MANAGED CARE: Stirs Discontent among Doctors

      "Across California and other regions, doctors are complaining that the era of managed health care has robbed them of autonomy, quality, income, time, prestige -- even self-respect," the front page of today's Los Angeles Times reports. But with dissatisfaction rising to such high levels, doctors are going beyond just griping and are starting to rebel outright -- "dropping HMO contracts, seeking clout and redress in professional alliances or unions, filing lawsuits, retiring early, going out on disability or moving out of markets colonized by managed care." The SEIU targeting of California physicians is no surprise given that doctor dissatisfaction is more pronounced in California perhaps than anywhere else in the country. Discontent is especially rampant among older doctors who have had to adapt to managed care later in life, but many young physicians voice the same apprehensions. According to the Times, one study found that "nearly a third of young California physicians wouldn't go into medicine if they could choose all over again."

A Cure?
      It could be argued, however, that "doctors have little to grouse about" as they still earn more money than most Americans and can pull in "even heftier compensations" by joining corporate ranks as CEOs and medical directors of HMOs. Doctors who do take these positions point out that this is a way for physicians to take back control of the health care system. Managed care "is a fact of life, and the question is, how can you make it better or worse? A lot of doctors are in the crying-over-spilt-milk phase," said Dr. Jeff Mason, CMO for ProMed Health Care. Others are quick to note, however, that "doctor-directed companies have presided over some of managed care's worst debacles," such as the bankrupt FPA Medical Management Inc.

Lost that Lovin' Feeling?
      Managed care advocates note that the new system has its benefits, such as holding premiums relatively flat for the past five years. And this has come with no adverse affect on quality, says California Association of Health Plans head Walter Zelman, pointing to a UCSF analysis. Nevertheless, many doctors and patients feel that under managed care "they've lost something ... not easy to measure" (Marquis, 3/3).