed we’d rather amputate a foot than teach a diabetic prevention since we’d be able to make $30,000 from the surgery.  False! The reimbursement is between $700-$1500.

Doctors know the urgent need for reform, and we believe healthcare is a moral issue. We’d like to work with the president; we’re not the bad guys. 60% of us believe in a real public option. From the ER trenches, in addition to the all important health insurance and pharmaceutical reform, I see two important obstacles. We need more primary care physicians and we need medical tort reform.

Consider that in 2006, there were 120 million ER visits; about 30% were uninsured patients. ER visits have escalated 26% over the last decade costing billions a year. Since there aren’t enough primary care doctors, wait times grow and patients are frustrated.

The prohibitive cost of medical training is an important cause in doctor shortages; newly minted doctors can have up to $200,000 in educational debt. So rather than specialize in primary care, many doctors seek more lucrative practices, such as cosmetic surgery. Effective healthcare reform must tackle this issue, and offer more incentives to doctors who choose primary care.

Tort reform is critical. During his address before the joint Congressional session, President Obama correctly noted that “defensive medicine may be contributing to increasing costs.”  That’s when doctors, fearing debilitating lawsuits recommend multiple (sometimes harmful) tests, referrals, hospitalizations, or prescriptions, thereby driving up costs.

A 2006 study published in the New England Journal of Medicine showed that in 1,400 malpractice claims, almost 40% involved no medical error. Still the threat of malpractice contributes to escalating healthcare costs—this point is often missed in the debate. Every physician is familiar with the quip: “There are only two types of doctors: those who are sued and those who are going to be sued.”

This isn’t to downplay the devastating effect of real malpractice on victims and their families. Any reform should consider creation of a national fund to compensate patients, with a formula that can be worked out, as used in countries such as New Zealand. So patients can be compensated for true malpractice, and doctors can practice medicine without the fear of lawsuits. Enforcement should also rid the industry of incompetent physicians.

We must act now; doctor shortages are actually getting worse. High malpractice insurance drives doctors away from riskier specialties like obstetrics/gynecology, neurosurgery and emergency medicine. Doctors retire early, avoid risky procedures, move to states with friendlier malpractice laws, or reject patients with complex ailments.

I haven’t heard these issues discussed by any of the Senate or House Committees now crafting a reform Bill, including the version approved today by the Senate Finance Committee.

Yet, would anyone discuss the Space Program without involving astrophysicists? It’s still not too late to get us doctors more involved.


Dr. Lumumba-Kasongo is an emergency medicine  physician in Albany, Ga.

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