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Physician Crisis in Montgomery Alabama |  | | By J. Allen Meadows MD |
Letter to the Editor of the Montgomery Advertiser
October 2006
I applaud the recent front-page story about the financial squeeze being felt by the fine physicians at the cancer center. However, this is only the tip of the iceberg. Most physicians in Montgomery County have been facing a similar crisis for years due to a number of factors. For starters, Medicare has an archaic regional reimbursement formula that pays doctors in Montgomery the lowest fees in the country, 20% lower than Ashville, NC, and 40% lower than San Francisco. Fees from private insurers are directly linked to Medicare fees and are not much higher. Second, a flawed annual cost of living adjustment actually cuts Medicare fees to physicians 4 to 6 percent a year. Fees for office visits are even lower than a surgical fee, which is particularly hard on doctors that don't operate at least part-time, such as Pediatricians, Internists, Family Doctors, and Endocrinologists. I know first hand of two family doctors in Montgomery who left practice bankrupt, when the banks would not loan them any more money. An increasing number of physicians in there 40"s are "retiring", leaving private practice for other careers; others just choose to leave Alabama. Many who choose to stay in private practice work second non-patient care jobs to subsidize the practice; I work out of town on average 3-4 days a month. My former personal physician "retired" telling me "One day I woke up and found 80% of my headaches and only 20% of my income came from my regular job, so I quit". Many people complain about the poor service in doctor's offices; unfortunately many doctors can't afford to hire qualified staff. Most of us have been forced to make very painful choices, like restricting access to Medicare or Medicaid patients, giving up hospital privileges, or curtailing indigent care, just to stay in practice.
Each year the Medical Association of the State of Alabama organizes a trip to Washington DC attended by about 150 physicians. Our congressmen politely tell us that there just is not money in the budget to fix this problem, and that the problem can't be too big since they have heard no complaints from patients having a hard time finding a doctor. It is an unfortunate truth that little will be done to solve this crisis unless members of congress begin to hear from non-physician constituents about specific examples of patients having difficulty being able to see doctors in Alabama.
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