FORT WORTH, TX – After serving in Vietnam, David Greer, MD, returned to his hometown of Henrietta, Texas, 100 miles northwest of Fort Worth, and opened a small solo family practice.
In a town of about 3,000 people, he knew he wouldn't earn a fortune, although he was able to achieve financial stability. But last year, for the first time in almost 40 years, he had to use his own money to keep his practice running.
Greer's trouble began when he had to re-apply to the Centers for Medicare & Medicaid Services for Medicare payments. He thought everything was fine until his claims were rejected. When he inquired, he learned his re-application hadn't been processed because of a mailing problem.
While he struggled to get the situation resolved, Greer lost hundreds of thousands of dollars in payments for several months, which ultimately forced him to use $250,000 of his personal funds to keep his office operating.
With the help of his Congressman, the Medicare problem was addressed. Nonetheless, Greer has still not been fully repaid, more than 13 months later.
In addition to using his savings to keep the office open, Greet and his wife, who does the office's bookkeeping, didn't pay themselves salaries.
"Fortunately, we live very simply here," he says. "I couldn't have survived a year."
Greer is just one of the physicians in Texas who report that they are forced to make extreme personal sacrifices to keep their practices running, says the Texas Medical Association in a recent report based on a biennial member survey.
The report, released in January, was based on a survey sent to 29,764 physicians, medical students, residents and interns. Of the 3,580 responding, half said they are worried about the economic viability of their practices, citing low or declining reimbursement rates from third-party payers, Medicare fee cuts, bureaucratic inefficiencies and increasingly expensive operating expenses.
Sixty-one percent of respondents said their income has decreased over the last two years and 69 percent reported cash flow problems due to slow payment, nonpayment or underpayment of claims by insurers and government payers.
Deborah Fuller, an OB/GYN practicing in Dallas, says slow payments and the ongoing reimbursement decreases are making survival increasingly difficult. She delivered a baby in October but didn't get paid for it until February. Lack of prompt payment for this and other services forced her to take about $40,000 out of her 401K so she could pay her staff.
"It's not that I'm not busy," she said. "I am busy. But I am making less and less money."
The increasing financial pressures felt by physicians have changed the medical field, says Randall Bock, MD, who runs a general practice in Revere, Mass. It's no longer an free market, he says, and physicians don't get paid properly for the services they provide.
Given such a business climate, Bock advises young people, "Think about going into dry cleaning or pizza."