07/16/2008 05:12 am ET Updated May 25, 2011

When Doctors Revolt

This week, Republicans in Congress will face the prospect of voting to cut physician reimbursement drastically. What's up with that?

There was a time when almost no one felt sorry for doctors and their ability to earn a living. Doctors could whine about it, but the public just didn't believe that they should feel sorry for a doctor making over $100,000 a year. But the average family physician's salary now may be less than that in some locations -- according to one survey, it is $72,000 a year and in other surveys the median in the U.S. is $153,000.

Given the amount of debt most doctors accumulate paying for medical school, and the price of housing in many places in the U.S., and the fact that salaries have been declining not increasing, the money issue has become a big deal.

So when the American Medical Association stood up and revolted over Congress' proposed pay cuts for doctors last week, and launched an ad begging Republicans to reverse their vote on the pay cuts, it made news. And the story was on the front page of the New York Times as well. The story is complicated and involves doctors vs. insurance companies vs. the government. And it blames Republicans for cutting doctor pay and for siding with insurance companies.

Why is this news and why should you care? You should care because in increasing numbers, doctors are dropping patients and insurance plans and Medicare reimbursement. If you are over 65 and have tried to find a doctor who will take Medicare or your particular insurance plan, you know it's a problem. And if you are not over 65, you may find that your doctor does not want you or your insurance plan any more either. Doctors feel they are seriously underpaid by Medicare and other payers. They're mad and they're not going to take it any more! Especially when they look out the window and see the big health plans getting paid more to cover Medicare patients but paying doctors less to do it. They get even madder when Republicans vote against them. It's a major revolt and the stakes could not be higher.

There are already serious shortages of some types of doctors -- doctors in emergency rooms in the U.S.; anesthesiologists to put you to sleep when you have surgery; plain old "family practice" doctors to reassure you your sore throat is not strep or to set the arm you broke while skateboarding (and at YOUR age!). And despite the fact that there are more students entering medical school than ever, the number of doctors entering family and primary care practice has declined, leaving all of us at risk of not being able to get a doctor to see us when we need one.

While doctors have been complaining about pay cuts in Medicare and private insurance plans for many years, this year is somewhat different. The cuts proposed for doctors this year are like salt in a wound, given that the health plans are being paid, by almost everyone's reckoning except theirs, more to cover Medicare patients than ever, but those over payments are not trickling down to doctors. And of course it's an election year and Congress is under special scrutiny by voters. How did Republicans get on the wrong side of this issue? How is it that Republicans are arguing for pay cuts for doctors and Democrats are not? It's too long a story for this blog, but to your local doctor, it's actually simple. It's a tipping point of sorts, and doctors are ready to hold politicians accountable. You are either for doctors or for insurance companies in their view.

Could this issue be the one to tip doctors toward supporting comprehensive health reform? Maybe even single payer? A recent survey revealed that 59% of doctors support a single payer plan that would eliminate the role of private insurers in health care. Keep your eye on this one. Who will win or lose? Doctors vs. insurers vs. Republicans vs. Democrats... VERSUS YOU.