December 31, 2009
Carl W. Peter Jr., M.D.
Lower Standards Will Cost Lives
NOTE BY ERICA CARLE: The accompanying letter was written by our son, Dr. Carl W. Peter Jr. in response to a Letter to the Editor complaining about the greediness of physicians. Dr. Peter's letter appeared in the Sumter, S.C. paper in January 2003. It seems relevant today when even the President of the United States complains about "greedy physicians."
Medical care was less expensive before it was insured, commercialized, and governmentalized requiring reams of expensive paperwork. My father who was a primary care physician never had more than one employee--a receptionist and occasional assistant. She could also handle all the bookkeeping and billing.
After WWII Dad moved his office from Milwaukee to Elm Grove, WI so he could share his practice with my brother. Many patients drove from the city to his office, some saying, "You never dunned us for money when we had hard times so we're staying with you."
Waukesha Memorial Hospital had an emergency room. It was staffed at night without charge by doctors who practiced there. My brother routinely gave one or two nights a month.
When the police department had an emergency case, day or night, they often brought the patient first to my dad's office because it was in his house. When the police called at night Dad would slip his shirt and trousers over his pajamas and greet the police and patient at the office door. If the case was serious he would give immediate treatment and then recommend they head for the emergency room, but many cases could be handled right in the office. Even then, the cost for an office visit would be far less than the emergency room visit.
When a patient did not pay, the physician just took the loss, or in some cases hired a collection agency. Many patients who could not pay were taken care of at the county hospital at no cost.
Many modern medical miracles are very expensive. That adds to the cost of care, but who would want to do without them?
The following was our son's response to those who criticize the "greedy physicians." -ERICA CARLE
To Critics of 'Greedy' Physicians,
Everyone does not have the God-given talent of Michael Jordan but some do. A lot of people with similar talents weren’t willing to make the decisions, sacrifices and efforts that he made to draw a multimillion-dollar paycheck.
business owner who sacrifices everything he has and works long hours is
more likely to succeed and become wealthy than the one who thinks he should
only work 40 hours a week and is unwilling to give anything up. Fair or
unfair, that’s just the way the world works.
I chose to play a lot of basketball and frisbee and waste time during college while others who were more focused and hard-working got into American medical schools. Then I worked the 100-hour weeks to start a business. My partner, with only a high school diploma, persisted longer with those hours and became wealthier than I will ever be. He deserves the money. He made more sacrifices than I did. We had similar intelligence and abilities but made different decisions.
I decided to sell everything I had, borrow money, step on an airplane, and go to a foreign medical school without any guarantee of becoming a physician. Of the 180 students in my class, fewer than 40 survived the stress, financial burden and testing required to practice medicine. Yes, I had some financial help from family, but many of my classmates had no money or family assistance and found a way to be there and finish.
of the physicians in Sumter were given a mental capacity to pass the tests.
Many other people with the same mental capacity chose not to make the
sacrifices. They weren’t willing to borrow $50,000 to $100,000 to
spend another four years in medical school. They weren’t willing
to spend three to six years working 80 to 120 hours a week under constant
mental scrutiny while frequently being chastised for their lack of knowledge
during residency and fellowship for less pay than the 40-hour-a-week nurses.
Our society has decided that we want intelligent, persistent and motivated people to be our physicians. If I thought I would be rewarded with an average lifestyle for an exceptional sacrifice, I would not have considered changing occupations. Most physicians could have found other vocations where they could help people and be mentally challenged. At least part of the reason many of the top students in the class chose this vocation was because they thought they would be rewarded for their hard work and sacrifice. If they think they will not be rewarded, you will be left with the average or below-average students to go to medical school. The top students will choose other vocations. You will have to lower the testing standards and soften the education process. The end product will be of lower quality.
I suspect that’s not the person you will want making life-saving decisions if you have a heart attack and wind up in the ICU. With lower standards you would have physicians who would not be willing to make sacrifices. They would not be willing to stay up all night and be there to care for you or your family member after a terrible accident or a heart attack. The primary care physician would not get up at 2 a.m. to initiate the hospitalization and decide what is required. The radiologist would not get up and read the X-ray or CAT scan. The anesthesiologist qualified to safely put that person to sleep would stay in bed. The surgeon would not answer his telephone and come in to perform surgery at 2 a.m. with minimal sleep. The cardiologist would manage the heart attack when he comes in the next morning if the patient were still alive.
So I can spend time with my family in the evening, I get up at 4:30 a.m. to do paperwork until I have to get ready to take children to school. I see patients all day, rarely get a lunch break and rarely get home by 5:30 p.m. My day off is mostly consumed with paperwork management issues and required education. On call nights I answer the telephone frequently at all hours and go in to the hospital twice on the average. On call weekends any time at home is spent trying to get some sleep between telephone calls.
I’ve found that if I cut back on my hours everyone who works in my office gets paid except for me. Medicare has decided I deserve a 9 percent pay cut over two years, and if I accept that, private insurers will assume I am willing to do the work for less and cut their payment by that percentage or more. If malpractice rates also increase more, it would likely cause me to close my office and take an hourly job in an urgent care or emergency department. Some physicians in Sumter have already moved or closed their offices.
This issue was raised because of malpractice costs and the physician plight in West Virginia. I worked in a West Virginia emergency department 14 years ago. The exodus was just beginning then. Physicians have moved to other states, taken jobs in other areas of medicine, retired early and changed occupations ever since that time. The physicians left there are the ones who don’t want to move. They hang on for the sake of the people there. They have been pleading for a change for over 15 years. They could also move.
It makes my blood boil when I see television reporters interview them as though they are uncaring, greedy people out to make more money. The trial attorneys make statements about how they are improving quality of care. I do not argue that this is true. If they are not allowed to prosecute and seek reparations for injured parties, dangerous situations for patients would not be corrected as quickly or at all. On the other hand when the trial attorneys are allowed to take so much of a physician’s income that physicians leave or do not practice medicine any more, a whole new dangerous situation arises.
I have yet to see one attorney asked by a television reporter how he feels about the people in small-town West Virginia having to drive two hours for medical care because all of their physicians have left. They don’t ask the trial attorney who blocked attempts at reform how he feels about allowing a situation where people die eight to 10 years earlier because their chronic medical conditions are not treated. They don’t ask the elected official who ignored the situation for years how he feels when a child dies of infection because his appendicitis was not diagnosed and treated promptly. They don’t ask the judge or jury member who awarded an outrageous settlement how they feel about the father of four who died of a bleeding ulcer because his family doctor wasn’t there to diagnose it.
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Letter writers condemning physicians are more than welcome to their opinions but they will not have a right to complain when South Carolina becomes like West Virginia. They won’t have a right to complain when poorly trained, marginally motivated, less intelligent physicians treat their medical conditions. The smartest and most motivated students will choose other vocations when they see physicians working long hours for average incomes to live average or below average lifestyles. They won’t consider sacrifices worthwhile.
Dr. Peter graduated from Bob Jones University in 1978, spent several years as co-owner of an auto restoration business in addition to teaching science at a private school. In 1984 he graduated MD at Utesa in the Dominican Republic. He completed a family practice residency at St. Joseph's Hospital in Reading PA in 1987. He practiced emergency medicine in Charleston, WV and Sumter, SC 1987-1996. Director of Emergency Medicine, Tuomey Regional Medical Center 1994-1996
He had a private practice in Sumter, SC from1996 to 2004. He returned to emergency medicine in Newberry, SC and Columbia SC in 2004. Dr. Peter is married and the father of 4 children.
E-mail Dr. Peter: [email protected]
� 2009 Erica Carle - All Rights Reserved
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Erica Carle is an independent researcher and writer. She has a B.S. degree from the University of Wisconsin. She has been involved in radio and television writing and production, and has also taught math and composition at the private school her children attended in Brookfield, Wisconsin. For ten years she wrote a weekly column, "Truth In Education" for WISCONSIN REPORT, and served as Education Editor for that publication.
E-mail: [email protected]