Arizona doctor goes Galt

posted at 10:12 am on April 14, 2010 by Ed Morrissey

Last month, a urologist in Florida told patients that he’d prefer ObamaCare supporters go elsewhere for treatment.  Today, a dermatologist in Arizona warns that he’ll be elsewhere if ObamaCare comes fully into law.  Joseph Scherzer says the penalties for dealing with Medicare patients, along with more top-down government control of health care, will drive him to close his doors:

While it may be years before most Americans feel the impact of President Obama’s health-care bill, a few patients in Scottsdale, Ariz., got a small taste of life under Obamacare last week when they arrived at their Dermatologist’s office only to see a sign with the following taped to the front door:

“If you voted for Obamacare, be aware these doors will close before it goes into effect.” The note is signed Joseph M. Scherzer M.D. and includes the following addendum: “****Unless Congress or the Courts repeal the BILL.”

Scherzer, who attended Albert Einstein College of Medicine in New York, has been a practicing Dermatologist in Scottsdale, Ariz., since 1976. Reached yesterday at his office, Dr. Scherzer, 63, said he plans to stop practicing before 2014 when the bill’s full impact will be felt because he refuses to deal with the headache of increased government involvement in health care. …

Scherzer said the bill’s emphasis on punitive measures for physicians not following government-prescribed treatment methods under Medicare would increase his anxiety level to the point he would no longer be able to practice medicine. The maximum fine was previously $10,000; under the bill it will now be capped at $50,000. Scherzer said the fine system makes seeing a Medicare patients a difficult and stressful exercise.

“Doctors have actually committed suicide over these things. There’s no insurance to cover it,” Scherzer said, calling the fine system “tremendously complicated and Frankensteinian.” “It’s absolutely impossible to be certain you’ve complied. I feel like when I see a Medicare patient I have the Sword of Damocles hanging over my head.”

Frankenstein isn’t a bad analogy for ObamaCare.  Its piecemeal approach to overhauling health care has already had some frightening and unintended consequences, the most humorous and ironic of which was stripping Congress of its health insurance.  The hidden tax for the middle class, which will cost people in the middle $3.9 billion in 2019 alone, is another.

Scherzer is near the normal retirement age anyway, but many specialists continue working in their practices past that time.  What matters here are the incentives and disincentives in play.  If Congress quintupled the penalty cap that the HHS Department can levy on Medicare issues, that provides a disincentive for providers to accept Medicare patients altogether.  In fact, the arbitrary nature of these fines probably accounts for at least some of the existing difficulties that Medicare patients have in finding providers, which is why 25% of Medicare patients purchase Medicare Advantage plans in order to get wider access to providers.

Except, of course, that ObamaCare makes deep cuts in the Medicare Advantage plans to pay for Medicaid expansion.  Oopsie!

Under these circumstances, as well as other disincentives to providers in ObamaCare, we can expect to see large number of doctors in all fields following Scherzer’s example, primarily the most experienced who see early retirement as a much better option than dealing with Uncle Obama’s medical-care directives.  What will that leave?  A less experienced and smaller cadre of providers with increased wait times and miles of red tape for everyone.  Scherzer may be one of the lucky ones, at least until he gets sick himself.


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Looks like your NP wasn’t really being supervised on-site by a doctor?

Jimbo3 on April 14, 2010 at 3:59 PM
NPs do not need to be supervised on-site by a doctor. PAs do, NPs operate independantly. They need a collaborating physician, and need a very small percentage of their charts reviewed yearly by that physcian. Part of the agreement is that they have access to discuss questions they have about diagnosis with their collaborating physician, but they do not need one in the building with them, nor do they need “supervision.”

In other words, they act/operate independantly from physicians and only are subject to a chart review periodically. And that’s fine with a good one with a lot experience who knows when to contact their collaborator and most importantly knows when they’re in over their head.

But with plans like this, they will be stretched to the limit. Fewer and fewer physicians will be available to be collaborators, stretching the whole system.

As was mentioned in an earlier similar thread about NPs being utilized more often, I don’t have issues with NPs (I’m a collaborating physician with 3 of them, only one is in the building I work in, and she’s here when I’m not) I have BIG issues with them (and me) being stretched beyond our capabilities to act safely.

DrAllecon on April 14, 2010 at 4:11 PM

FYI: Looks like states have different laws regarding how independent Nurse Practitioners can be. Some seem to require collaboration with a MD, others require involvement and still others require neither for general services and/or writing prescriptions:

http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

Jimbo3 on April 14, 2010 at 4:44 PM

But I still get to keep my high premiums right?

ronsfi on April 14, 2010 at 4:01 PM

You can remove those high premiums rather easily. Cancel your health insurance. 100% reduction in premium costs to you.

Any health care needs you incur, you can choose to pay the people who provide you services directly. You don’t need a middle man involved if you don’t like the service the middle man supplies.

ButterflyDragon on April 14, 2010 at 4:50 PM

http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf

Jimbo3 on April 14, 2010 at 4:44 PM

Thanks for the info. I practice in NY, but clearly it differes from state to state.

That, however, does make the point of the system being stretched even more important. If in a state like mine where a physician can be a collaborator for several NPs will likely reach a point where there will be too many NPs for one physician to safely collaborate with, what will states do who require direct physician supervision?

My guess is those states will likely no longer need direct supervision or some other legal trick that will allow more NPs to practice with less physician involvement.

However you look at it, quality of care is going to be compromised, either in levels of safety or waiting times, or time spent with each patient, or times between visits, etc.

DrAllecon on April 14, 2010 at 4:56 PM

Looks like your NP wasn’t really being supervised on-site by a doctor?

Jimbo3 on April 14, 2010 at 3:59 PM

I might be confused as to whether this person in my community clinic is an NP or a PA-but there is NO Dr at ALL on site.
In fact, the nearest Dr at any moment serving that clinic & this rural area would be at least 45 miles aways.
I was seeing the NP or whatever bcs that’s the only choice I got unless I was willing to wait til a Thurs, & who knows which one depending upon the Dr’s load for that day.
Then I’d have to wait til another Thurs etc.
Now I have no problem going to the NP or PA when I know I have bronchitis or a bacterial infection, so I can just get the prescription & go.
But when my problem is a mystery as to the cause, I want a real Dr with experience & all.
I will go so far as to ask our veterinarian when there’s an infection problem in humans if I can’t get a doc.
Bcs some of the infections are similar to those in animals & there are times I know I can self medicate.
I.e.-husband needs stiches.
Asked the doc when he was getting them if the lidocaine used on humans to dull nerves was the same the vet gives you for numbing animals’ tissue.
Doc said yes.
Problem solved for future stitches.
We can now stitch up at home.
But I wouldn’t do that for other stuff when I know I have no clue what I’m talking about.
But real point here is I resent Obamacare bcs this is going to limit my choice in being able to see a Dr over a NP or PA.
And that will lead to higher mortality rates bcs they won’t be catching stuff the docs would be catching.

Badger40 on April 14, 2010 at 5:10 PM

Jimbo3 on April 14, 2010 at 3:55 PM

so you & the writer for the wsj don’t understand how foreign doctors can apply for a PERM, or other methods to expedite their status. It’s a poorly researched article, they fail to mention that a lot of foreign applicants are not applying for primary care. And Obamacare will make this situation worse.

batterup on April 14, 2010 at 5:17 PM

The guy is 63. . . . he’s pushing retirement anyway so this really means nothing to me.

Notorious GOP on April 14, 2010 at 10:20 AM
I’m with you; when I go to the doctor, first thing I look for: lack of experience. I mean, who wants a doctor that’s seen it all already?

LastRick on April 14, 2010 at 10:25 AM

Pwnd. That’s gonna leave a mark. +100

Midas on April 14, 2010 at 10:27 AM

Right. I said nothing about experience.

What I meant was, this guy doesn’t have many years left in him. . . so he could easily retire soon anyways.

If a guy who was 35-40 years old, I’d put more stock into this story. . . he’d have to go live somewhere else and do something else with his life. INstead, I’m sure this guy could retire now and he’d be set for life . . . it’s not like he’d really be giving up anything.

Notorious GOP on April 14, 2010 at 5:48 PM

Why keep bickering over this? The libs are in their heyday, and every dog has its day. Except some days are longer than others.

Liberals will whimper, simper, whine, b*tch and moan, to at last realize the spite they thought on us comes back at them just as hard. Mock them as they deserve. Then ignore them.

They got just what they wanted, except it’s more full and against them, too, than they expected.

I delight in this, that what what the libs sought against us comes back at them, too. Liberals will call me ‘evil’ for laughing at their plight, the one THEY brought on. Okay, whatever.

If that’s somehow ‘evil’, I bask in it. I want nothing less than liberals paying on their own the spite they thought they were using against we Cons, s if those libs were immune.

Liam on April 14, 2010 at 5:50 PM

. it’s not like he’d really be giving up anything.

Notorious GOP on April 14, 2010 at 5:48 PM

Except for maybe 10 more years or so of earning a living in a field that took over a decade to be allowed to practice in. Doctors aren’t civil servants…yet. They rarely retire before their 70s and ones in relatively low burnout specialties can and do practice for as long as they possibly can or want, often until the day they die.

The news isn’t that a guy near standard retiring age is retiring. The news is that a guy is retiring from a highly specialized field (in which there is already a severe shortage of specialists) up to a decade earlier than he might normally have done.

Would it have more impact if a 40y.o. doctor did it? Sure. But it is very significant.

Look at it this way. Let’s say he made (a conservative guess) $150k a year. As a dermatologist, he likely makes more, but let’s go with it for now. He feels the restrictions that will be imposed on him are so significant, that he’s willing to give up anywhere from another 3-10+ years of that level of salary just to avoid them.

Honestly. It’s a big deal.

DrAllecon on April 14, 2010 at 6:02 PM

Dr. Scherzer put the sign on his door, but it’s reflective of the talk behind a lot of office doors. Retire, or go cash only. And it’s not just MD’s, it’s the PA’s & NP’s who are talking about this too. None of these professionals have to be “in network” for any plan.

I suggest you have a discussion with your provider about how they will handle this in 2014 (if it’s not repealed).

batterup on April 14, 2010 at 6:26 PM

Dr. Scherzer put the sign on his door, but it’s reflective of the talk behind a lot of office doors. Retire, or go cash only. And it’s not just MD’s, it’s the PA’s & NP’s who are talking about this too. None of these professionals have to be “in network” for any plan.

I suggest you have a discussion with your provider about how they will handle this in 2014 (if it’s not repealed).

batterup on April 14, 2010 at 6:26 PM

Yep. My wife is dropping all insurance patients on January 1, 2011, and will take cash paying customers only. I know several other practices that will do the same.

Norwegian on April 14, 2010 at 6:39 PM

Notorious GOP on April 14, 2010 at 5:48 PM

If the 63-year-old deciding to retire doesn’t bother you, maybe a 47-year-old deciding to will? My sister-in-law is 47, and is overworked in her practice under the current system. She hates to think of giving up the work she trained for so many years to do, and has spent nearly two decades becoming a respected professional in.

But there is a strong probability that she will do just that if Obamacare isn’t repealed. The rewards would no longer outweigh the expense and aggravation. Her good friend and partner (in a multi-physician practice) is also looking at the same thing. If they quit the practice, it will almost certainly have to break up, and its partners reevaluate their professional arrangements and even life choices.

My brother and sister-in-law aren’t sure what they’ll do. He’s an electrical engineer, and the two of them would be employable overseas, which is something they’ve been seriously considering. They hate to uproot the kids, but what matters is opportunity and a promising future.

What they will not decide is that Lynne will remain in practice in the US, under the worse conditions that are inevitable with Obamacare. It’s not even just workload and pay. As the Arizona doctor’s comments make clear, it’s loss of professional discretion while still being stuck with all the liability, and higher penalties. It just won’t be worth it. A very large number of those who have the option of dropping out will.

J.E. Dyer on April 14, 2010 at 7:04 PM

Hawkeye: Nurse! Nurse!

Nurse: Are you calling me, Doctor?

Hawkeye: Why should I call you doctor? I’m the surgeon.

davidk on April 14, 2010 at 7:57 PM

it’s not like he’d really be giving up anything.

Notorious GOP on April 14, 2010 at 5:48 PM

I’m not sure why you’re worried about him. I’m not concerned by what he’s giving up by retiring. I’m wondering what I’ll be giving up by having him and others like him retiring.

Less doctors, more people; considerably longer wait times and/or less trained people seeing patients. I think this would be worth avoiding; but I’m selfish like that. I worry about how it affects me, not how it affects this one guy retiring.

gekkobear on April 14, 2010 at 8:30 PM

Frankenstein isn’t a bad analogy for ObamaCare.

Coming soon to a neighborhood near you!

Frankenstein’s Monster 2010!

An exiting remake of the old classic staring Barack Obama as Herr Doctor Victor Obamastein and Nancy Pelosi as Frau Nurse Piglousy as the determined pair set about with their grand medical experiment to create a superior medical system. Millions of supporting cast members [employment at last] played by Americans in the role of lab rats and body parts!

MB4 on April 14, 2010 at 9:17 PM

This is all very stirring, but I don’t give a crap. Finally, the doctors speak up! A fine time to do it – they’ve had a nice little ping-pong game between themselves, the insurance companies, and the OEMs for too long. And when they can’t keep the ball in the air, you know who can step in? The government. So, thanks for your bold little speech but it’s too little too late.

GTR640 on April 14, 2010 at 9:31 PM

Well, anyway, I think anyone who lets their insurance company determine their healthcare is truly playing a victim card.

You need to see a doctor, for real?

Then scrape up the money to do so.

There are tons of programs out there for people. Don’t just sit there waiting for your GOVERNMENTinsurance to say you get help.

AnninCA on April 14, 2010 at 11:04 AM

FIFY -I was struck by the way you articulated my opposition to the bill. The bill puts the personal responsibility to “suck up and stand tall” to another 100 or so new agencies to manage your life and bleed the Country dry.

You just made a perfect conservative argument, only I don’t think you previewed.

seesalrun on April 14, 2010 at 11:14 PM

Libs are a hoot.

They are generally dull witted and utterly lacking in the self insight that would make them realize that they generally act based upon their envy, greed, vindictiveness and other base emotions.

A small example is the niggardly charitable contributions of libs- they attempt to assuage their subliminal guilt by enthusiastically supporting the giving away of other people’s money via the government.

I enjoy Greek tragedies, where the principal character ultimately suffers greatly as a result of their own personal flaws, naiveté and hubris.
The tragedy that we are watching unfold is going to be a doozy.
And I shall greatly enjoy watching the libs suffer*.

*Just one of my own personal flaws. Hey, nobody’s perfect.

justltl on April 15, 2010 at 1:03 AM

I just had a post rejected, that, if I do say so myself, was erudite and excellent.

Buster informs me that it was because it contained the word “nig·gard·ly”.

Ahahahahahahahahaha!!!111!!!11

justltl on April 15, 2010 at 1:21 AM

That was your doing, wasn’t it, AP?
You naughty girl, you!
Hahaha…OMG…hahaha!

justltl on April 15, 2010 at 1:30 AM

No matter.
It looks like my post was pretty much a reiteration of what Liam said up there.
And, now that I read his post, he said it better than I did.

Please go read Liam on April 14, 2010 at 5:50 PM.

justltl on April 15, 2010 at 1:38 AM

I find the Dr.’s actions admirable. I am puzzled as to why there haven’t been more M.D.’s stating similar things. I guess there isn’t much interest yet because the full force of government hasn’t been experienced by the physicians and the patients.

fgmorley on April 15, 2010 at 3:57 AM

fgmorley,

I would imagine that most of them have seen what happens to doctors who speak up* and are just quietly planning to retire and go Galt.

They are doing pretty much the same thing alot of people I know who own business did after the 2008 election. They laid off people, got their financial houses and personal affairs in order, sold or closed their businesses, bought a nice farmstead and put their money offshore and into physical gold. Some of them have emigrated to places like Costa Rica or New Zealand.

*Become a MSM propaganda whipping boy. See the “Inside Edition” hit piece on that Florida doctor for a fine example of that.

Nahanni on April 15, 2010 at 7:51 AM

What I meant was, this guy doesn’t have many years left in him. . . so he could easily retire soon anyways.

Notorious GOP

My own personal doctor is older than this guy and still works at the general office and makes rounds at the medical facility I work at.

I suspect he is well paid for his experiance, why do you talk down about this other fellow? The long and short of it is he will retire and lose revenue the minute he does so.

gdonovan on April 15, 2010 at 8:08 AM

Now that the lawyers have done such a bang-up job reworking our medical system, how about we have some plumbers rework on “justice” system and flush the turd lawyers out.

NoDonkey on April 15, 2010 at 11:52 AM

For all you docs out there, here’s the bottom line (and forgive me if someone pointed it out already up there):

-You, not the government, but you are going to be forced to cut back on and ration your patients’ care.
-You, not the government, but you are going to be liable for the results of the rationing.

And as a bonus, your re-imbursement is going to continue to drop, your taxes will continue to rise and your paperwork and hassles will continue to expand.

Enjoy.

P.S. NoDonk is correct. Thank the trial layers and democrats for all of this.

justltl on April 15, 2010 at 12:09 PM

I know a doc- the best doc that I have ever encountered- finished in the top 20 in his class of 2000+ at an Ivy League university, finished 3rd in his class at a prestigious medical school, consistently scores in the highest percentile in the nation on all board scores, is an associate professor on the teaching faculty at a local med school, all while maintaining a full private practice. You get the picture, right?

Well, this doc sees the shitstorm that is coming and what is happening to the profession that he loved, and is actively searching for a way out of medicine. Seriously. He figures you can only tolerate so much abuse.

justltl on April 15, 2010 at 12:16 PM

I forgot- that doc up there did his residency, chief residency and fellowship at one of the top flight programs in the nation.

And he is beloved by all creatures of the earth. Especially his cats Petey and Rocky.

Anyway, he’s had it and says regularly nowadays to no one in particular: F… the f…ing lawyers…f… the f…ing libs…blah…blah…blah…blah…blah.

It sad to see, really.

justltl on April 15, 2010 at 12:21 PM

I forgot- that doc up there did his residency, chief residency and fellowship at one of the top flight programs in the nation.

And he is beloved by all creatures of the earth. Especially his cats Petey and Rocky.

Anyway, he’s had it and says regularly nowadays to no one in particular: F… the f…ing lawyers…f… the f…ing libs…blah…blah…blah…blah…blah.

It sad to see, really.

justltl on April 15, 2010 at 12:21 PM

–He should be writing himself prescriptions for Pr*zac and other happy p*lls.

Jimbo3 on April 15, 2010 at 1:25 PM

Jimbo3 on April 15, 2010 at 1:25 PM

Ho, ho!

Better yet, he could just leave the next lawyer he finds requiring care, pissing himself and screaming in agony until he passes out from the pain.

But he won’t do that. He’s a human being, unlike the worthless, idiot, bloodsucking lawyer scum who put together health care “reform”.

NoDonkey on April 15, 2010 at 6:39 PM

I appreciate the comments from Dr. A above.

There are those who would say that MD’s were not actively involved. This is not correct. I have repeatedly contacted the AMA and ACP, both which have responded to my concerns with the following response, “You should contact your congressional representative.” So I did, as I know many physicians also did, to no avail.

Unfortunately, I think this health care saga promoted a division among clinicians to varying degrees in different areas of the country.

Those who are practicing in a primary care field seemed to support this law, because theoretically (we won’t know for sure), their reimbursements would increase for what they do. (How is that doctor fix going?)

Most specialists and surgeons that I interact with, are not fans of this law.

Speaking as an infectious disease fellow, I want to make a few points, which I have made before:

1. When both my wife and I become independently practicing physicians, we will have completed 22 YEARS of POST-college studies and training. We made our choice to do so. This is not uncommon for physicians. We also happen to believe that physicians should be reimbursed accordingly.

2. Because we are not independently wealthy, we have two mortgages. We only have one house. Our second mortgage, $270K worth, is what we owe for student loans. Again, our choice.

3. With our combined potential income, we forsee a disincentive for us to work full-time, as ~ 50% of our combined gross income will be lost to some form of tax. So why bother working more hours, seeing more patients, for more family stress and less pay? So we just can be “patriotic” giving money to be wasted in another government program? Provide another paycheck for an unemployed person not seeking a job because it pays better to be dependent on government subsidies? (My sister-in-law and her husband fit in this category.)

4. Don’t expect foreign medical graduates (FMGs) to pick up the slack for a lack of primary care physicians for the increased number of patients we will now see. I can only say this from my experience in Michigan and Minnesota – FMGs are pursuing subspecialty training in larger numbers than before. More are deciding to return to their country of origin as well (e.g. Pakistan, India, etc.). What is their incentive to stay and be swamped in an underserved area? To see more Medicare patients?

5. After my experiences in Michigan and Minnesota, I am firmly convinced that physicians in academia and those who practice at VA medical centers, don’t understand (nor do they want to understand) private practice medicine. It takes business management savvy, legal knowledge, a high level of efficiency, AND thorough knowledge of the respective field of medicine. Sadly, academic medical centers betray their politics by demonizing not only insurance companies and pharmaceutical companies as greedy, but also private practice physicians. This is unfortunate, and a mistake.

6. I don’t know how DrA does it, but I can’t even imagine having the time to periodically doing chart reviews for nurse practitioners. It doesn’t seem that there is enough time as it is. How many more physicians will sacrifice what little family life they have remaining to oversee more NPs?

7. My wife and I are still young. Are we entertaining the idea of pursuing new careers, such as practicing law? Why not? What does another 3 years mean to us at this point?

Having practicing physicians comes with a price. DrA makes many good points about this.

(Sarcastically speaking, think of the irony if younger physicians change careers and become malpractice attorneys. Then they can pay off their loans and make a great living suing the physicians, nurse practitioners and hospitals which supported passage of this law.)

Neither the field of medicine, nor this country, will ever be the same.

Danny on April 15, 2010 at 7:52 PM

Jimbo3 on April 15, 2010 at 1:25 PM

Ho, ho!

Better yet, he could just leave the next lawyer he finds requiring care, pissing himself and screaming in agony until he passes out from the pain.

But he won’t do that. He’s a human being, unlike the worthless, idiot, bloodsucking lawyer scum who put together health care “reform”.

NoDonkey on April 15, 2010 at 6:39 PM

–Don’t look for help from us for the next drunk driving or speeding ticket that you get. Unlike the MDs, our Code of Professional Ethics allows us to decline to represent clients. (I bet the MDs now wished they had hired a lawyer to write their Code.)

Jimbo3 on April 16, 2010 at 12:02 AM

. My wife and I are still young. Are we entertaining the idea of pursuing new careers, such as practicing law? Why not? What does another 3 years mean to us at this point?

Having practicing physicians comes with a price. DrA makes many good points about this.

(Sarcastically speaking, think of the irony if younger physicians change careers and become malpractice attorneys. Then they can pay off their loans and make a great living suing the physicians, nurse practitioners and hospitals which supported passage of this law.)

Neither the field of medicine, nor this country, will ever be the same.

Danny on April 15, 2010 at 7:52 PM

–Danny, law now sucks in the US. If you and your wife are not in the Top 25% of the graduates of the Top 15-20 law schools in the US (or don’t believe you have a 80%+ of being there), don’t do it.

Jimbo3 on April 16, 2010 at 12:05 AM

–Don’t look for help from us for the next drunk driving or speeding ticket that you get. Unlike the MDs, our Code of Professional Ethics allows us to decline to represent clients.

Jimbo3 on April 16, 2010 at 12:02 AM

The freedom to refuse service is indeed a two-edged sword.

Dark-Star on April 16, 2010 at 12:35 AM

Infectious Disease docs are pretty brainy.
He should be able to get into pretty much any law school he desires and easily finish at the top of his class without breaking a mental sweat.

justltl on April 16, 2010 at 6:57 AM

Dang, he could even make a career out of parasitizing lawyers.
That’s where the deep pockets are now.
Low hanging fruit right there.
Go for it, Danny.

justltl on April 16, 2010 at 7:08 AM

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