Why Might the Docs Be in a Fix?

A context-light, anecdote-heavy CNNMoney story fails to mention US's high medical costs

Sacre bleu! Docs are going broke! Or so says CNNMoney in a story that is a great example of a puff piece for doctors that also happens to fit the modus operandi for the docs’ public relations strategy every time the threat of cuts in Medicare fees comes up. In the before-Christmas deal that extended the payroll tax holiday until the end of February, Congress gave physicians another reprieve from scheduled cuts in their fees mandated long-ago by Congress as a way to lower government health-care spending. Over the years doctors have pushed back, and Congress has blocked those cuts thirteen times in the past ten years, according to CNN.

The story begins with an unsupported assertion that “Doctors in America are harboring an embarrassing secret: Many of them are going broke.” That calls for some backup—a well-done study or two with hard numbers that could answer some basic questions: How many doctors? Where are they located? Which kinds of specialists are having money troubles? Instead readers learn:

“This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry watchers say the trend is worrisome.”

The source for the later point is the CEO of a company that advises doctors in independent practices where half of all the country’s doctors still work. Reasons for the docs’ financial problems are the ones they historically complain about—lower insurance reimbursements, regulations that change all the time, and the higher costs of doing business in general. CNN Money reports that “experts” say there is another one: lack of business acumen.

Absent any hard data about struggling doctors, the piece resorts to anecdotes to bolster its thesis—about, not surprisingly, a cardiologist, an oncologist, and a family physician. Recall those are the three medical specialties mentioned in the nut graph. Readers meet Dr. William Pentz, a Philadelphia cardiologist who had to tap his personal assets last year to make the payroll. He has resorted to skimping on his own pay. Pentz says Medicare cuts of 35 to 40 percent for stress tests and echocardiograms have taken their toll on revenue. Then there’s Dr. Neil Barth, an oncologist in California, who says that changes in reimbursements for cancer drugs have hurt him badly. Cancer doctors like Barth once bought expensive drugs in bulk prices and then turned around selling them at much higher prices to patients. In the mid-2000s, Medicare ended this practice. “Our reimbursements plummeted,” he said. Barth owes $1.6 million to drug companies that was not reimbursed. Dr. Mike Gorman, a Nevada family doctor, had to take a loan from the Small Business Administration. “It’s embarrassing,” he said.

The piece reads like the reporter interviewed the CEO from the consulting firm and three of his clients and stopped there. While some physicians no doubt have legitimate beefs about reimbursement, especially primary care docs who are not as well compensated as oncologists and cardiologists, CNN didn’t present the other side of the story that the public needs to hear—that the price level for medical services, including what doctors charge, is extraordinary high compared to other nations. Price levels are much lower in countries with universal health care and better health outcomes. Insurers, including commercial carriers and Medicare, are trying to bring the cost of care more in line with the rest of the world, and the drive to reduce health care spending does pinch the docs’ pocket books. They don’t like it one bit.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: ,