The insurance lesson I learned after “retirement”

I’m a Seattle family physician who retired 2 years ago, at the relatively young age of 58, because I was burned out after 30 years of intense involvement in the governance of a private family practice.

Our practice had grown over the years from 3 practitioners to 27. We formed a large (80-physician) network to gain negotiating clout with health insurers.

In my final year, we entered a period of extraordinarily difficult negotiations with a local carrier. After years of complying with chart reviews, generic prescribing, and a range of other cost-cutting measures, we were flatly told that the insurer’s goal was to pay us the lowest rates of any family physicians in the area—despite our excellent ratings. The reason: We didn’t control specialty costs as well as a multispecialty clinic, the negotiators said. (We believed we contained costs by choosing referrals wisely.)

A costly public relations battle ensued, alienating us, confusing our patients, and resulting in more stress and less efficient care for the insurer’s enrollees. For me, this was the final straw. I retired.

After a year off, I was ready to give medicine another try. I have since taken locum tenens jobs in rural Washington, on the Navajo and Zuni reservations in New Mexico, and at a struggling community hospital in Burien, a suburb of Seattle.

Interestingly enough, I found the Indian Health Service, with its single-payer structure, to be one of the most satisfying places to work. Their constituency is not facing bankruptcy from high costs, and although the money tends to run out at the end of the year and there are sometimes long waits, no one is turned away.

Working in a variety of settings has made me a believer in universal health care. I understand that the Obama administration is trying to make evolutionary changes in health care rather than risk losing the opportunity to make any change at all. But I fervently hope that the companies with the biggest stake in our existing system don’t lobby the way to annihilation of a public insurance option. I also hope that more idealistic physicians—and most importantly, the uninsured—don’t get lost along the way.

Laura Lippman, MD
Seattle, Wash