This article is in today's
Santa Rosa Press-Democrat:
Fed up with paperwork, low payments from health insurers and the high costs of practicing medicine, Gutfreund told her patients she was packing up her stethoscope and moving to Kaiser.
"I loved being in private practice. I never thought I would go to Kaiser. But I just couldn't stand the terrible financial instability," said Gutfreund, 40, a Sebastopol family practice physician. "You're constantly fighting the machine to take care of your patients."
Gutfreund is one of an unprecedented number of Sonoma County physicians who have left private practice this year to go to work at Kaiser Permanente's Medical Center in Santa Rosa.
In Sonoma County, the famous wine area north of San Francisco, the cost of living is rising astronomically. The Greater Bay Area is marching north to consume the formerly rural Wine Country. But reimbursement levels for physicians are still thinking of Sonoma as being rural, and not matching the cost of housing, office space, and other expenses.
Physicians everywhere, not just in Sonoma, are feeling the squeeze of increased expenses for office rent, employees, insurance, utilities, and all the time taken arguing with their patients' health insurance companies and filling out every different kind of claim form. Many are tired. They went into medicine to help people and treat them and make them well, not to balance books and write business plans and quibble over diagnostic codes. Kaiser's guaranteed salary looks better every year.
Kaiser in Northern California does seem to be among the better run of the various Kaisers. And, the competition is largely Sutter-owned hospitals, a chain with a dreadful reputation that has been diaried here before.
"There are family practice physicians in this community who would do better working as a nurse, and have a more stable income," Perez said.
The North Coast of California is fortunate that its quality of life generally attracts talented people to the area, even if net after expenses they might do better elsewhere. And, thus, it's true that people who come to practice in Sonoma don't come for the money, but for the lifestyle. And the rat race of arguing with the people you bill day after day is incredibly draining. What's the point in living in paradise if you're working 14 hour days and can't enjoy it?
Obviously, the Kaiser lifestyle isn't for everyone, and I'm sure there are many doctors who enjoy the business aspects of their practice. But with so many successful physicians in Northern California deciding to give it up and move to a salary situation at Kaiser, that has to be a bellwether for the system as a whole, that the fee for service system is not working for these physicians any longer.
The average doctor in Sonoma County is still making over 100,000 a year. But this is in an area where you can buy an average ordinary single family tract home for only $500,000. $100,000 will only buy you a middle class lifestyle here: two ordinary cars, a house, health insurance, and a bit to put away for retirement - that is, assuming your education loans are all paid. Real estate has skyrocketed in the past 10 years. Older doctors have houses purchased years ago, and are in offices that they either own or probably rent at below market rates. New doctors have to pay full price for their new space, and somehow still find patients, and deal with reimbursement levels that get lower every year. I have a friend in Arizona who is a young doctor who realized she was making more money with her art than she was netting out of her medical practice; she is shutting down her practice to do art full time.
The current system isn't working for patients and it's not working for doctors. We need to work on universal health care and health care reform.