This eye-catching sunrise, viewed from The Bluff on Isle of Hope, signaled the dawn of a new day. We and everything around us are in a constant state of change, and we all hope for a change for the better.
Healthcare over my lifetime has evolved/changed in many ways. When I was a child, our family physician actually made house-calls. Dr. Shugrue had a small office on Calhoun Street in Charleston; his wife was his receptionist, billing person, and nurse. As a teenager one New Year’s Eve, I was running in the rain from my car to a party, fell, and cut my knee. From a pay-phone I called Dr. Shugrue, and he said to meet him at the emergency room where he put a few stitches in my knee – I did not have an insurance card, nor parental consent to be treated, at age 16. To put into a time perspective, this event happened several years before Medicare and Medicaid were initiated in 1965 under Lyndon Johnson.
I left the US Army in 1982 and set up practice in Savannah. I recall that my liability insurance the first year was $1600. When a new patient came in for an annual examination, she paid for the visit out-of-pocket, $60 as I recall. When a patient needed surgery, it was scheduled, then performed, and a bill was sent to the insurance company. In the late 80’s, attorneys started advertising, lawsuits increased in number, and my insurance premiums skyrocketed to over $80K per year. Then came co-pays, pre-certification of services, second opinions, huge deductibles, healthcare networks; the cost of healthcare has gone up in an astronomical fashion. Due to physician shortages, both the nurse practitioner and physician assistant programs were started in the mid 60’s. More recently the Affordable Care Act was enacted providing coverage for millions without insurance but with limited access to participating providers and services along with large deductibles that few could afford to pay. The next chapter started with the election of a new president, and it appears that the ACA will be repealed and replaced with an unknown.
The bureaucratic/legal complexity of our healthcare system is overwhelming to most of us, even those of us who provide the care. Laws, rules, regulations, and guidelines have been put into place in an effort to improve the system but in many cases have resulted in increased cost without improving the quality of care. The solo physician is rapidly becoming extinct. Because of escalating overhead without a concurrent increase in income, many solo practitioners have retired or joined large groups, often employed by hospitals. My plans for retirement are undecided – I plan to continue to practice gynecology as long as my health and the government will allow. I truly believe that we should do the right things for the right reasons the right way at the right time. We are currently accepting new patients, and I and my wonderful staff appreciate your support.