By Dr. Lawrence A. Epstein

Other Voices

Four years of medical school, one year of internship, three years of residency in internal medicine, one year in Vietnam, followed by a year at Ford Ord, culminated with my entering practice in Los Altos. In 1968, I was anxious to hang my shingle with a private practice specializing in internal medicine.

During the past 32 years in the El Camino Hospital District, I have seen many changes in the system - and in medicine in general. I am 64 years old and find myself working harder and making less income than a San Francisco Muni bus driver.

In the past few years, we have seen the continuous erosion of quality medical care disguised as HMOs and PPOs. Insurance companies - those vast, powerful giants with unlimited wealth - and their overpaid moguls have increasingly taken over the way medicine “should” be practiced. Insurance premiums have risen for those sickest and least able to afford them. Many are refused medical insurance because they are “too risky” and might cost the insurer too much money before they die.

In our system, people without any medical experience can determine whether the tests a physician deems necessary for diagnostic or recovery purposes are “not necessary” or “too expensive.”

Lester Abramson, former CEO of United Health Care in New York City, has an annual salary of $800 million, with bonuses for saving the company money and returning great dividends and value to shareholders. He has degrees in business and finance but no medical training.

We as a group have allowed our humanitarian profession to evolve into this. We have made diligent efforts to improve health care, but our economics promise genocide for our profession. Fewer and fewer young people are entering the medical profession. As noted on Channel 7 in San Francisco, there is a crisis in health care and a future that looks very dim for your health care and mine.

Patients are unhappy. They don’t understand HMOs, PPOs and IPAs and the word-salad of confusion perpetrated by the government-insurance conglomerate. They have to wait longer to see their “primary care” physician and I am no longer referred to as an internal medicine specialist.

After 32 years in internal medicine practice, I have never worked harder or longer hours, often without a lunch hour. I arrive home at 8 p.m. for a late dinner. I’m late because of paperwork and telephone calls that I must make in the quiet of my office. I retire early so I can rest before arriving at the hospital for my 7 a.m. rounds.

Yet, the “Rich Doctor” myth survives. I receive one- to two-thirds less revenue than nine years ago, work more hours and require more staff to feed the managed care system.

Today’s heroes seem to be the baseball players with their $70 million contracts, professional entertainers and other icons who all reap the high-paying rewards. Where are the thinking and the values of this wonderful nation?

When you are critically ill and can find one that takes an HMO, the real hero will be your doctor.

Dr. Epstein practices at El Camino Hospital.