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Background

Is our country really plagued by an abundance of bad doctors?

By Marion A. Stahl

An alarming amount of war stories seem to be floating around the news lately regarding bizarre medical board actions, physicians being jailed, and even physicians committing suicide. In response to this trend, we resolved to conduct a close investigation to identify the patterns among various states. While this phenomenon is by no means new, it does seem to have reached epidemic proportions in the past year, causing great harm to patients as well.

In the last ten years, an estimated 20,000 physicians have been sentenced for crimes ranging from drug dealing felonies to fraud and racketeering. Is it truly possible that our country has so many bad doctors, or have our state medical boards gone out of control as a result of governmental pressure?

As Gene Healy states, “treating doctors like criminals cannot help but erode the quality of the medical profession.” In reality, pointing to fraud and abuse may be simpler than facing the complicated process of restructuring the payment system. Similarly, it is easier to accuse physicians of criminal intent in the death of patients than to look at the larger safety issues behind new drugs or medical devices. On the subject of expenditure, physicians are easy scapegoats; their reputation hangs on a license managed by the state and an appointed medical board that is under pressure to discipline providers and revoke licenses.

The revocation of licenses and ordering of jail sentences empowers the public with a sense of rightfulness and creates the illusion of addressing the problem of health care expenditure. Little is said, however, about the fact that doctor’s fees represent only 8% (1) of the total cost of health care. As Richard L. Jackson, chairman and CEO of Jackson Healthcare, (2) points out: “At eight percent of total healthcare costs, if physicians worked for free we would still have a serious cost problem.” The rising cost of practice overhead drives the increased rate of medical fees, yet the percentage does not change. The culprit is elsewhere, yet doctors have been chosen as scapegoats at the cost of patient’s safety and sound medical care.

Another example of these excesses is the “War on Drugs”. On the one hand, it is difficult police and the Drug Enforcement Administration (DEA) to arrest such ‘drug dealers’ who are reselling prescriptions without an office or a license. Such illegal traffickers have made a business of reselling prescription medicine, and know how to defy the law with agile schemes. On the other hand, it is much easier to arrest and confiscate the assets of good physicians who are practicing at a desk under a licensed shingle. The incarceration leads to a great amount of press as well as doubt in the profession. It divides and conquers the public attention; however, the deaths of countless innocents are not discussed in their reports. Many patients with fragile souls who have lost their long-term physicians as a result of this monster chase end their lives; likewise, doctors disfigured and portrayed negatively by this monster chase sometimes commit suicide. The list of harmful effects is staggering and disturbing as it also represents a disruption of care for thousands. We all know that drug dealers will not disappear; they will simply figure out how to obtain the same prescriptions elsewhere, whether online or in Canada or China. The arrest of physicians gives the illusion that the task force is resolving a serious problem, but perhaps it has created a much deeper one in the process. Physicians are distraught over the measures taken toward them and are losing faith in government.

Doctors are not policemen; they are usually willing to work with government authorities. Thus, a respectful approach might be more effective and less harmful than raids on their offices. The resulting shortage of providers is harming patients. Ultimately, nurse practitioners and physician assistants, often with little clinical experience but holding a fresh degree, replace these doctors.

The Cato Institute has been so alarmed by the criminalization of medicine and bizarre conduct of medical boards and law enforcement that it has offered a new policy to solve this problem. According to Cato adjunct scholar Shirley Svorny, also a professor and chair of the Department of Economics at California State University-Northridge, “Consumers would benefit to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions to the private sector and other courts.”

Gene Healy, editor of: The Criminalization of Almost Everything, points out in his research that ‘overuse of punitive sanction damages the moral fabric of the culture. Lumping trivial with serious transgressions undermines people’s sense of moral.’ The issue for physicians is that “one cannot possibly keep up with all the rules and cannot afford to try.” His concerns are that ’during the past 25 years, the habit of loading criminal provisions and other sanctions into every law has become a thoughtless reflex.” In fact, certain medical societies have begun to publish volumes of laws for the medical profession.

Nancy Dickey, MD, former president of the American Medical Association, points out that “demonizing the entire medical community with a broad brush of ‘fraud,’ waste and abuse’ trivializes real fraud and sets an adversarial tension in every patient-physician encounter.” In turn, Grace-Marie Turner, president of the Galen Institute, 2 in an article called “HIPAA and the Criminalization of American Medicine” points out that “an expanding dragnet for ‘health care criminals’ is threatening and intimidating innocent doctors as well. It is creating an unhealthy climate of fear and adverse impact on the medical profession.”

Most doctors had no sense that they would become targets of such a witch-hunt. Many, like Dr. Quaile in the novel A Monster Chase, were fighting abuse themselves and could not imagine becoming the scapegoat of such draconian measures. Turner points out that “the statues are being enforced by hundreds of federal agents, armed with hundreds of million of dollars in investigatory funds.”

Marion Stahl is the author of A Monster Chase, a fiction on the criminalization of medicine that illustrates the drastic approaches being allowed by medical boards today.

(1) Calculating the percentage using the most recent statistics on the number of practicing physicians in the U.S. from the American Medical Association and salary figures from MGMA, annual aggregate physician salaries total $216 billion, or 8.6 percent of total U.S. healthcare costs. The MGMA statistics were obtained from a 2010 report using 2009 data.

(2) Jackson Healthcare is one of the largest healthcare staffing companies in the U.S., serving more than five million patients in over 1,300 healthcare facilities.