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As many of you are aware, health care has been a hot topic recently, and will remain a discussed and debated topic for months to come. Many experts expect a toned-down version of the health care bill to pass this summer.

Instead of boring you with analytical detail, I am going to give you my practical view of where medicine is heading in the future. Unfortunately, my vision is not bright.

Let us start from the beginning. When I was a medical student at University of Southern California, the tuition fee was $12,000 for the first year and increased to $16,000 during my fourth year. Currently, the tuition fee is $44,800! This means from 1986 to 2010, a 24 year period, the tuition fee has increased 272%. This translates to an average annual increase of 11.4%, which is significantly more than the inflation rate. Remember, this does not include cost of living, transportation, etc.

The data shows the income of physicians has not increased and in some specialties has slightly decreased over the past ten years. Therefore, medical students are graduating with a larger and larger debt, with an income which is not even keeping up with inflation, let alone cost of education.

Then there is malpractice insurance, which is mandatory for all physicians, if they plan to work at a hospital or perform surgery at a surgery center. The average insurance cost for a plastic surgeon in California with a “clean” record is around $25,000-30,000/year. The rate for an OB/Gyn doctor is $50,000-60,000 or more. This is equivalent to the annual salary of the average American family! Why are the rates so high? Part of the problem, if not all, is the ease with which law suits can be filed and the ability or inability of a jury to correctly asses the data. I know of a case where the jury awarded $70, 0000,000 to a patient for inability to have sex after a tummy tuck surgery! This is not a typo and I will confirm the award: $70,000,000. Having said this, I have read of cases where the surgeon was clearly at fault and the jury did not award the patient. The point is I do not believe a jury of lay people has the capability of adequately assessing complicated medical lawsuits.

Furthermore, many of these cases take years to resolve. Why do we have such an inefficient legal system is not clear to me. Common sense, however, tells me if an attorney charges by the hour, why would you want to have an efficient system?

Another issue is Medicare’s plan to reduce payment to physicians by 21%. This probably has nothing to do with reducing the cost of health care as much as balancing the budget. Unfortunately, PPO and HMO companies adjust their payments by using Medicare fees as a base-line.

There is now increased government intrusion (some of it good, most of it extra paperwork for less payment). The new big thing is pay for performance, meaning physicians will be awarded for being efficient and cost effective in their delivery of health care. Why not do the same to the judicial system? Can you imagine the amount of money and time which will be saved? Why not have all medical lawsuits screened by an experienced panel (may be two physicians and two judges). The decision to pursue the lawsuit should be unanimous and the final decision should be unanimous as well. I urge you to write your representative in congress about changing the legal system. Even writing to your local newspaper to cover a story about the “hidden” legal cost of health care can’t hurt. The problem is trial attorneys pour an annual budget of $6.5 million to lobby at Congress. The change may never happen, but it is worth a try.

What about universal health care? I think it is important for every one to have coverage for basic and emergency medical care. However, please note this will not equate to increased income for the hospitals or the physicians. With the budget deficit as it is, the payment for the newly insured will come from decreasing payments from Medicare and other programs. In other words, the hospitals and the doctors will have to see more patients with no increase in re-imbursement. This has to affect quality of care at some point. I wish I had an answer how to cover every one without financial sacrifice, both from the medical side and from you, the tax payer.

What does all of this mean? Well, the number of applicants to medical schools has dropped 20%. I know of two people who got accepted into medical school this year and decided to pursue other careers. If this trend continues, medical schools have two options: either lower the standard of admission or accept foreign medical graduates. Outsourcing of medicine has the advantage of hiring these doctors after residency training with less pay. Many of these graduates will have a better quality of life than in their own country, even with lower salaries. The question is how to pick the “cream of the crop” and will the “cream of the crop” be as good as the medical applicants from this country? Either way, I see a potential decrease in the quality of applicants and, therefore, quality of care.

Many of you may say “Oh, here is another doctor who whines all the time. He probably plays golf all the time and makes millions.” Yes, this statement was true in the 1970’s, the so called “golden age of medicine”. My generation is more like the “cubic zirconium” age of medicine!

But to put things in perspective, a plastic surgeon goes to four years of college, four years of medical school, and 6-8 years of residency after that. That is 14-16 years of education beyond high school. An attorney goes to 3 years of law school and can practice after passing the Bar. The cheapest attorney fee I have seen is $250/hour, and the attorney charges by the hour. The insurance companies, however, reimburse physicians by the procedure code they use to describe what was performed. The payment is fixed, regardless of the time of surgery. What about a basketball player with college or high school education? How about getting paid $200,000-1,000,000 a month to throw a ball through a hoop! How much do you think it is worth allowing a surgeon to cut you open, take things out or re-arrange things and then put every thing back together so that you are better off after surgery?

Michael A. Jazayeri, M.D. is a board certified plastic surgeon in Santa Ana and a member of American Society of Plastic Surgeons. His office is located in Central Orange County. If you like to schedule a complimentary consultation, please call (714) 834-0101.

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