Balance billing will come too late for this doctor but may save others

Regarding "AMA to renew fight for Medicare balance billing" (Article, Dec. 3): Please fight hard for Medicare balance billing.

Primary care, at least in the geriatric state of Florida, will not survive without being able to cover ever-increasing office expenses.

There is a three-inch stack of paperwork every day in my office -- labs, x-rays, prescriptions (many requiring extra paperwork after being denied), telephone calls, consultations, tickler files to be followed up on -- which require three hours per day of uncompensated physician time plus at least one extra staff member besides the nurse and receptionist. I am an uncompensated "medical home."

My income, seeing the same number of increasingly ill and complex patients per day, has declined by more than 50% since the mid-1990s. I have two choices: First, see six elderly sick patients per hour to pay my expenses, or second, which I had to choose, get a new job.

I'm forced to leave my practice after 14 years because I know I cannot give the best care to these patients at that speed. People deserve time. Trust develops over time and increases compliance with medicines and preventive care. Answering people's questions and listening to their concerns should be a part of a visit to the doctor. Many 85-year-olds have 10 problems and several new problems every visit, and I cannot see these individuals in 10 minutes and not miss something.

Since Medicare pays the same every year (when it doesn't threaten to cut payments) with inflation rising 35% over this time period, I have seen a pay cut virtually every year for 14 years. I was in debt last year to cover office expenses.

By getting Medicare or some payment to cover costs, hopefully other primary care docs can continue to serve patients.

Sharon Oglesby, MD, Palm Coast, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/01/14/edlt0114.htm.