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Doctors Say Frustrations Of Managed Care Causing Them To Quit

February 8, 1996

PHOENIX (AP) _ Doctors demoralized by managed care plans are hanging up their stethoscopes in frustration over red tape and loss of control.

``The things people are trained to do and derive gratification from have abruptly stopped working,″ said Dr. Malkah Notman, a Harvard psychiatrist who treats doctors.

Notman will lead a panel on physician burnout at this week’s International Conference on Physician Health in suburban Phoenix. The conference is sponsored by the American and Canadian medical associations.

The American Medical Association didn’t have any figures on the number of doctors who have left the field because they are fed up with practicing medicine.

But membership surveys by the AMA and other groups over the past five years have revealed growing frustration as more companies adopt managed care programs that promise comprehensive health care benefits for a flat fee. The plans generally work by restricting access to doctors, hospitals and medications and closely scrutinizing treatment.

``I haven’t been in a meeting where that wasn’t the number one topic,″ said Dr. Larry Goldman, director of the AMA’s mental health department. ``It’s these economic changes that are driving these doctors crazy.″

Some doctors have quit practicing and others have turned to drugs and alcohol or sought counseling, Goldman said.

``For a poorly-trained, unknowledgeable management person to be telling the doctor what to do becomes very irritating,″ Notman said.

More than 20 percent of 1,700 therapists surveyed by Psychotherapy Finances last year said managed care and other cost-cutting trends in medicine were making them close their practices.

Since 1990, the number of doctors filing for disability has increased to the point that some insurance companies have placed them in a higher risk catagory.

``Physicians were the best class of risk for a long time, but recently many companies took a look and decided to reclassify them,″ said Scott Gilliam, a senior underwriting officer for Swiss Re America in New York. ``What’s happened is that they are filing more claims for disability than they have in the past, in some cases considerably more.″

Swiss Re hasn’t concluded that stress related to managed care is behind the increased filings, Gilliam said, but it’s a likely reason.

``It mostly started with the threat that the Clinton health care plan would become law, and the increase in managed care,″ he said.

Some have fought back by deciding to get business degrees and become health care administrators.

``If we cannot change it ourselves, the only other alternative is to get into the driver’s seat,″said Dr. Marwan Wehbe, an orthopedic hand surgeon in Bryn Mawr, Pa.

Dr. Warren Glaser closed the internal medicine practice he had for 20 years in Rochester, N.Y., because he was tired of health maintenance organizations telling him what to do. He is now an associate medical director of Preferred Care, a local HMO.

``My wise father said, `If you can’t lick ‘em, join ’em,″ Glaser said.

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