Pity poor Marc Siegel, a hard-working, primary care doctor who is facing hard times. “As the months drag on, and my office expenses continue to increase, my patients will find that I am barely able to continue to keep my office open. Many will grow more disappointed as my carpeting grows worn and my wallpaper begins to peel,” he writes in a commentary this week for Forbes.

Struggling to survive on dwindling reimbursement from Medicare, routinely having to tell patients that insurance won’t cover their name-brand prescription drugs and batteries of diagnostic tests, Siegel, who is based in Manhattan, says he can’t even think about accepting Medicaid patients.

For him, health care reform offers no salvo for this sad state of affairs; he might have to close up shop. In fact, in Siegel’s view, health reform is not only an unmitigated disaster, it’s something more sinister as well; “the government is plotting to spread expensive insurance to pay for low-tech care for the entire population.” Government plots, low-tech care for the entire population? Hmm, who is this Marc Siegel after all?

Turns out that Dr. Siegel might be using a bit of artistic license in his description of fraying carpets and peeling walls. After all, he must be paid something for being a Fox News Medical Contributor who appears regularly on Sunday morning’s Fox and Friends show. Siegel’s lamentations about health reform, “death panels,” and government recommendations on prostate cancer testing and mammography, (as well as other commentary) can be found in the Washington Post, Forbes and USA Today. Through his regular media exposure, Siegel has become a particularly shrill voice for those angry doctors who feel their livelihoods are threatened by Obama and his brand of health reform. He’s the more literate mouthpiece for practitioners like the urologist outside of Orlando who posted a sign recently on his office telling patients:   “If you voted for Obama…seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

The truth is that Siegel is right about the challenges facing many primary care practitioners now and in the days ahead. We do have a serious shortage of primary care doctors at a time when some 32 million additional Americans will soon be insured and seeking care. The reasons for that shortage are complicated and include lower pay, long hours and increasingly time-consuming administrative duties. Indeed, a study of primary care doctors in the Annals of Internal Medicine found that; “More than one half of the physicians (53.1%) reported time pressure during office visits, 48.1% said their work pace was chaotic, 78.4% noted low control over their work, and 26.5% reported burnout.”
 
Toni Brayer, an internist and hospital administrator in Northern California recently wrote about this shortage issue on the blog KevinMD.

“It takes 8-10 years for an under supply of physicians to be corrected because physicians have to go through medical school and residency. There has been no up swing in physicians choosing primary care specialties for years and, in fact, the shortage is predicted to be 46,000 full time physicians by 2025 (Association of American Medical Colleges). Now add millions of new patients, baby boomers reaching Medicare and you have a disaster in the making.”

Siegel is also right that currently, primary care doctors are underpaid by public insurers for their services—especially for the time they spend talking with patients and providing preventive care. But in his Forbes commentary and frequent attacks elsewhere on health care reform legislation Siegel ignores the fact that the health bill provides a 10% Medicare bonus from 2011 to 2015 for primary care and other incentives (see Maggie’s post “Myths and Facts: Doctors Who Take Medicare”  for more on this issue.) The legislation also increases reimbursement for Medicaid primary care to 100% of Medicare rates in 2013 and 2014 and boosts funding for community health centers.

The reality is that Siegel and his ilk aren’t really interested in change—they’re interested in subverting it. Clinging to the old model of medical practice, they fear that government-sponsored comparative-effectiveness research and recommendations will hamper what Siegel calls his innate ability to “practice the art of medicine.” In his no-holds barred, “doctor-knows-best” view of medicine; no one—especially the government—interferes with the “artist.” 

In March, Siegel published a commentary (also in Forbes) expressing his dismay with the American Cancer Society’s new recommendations to delay PSA screening for prostate cancer until age 50. Touting robotic surgery and other cutting-edge (but of questionable benefit) technologies, he vows to keep testing younger men and moving them into treatment. Predictably, Siegel also urged women to disregard the US Preventive Task Force recommendations that include waiting until age 50 to have yearly screening mammography. In the New York Post, Siegel misleadingly warns readers that USPTF recommendations will be mandated under health reform, depriving them of needed care:

“[U]nder ObamaCare, guidelines will quickly become mandates, and patients will routinely face the choice of paying hundreds of dollars out of pocket or accept higher risks of cancer. It will take government bureaucrats years to admit mistakes, if they ever do — and by that time thousands of women will have needlessly gotten sick or even died of cancer.”

Doctors are often attacked for being too focused on their incomes and autonomy and unwilling to make sacrifices for achieving universal coverage. Many of these attacks are unfair and fail to point out the very real pressures faced by some practitioners—most of them in solo or small primary care practices who see a lot of publicly-insured patients. We are facing a primary-care shortage, we will see a huge influx of new patients—some of them very sick—and we will have to figure out how to shift compensation so that Medicare reimbursement is less procedure-driven and based more on prevention and comfort care.

But commentators like Siegel are doing nothing to help the plight of these physicians. He warns that doctors in his network of specialists are refusing to see Medicare patients and certainly don’t plan on treating the flotsam and jetsam—those previously uninsured patients who either couldn’t afford coverage or were turned away because they had pre-existing conditions—who soon will be showing up seeking care. He writes of an elderly patient who worries that her Medicare card  will no longer be accepted by Siegel for payment: 

“Thinking about her and those like her makes me very angry. Should I tell her that the very art of medicine that I rely on to take care of her is in mortal jeopardy? I barely have enough time with my growing list of patients to concentrate on her case as it is, and the reform will bring me more patients with lower payments. Should I mention that many of my contemporaries (the network she relies on) are no longer accepting her Medicare, even before the reform bills sink their claws into it and cut Medicare to the bone with hundreds of billions in cuts?”

Primary care physicians are understandably worried about the future of their practice. And I think it’s important that their voices are heard from the trenches as we begin to implement reform. They are, after all, the foot soldiers in the mission to achieve universal coverage while reining in sky-rocketing health care costs. But Siegel isn’t really one of them. Dingy carpets and peeling wallpaper aside, his constant fear-mongering in the press and attacks on health reform have made him a tool of the conservative media.

As one commenter on Forbes’ recent blog put it, “I’m glad Marc Siegel isn’t my doctor.”

Me too.