Put to rest the myth of the highly paid doctor

In case you missed it, there’s been lots of health talk recently. Much has been about patients struggling to get care. Rarely do we hear about doctors struggling to give it.

One such doctor is Erica Jurasits.

Not long ago the owner of North Country Family Health and Medicine in Rocky Point was thinking of giving up the fight. “I keep putting money in, reinvesting in the practice, but not getting anything back out,” she told me recently. “At some point you have to say that’s enough, cut your losses and move on. Join a multispecialty practice or become a teacher at the university. A lot of physicians are retiring early and moving out of state.”

But she doesn’t want to do any of that. “I love my practice, and I love my patients,” she said. “I think I give quality care but the business end of things gets a little difficult.”

The business end includes Long Island’s notoriously high real estate prices and taxes, plus salaries for her 3.5 employees, big student loans that are “like a second mortgage, basically,” and on and on. Worst of all is the “horrendous” malpractice insurance.

In Nassau/Suffolk, which ranks sixth highest in the nation, specialists pay well over $100,000. “Even family physicians are in the $20,000 range,” Jurasits said. Match all that outlay with inadequate HMO reimbursements and the dilemma is clear. “Insurance barely covers costs. I don’t even give vaccinations for HPV or shingles anymore.”

As a result, Jurasits began taking on more and more patients and seeing up to 50 a day. “It really burnt me out,” she said. “It’s what I needed to do to keep my practice afloat, but I just knew I couldn’t give quality care.” Since then she’s added another doctor and is cutting her appointments to a maximum of 30 a day.

Problem solved? “Not yet, but we’re working on it,” she said.

Jurasits brings a broad spectrum of experience to the subject. A 1991 graduate of the New York College of Osteopathic Medicine, she interned at Peninsula Medical Center in Queens and then at Robert Wood Johnson Medical School in New Jersey. On a health policy fellowship she helped write one of the nation’s first patient protection acts.

She also has two children, one of whom was home sick the day we spoke. So you could say that Jurasits sees health issues from all sides: public, private and practitioner. “Absolutely,” she agreed with a laugh.

And not only from a U.S. viewpoint, since she also did a residency rotation in England. I asked her about the popularly held notion that doctors in countries with nationalized health care make modest livings while those in the United States all live in beachfront mansions and drive Mercedeses. Her laugh turned rueful. “That’s a definite misconception,” she said. “We live in a two-bedroom ranch house on barely a quarter-acre, and it’s not on the water. I drive a little Toyota van.”

(By the way, she doesn’t have much hope for nationalized medicine here due to restricted access. “I don’t think the American people will stand for that,” she said.)

Meanwhile, some U.S. doctors aren’t standing for the current situation. Some have started charging a flat $75 per visit. Some are offering concierge service, in which patients pay a couple thousand dollars per year just to get guaranteed access. The advantage there is the ability to see fewer patients and give them more time and attention.

Jurasits has seen figures indicating that a primary care physician’s practice needs 3,000 to 4,000 active patients to survive. But that doesn’t work for her brand of doctoring. “Osteopaths are much more geared toward prevention,” she said, daunted by the notion of giving thorough care to that many patients.

Yet another problem might be the average person’s disbelief that doctors can suffer financial distress. It’s a refutation of a deeply held American belief: that medicine is a sure-fire career path to wealth.

These days, in many cases, it’s apparently not true. And after 11 years of practicing, six of them in her own company, Dr. Jurasits herself seemed surprised to be saying, “I would have thought it would be profitable.”

Long Island Business News / December 3, 2009