Letters

Is malpractice risk higher for employed physicians?

To the Editor:

The article "Understanding the Physician Liability Insurance Crisis" [October 2002, page 47] failed to mention one aspect of the growing crisis. I would argue that as increasing numbers of physicians are employed by organizations, especially organizations not wholly owned by physicians, our malpractice risk increases. For example, accountants at my hospital system determine that we need to see more patients per hour, causing documentation patterns to change and the doctor-patient relationship to suffer. In this environment, the employed physician no longer represents the best interests of the patient, but now represents the needs of the organization.

I would argue that over the next decade, part of the insurance crisis could be solved by enabling physicians to once again be entrepreneurs. In the current climate, insurance costs make it next to impossible for someone to open a solo or private practice. However, it has been shown that a low-volume, high-intensity practice can survive financially, improve patient care and increase patient loyalty ["Going Solo: Making the Leap," February 2002, page 29]. These factors will help drive down the cost of malpractice insurance.

Thomas C. Erdmann, MD
Seattle

Costs of e-prescribing

To the Editor:

I would like to ask for clarification about Dr. Louis Spikol's article "Good Medicine: E-Prescribing" [October 2002, page 63]. Regarding the estimated monthly costs for Allscripts prescribing software, Dr. Spikol indicates that his practice pays about $50 per month per physician. I find that price to be amazingly low. Allscripts recently quoted me nothing near that rate. I realize the price is dependent upon the practice size; however, I would be interested to know whether Dr. Spikol's office is still paying that amount. I noticed he is a shareholder of Allscripts. Perhaps he gets a better rate because of that?

Jennifer K. Schultz, MSEd
Syracuse, N.Y.

Author's response:

The price my (now former) practice pays for Allscripts has nothing to do with me being a shareholder. We got involved with e-prescribing fairly early, and we continue to pay $50 per doctor per month. I'm sure Allscripts found they could not continue to support their product at this price, especially as they began to offer a more complete model. Thus the price of their e-prescribing software has jumped significantly.

Louis Spikol, MD
Allentown, Pa.

What's in a name? A lot, apparently.

To the Editor:

Dr. Dale Glenn hit the proverbial nail on the head ["What's in a Name?" November/December 2002, page 18]. There is a lot of debate going on in my "family practice" residency right now about changing the name to "family medicine." I believe we are at a crossroads, one that will determine how we are perceived not only by the general population but also by our peers. We must undergo a transformation from our current system of training and nomenclature to a more modern and up-to-date specialty. I think we need to pursue the same course that internal medicine did about two years ago when they started sending out brochures to practices touting the idea that internal medicine was "adult medicine." That was a public relations pitch to enlighten patients that IMs practice medicine on adults only, not children. It is time we touted our medicine skills as well.

Fernando Petry, DO
Savannah, Ga.

To the Editor:

I am a doctor or a physician, not a "practitioner" or "manager." My business card says Board Certified Family Physician, and there's an MD after my name. It's confusing enough that nurse practitioners "aren't really doctors" to some patients while others see them as "doctors who aren't paid like doctors." I don't need people confusing me with a nurse practitioner.

Andrew Minigutti, MD
Dallas

To the Editor:

"What's in a Name?" struck a chord with me. For years, I have advocated using the title Family Physician, capital letters and all, which is the most apt and accurate term for who I am and what I do. The larger, underlying implication of the editorial is the lack of equality and importance that some Family Physicians feel due to confusion about the name our discipline uses. The patients who come to me and my Family Physician colleagues feel that we are "their" doctor. They trust us to take excellent care of them, and they respect our knowledge and expertise. Our referrals to sub-specialists for more complex problems, or for procedural interventions we do not handle, also make patients feel more comfortable that we do not pretend to know everything. I do not feel discriminated against or looked down upon. My patients trust me and my judgment, and they want me to stay in my practice. What greater reward can a physician ask for, whatever the name?

Toby Acheson, MD
Bellevue, Ky.

To the Editor:

Sadly, if we are to stand out, we must drop the "practitioner" from our name and pick another, more impressive-sounding one. How about: "Obstetrical-Pediatric-Adult-Geriatric-Surgical Health Specialists?" With a title that long, surely the government will give us back part of our pay cut!

John White, MD
Jackson, Tenn.

To the Editor:

It grates on my self-esteem when I am called a practitioner and considered by the uninformed to be equal to a nurse practitioner. I often take the extra time with my patients to explain the difference between the two.

I took it one step further when I wrote to TriCare, telling them I was not a medical manager but really a fully qualified physician, proven by my high malpractice premiums. Managers don't have malpractice insurance, I assured them. Yet in their frequent communications to me concerning patient care, they insisted on calling me a medical manager. They informed me that the government says I am a medical manager, so I must answer to that name. They included a reference to the government dictate they quoted, but I threw that out ... along with my TriCare contract.

Stacey M. Kerr, MD
Santa Rosa, Calif.

Making independent practice work

To the Editor:

Dr. Sanford Brown's recent article ["10 Reasons to Be a Self-Employed Family Physician and 10 Ways to Do It," October 2002, page 41] is so true it hurts. These tips have revitalized me and ensured that I will continue with my number one passion ­ the art of practicing medicine independently. I was getting more and more involved in the business of practice, seeing it as more glamorous and less labor intensive than clinical practice. I had not looked at the good side of our noble profession in a long time. Thanks for waking me up!

D.D. Pupuma, MD
Johannesburg, South Africa

WE WANT TO HEAR FROM YOU

Send your comments to FPM Letters Editor by e-mail, fpmedit@aafp.org; by mail, Family Practice Management, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672; or by fax, 913-906-6010. Include your address, daytime phone number and fax number. Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.

To the Editor:

How does Dr. Sanford Brown manage to work three days a week as a solo physician? I am interested in doing that as well. What if patients need him on the other days of the week?

Lori Van Horn, MD
Fredericksburg, Va.

Author's response:

I work the equivalent of three days in the office (24 hours divided over four days), which amounts to half days on Mondays and Fridays and full days on Tuesdays and Thursdays, with Wednesdays off. My nurse practitioner covers the office on Wednesdays, and I usually come back after lunch for a short while on Mondays and Fridays to do paperwork and catch some stragglers that couldn't make it in before noon. My office answering machine allows me to retrieve messages in the afternoons when I'm not there so I can handle any patient problems from home. Except on weekends when I sign out to a hospitalist, I am always available to my patients and can meet them at the office or hospital anytime (though going in after hours for a problem that cannot wait until the next day is a rare occurrence). As an unforeseen perk to semi-retirement, I pay half the standard malpractice rate because my insurer considers a work schedule of 24 hours a week half time. That's how I do it.

Sanford J. Brown, MD
Mendocino, Calif.

Attraction dilemma

To the Editor:

Thank you for the very interesting article "How to Cope if You Feel Attracted to a Patient" [November/ December 2002, page 92]. I am not an expert on the issue, but I disagree that feeling attracted to a patient is necessarily a sign of burnout. One may argue that after returning from a restful, stress-free vacation, a physician could indeed be attracted to the first patient he sees. Attraction between the sexes is very normal and not part of a syndrome. It becomes a problem if the physician makes the patient aware of this attraction either verbally or nonverbally. I do agree that in some instances a physician's involvement with a patient could lead to crossing the boundary.

Zakari Tata, MD
Livonia, Mich.

Author's response:

I completely agree with you. I have written elsewhere that attraction to
a patient can represent either an intrapsychic surplus or an intrapsychic deficit; that is, a physician's attraction to a patient is not necessarily pathological. Since the Balancing Act department deals with professional burnout, the article represents that angle.

Frances A. Spickerman, PhD
Marshall, Mo.

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