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Testimony of Larry S. Fields, MD, to the House Committee on Small Business
FOR IMMEDIATE RELEASE
Tuesday, June 14, 2005
Larry S. Fields, MD
American Academy of Family Physicians
To the: House Committee on Small Business
For the 95,000 members of the American Academy of Family Physicians and,more importantly, for the 50 million of your constituents who give us the privilege of taking care of their health every day, I sincerely and, humbly, thank you for your invitation to participate in this hearing.
A few years ago, you invited our then - President, my friend, Dr.Warren Jones of Mississippi, to testify on Medicare payment policies. He remembers that exciting, thoughtful experience as the highlight of his service as leader of our academy.
Like Warren, I am truly honored by your request to testify this morning.
On behalf of the AAFP, I commend you for your persistent and successful efforts to ease the burdens of small businesses in this country.
I am particularly honored to be here before this committee as it includes one of our academy·s outstanding members, Rep. Donna Christensen, who is serving as the leader of the Congressional Black Caucus Health Brain Trust.
Family physicians are serving proudly and with distinction in all branches of our military. We practice in all 50 states, here in the District of Columbia, Puerto Rico, Guam ,and, as Rep. Christensen can attest, in the Virgin Islands.
As family physicians, nearly half of Dr. Christensen·s and my patients are Medicare beneficiaries, on Medicaid, or have no insurance at all.
A large percentage of family physicians work in small and medium sized practices of four physicians or fewer. Our practices are typical of small businesses that operate with very tight financial margins.
The average gross revenue for family medicine practices in 2003 was $360,000. From this total, family physicians pay staff salaries, rent, utilities, medical equipment costs and medical liability insurance premiums.
Most of these costs have risen rather steadily and predictably with the single, significant exception of medical liability premiums.
When they increase at the rate we have seen for the last several years, my practice has no way to absorb them.
So, among my alternatives are:
- Cutting premium costs by eliminating specific services;
- Reducing staff, thus creating the equally regrettable consequences of human suffering because of unemployment and the further reduction of services;
- Borrowing to cover current costs -usually the path to bankruptcy for a small business; or
- Selling the business to a larger organization that can absorb the sudden spikes in premiums.
They are your constituents, who no longer have a medical home, who can no longer find the friendly, familiar faces that humanize medicine and provide a safe haven in the complex world of 21st century medicine, or who can·t find the obstetric services they need.
I practice in Eastern Kentucky, close to where I was born, a beautiful, rural, underserved area.
Last year, the liability carrier we had for 22 years, without a dime ever being paid in claims, dropped our practice and, for a couple of months, there was the very real possibility that 18,000 human beings would not find that friendly face I spoke of earlier.
My heart aches every day when I see the financial hardship created for my patients by the forced defensive medicine practiced by emergency physicians, sub-specialists, and by me.
Much like me, my colleague Dr. Julie Wood in Missouri was raised in a rural area to which she returned to practice family medicine.
Julie did a full scope of practice including OB. 50% of her patients were Medicaid and that program covered 80% of her OB patients.
Six years after starting practice, her liability carrier informed Julie her premium would raise from $19,000 to $71,000.
Because she loves mothers and children and the special relationship that forms between physician and expectant mother, she had no alternative.
She left practice in her hometown and took a position with a large academic health center in Kansas City where the hospital pays her insurance.
There is now no OB in a corridor of northern Missouri stretching from Hannibal to St. Joe.
Some people can drive the 2 hours to see Julie, but what do we tell the people who can·t afford to do that?
What do we tell the 15 year old, intellectually challenged, pregnant girl who rode her bicycle to Dr. Wood·s office because her only other way to get there would have been to walk?
Do we say that because they are poor, or not as smart, or live in the wrong place they do not deserve prenatal care or must risk having their baby born in a car or ambulance on a lonely highway in the middle of the night?
My friend, Dr. Neil Brooks is a family physician in Connecticut, where he was born and raised.
He was part of a 4-physician group in his hometown of 30,000.
Three years ago his liability premium had skyrocketed 600% to $31,000, and, at age 59, Dr. Brooks was forced to retire from his practice through which he had served four generations of his friends and neighbors, 50% of whom were by then Medicare beneficiaries.
Neil was followed into retirement by the best surgeon in town and by two ob/gyns, all of who had to leave practice before they drowned in red ink produced by liability premiums.
I am the AAFP·s Member on the AMA·s Commission to end health care disparities.
I assure you that American Medicine can end this problem.
But, I have to tell you now that such disparities will never end unless physicians in this country are freed to do the right thing for our patients, each and every one each and every time.
Free of a system that allows any lawyer who can chase down a victim and dig up an expert to drag a physician through the courts for 5 years, all the while demanding that the physician pay ever higher liability premiums, and at the end of the day pays next to nothing to the alleged victim.
The specter of medical liability is an equal opportunity employer. It affects everyone, but it does not affect everyone equally.
If you are black, if you are Hispanic, if you are poor, if you are weak or innocent, if you live in Eastern Kentucky, or Macon, Missouri, or Vernon Vermont it robs you of the full opportunity that this country can offer.
What I am really saying is there is opportunity here.
American medicine can be the highest quality, most cost efficient, most accessible, health care system in the world not just for a segment of our people, but for everyone in this country.
Please, for the good of those innocents, continue to try and find ways to free American Medicine to be what I know in my heart it can be.
I promise you the full support and assistance of America·s Family Doctors in your work.
And, I promise you a health care system the likes of which the world has never seen.
Thank you, Chairman Manzullo and Rep. Velazquez. I am happy to be here and to be able to answer any questions you may have.
# # #
Founded in 1947, the AAFP represents 110,600 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.
Approximately one in four of all office visits are made to family physicians. That is 240 million office visits each year — nearly 87 million more than the next largest medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.
To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website, www.FamilyDoctor.org.
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