HMO DOCTORS: ‘Fed Up’ Stockton Gynecologist Calls It Quits

      Stockton Record columnist Michael Fitzgerald profiles Dr. Daniel Fisher, a Stockton gynecologist who recently "sent a remarkable letter to all his 2,651 patients." The letter read: "As of 7/1/98 I am quitting the practice of medicine. The system of HMOs, managed care, restricted hospitals and denial of needed medications has become so corrupt, so rotten, that I cannot stomach it any longer." He "urges people to raise a stink with politicians over our 'deteriorating medical system where profit is king.'" By way of explanation, the 61-year-old physician said of his decision, "My dad told me I had to like the guy I saw in the mirror when I was shaving. And I was getting where I didn't like that guy any more." He lays the blame for the decline of medicine on a decision by Congress in the 1980s to allow "for-profit HMOs with dividend-hungry shareholders and high-salaried administrators." He said, "The prime concern became profit. And they make that profit by exacting the highest possible premium from employers and paying out as small a benefit as possible to patients." He cites the example of an HMO that "decided in midyear it would no longer pay for Prozac, leaving Dr. Fisher to figure out other, possibly inferior, medications to prescribe for 28 of his depressive patients."

Time To Go
      Fisher also cited the declining value of his medical judgement in the face of the HMO authorization process and HMOs that demand exclusive arrangements with physicians as reasons for his decision. In addition, he said he was beginning to feel pressure from HMOs that track doctors' prescribing patterns and "'dump' doctors who exceed the norms," and was changing his "prescription habits from the best medicine I knew to the one that would look best on my profile." However, Donald White, a spokesperson for the American Association of Health Plans, "said oversight improves health care quality while competition keeps costs down" (5/29).