I owe my life to doctors. Here's what they're up against

Since I got cancer, I've been making it a habit to thank my doctors, nurses and pharmacists for saving my life – at least thus far, as my radiologist modestly pointed out. Nobody better run down Cape Cod Hospital near me! But recently, I decided to turn my telescope around and see what it's like for the people treating me. For the big picture, I got to sit with the leadership of the Cape Cod and Islands Physician Council. The Council exists to bring doctors together, advocate for members and also for other providers as well. The CCPIC offers healthcare professionals peer support, and organizes social and professional development events. There are 14 people on the board and 217 subscribers so far. Doctors and nurses take care of us every day. Here's something for them. (www.capephysiciancouncil.org) Recently, I sat down with Dr. John Homa, their President and my urologist… Attorney Bruce Bierhans, their VP… Dr. Mary O'Neill, the organization's Secretary… and Mary McNair, their Administrative Director. All of them have deep experience, not only in the practice of medicine but in the profession. They were collectively unhappy with what's happening, not in the development of new cures and treatments, but in the health of the medical profession itself. You're gonna want to know why. First of all, when doctors treat patients on Medicare, the government sets schedules of payment. for each procedure. This determines what physicians actually receive for what they do. Before going any further, I suspect that many readers imagine our doctors are rolling in money. I'm sharing this column with you, at least in part, to replace this pampered image with the actual reality our doctors face in their daily practice. Most of them come out of medical school burdened with debt, which they have voluntarily incurred because they wanted to be doctors. They want to fix things that are broken and don't work properly, relieve pain and save lives. Ironically, more and more of their experience is mirroring that of many of their patients, that whatever all of us are trying to do in our lives, remuneration is shrinking and expenses are rising. Doctor Homa reminded me that in straight up dollars, reimbursements for many procedures are 50% less than they were in the 1980s. For a typical bladder cancer surgery, a local surgeon receives a reimbursement from Medicare of below $400. This is the reality for all kinds of doctors, across all the disciplines. We remember the COVID epidemic that pushed doctors and nurses past their breaking points. Professionals who may have lost a patient only a few times in a whole career were suddenly losing them daily. Too soon we forget the mobile morgues being set up in major cities across the country as people were dying faster than medical facilities could keep up with. I remember interviewing nurses on Zoom during COVID. At one point or another, every single nurse blackened her screen so she could cry before finally coming back. 'And how,' asked Dr. Homa, 'did the federal government respond as the emergency finally passed?' They cut physicians' reimbursements yet again, he said. The American Medical Association is no match for the political influence wielded by Big Pharma and corporate medical providers. As corporate profits continue to rise, the money shifts away from patient care to corporate interest. At a national meeting, Dr. O'Neill remembers a corporate officer actually pleaded with the physicians gathered there, 'Think of the shareholders!' But you see, when doctors take the Hippocratic Oath, they do not promise to put the interests of shareholders or corporations first; they pledge to care for their patients… to do what is right for them. Dominoes fall. Doctors, faced with ever-rising expenses and ever-falling reimbursements, find it harder to maintain a private practice. Eventually, they're forced to join corporate health-provider programs – or quit. While financial compensation for top hospital executives is up some 1,000% in the last several decades, an estimated 117,000 physicians left the profession between early 2020 and late 2021. Since the start of 2025, 35% of physicians polled said they have considered leaving medical practice altogether. What's happening nationally is happening locally. Once your physicians join a corporate medical practice, whenever you meet, there's an invisible corporate bean-counter in the room with you, not to ensure you get what you need but to 'correct' your doctor for spending too much time with you (time being money) and to make sure your treatment doesn't cost too much. There often is, attorney Bierhans reminded me, a corporate quota system regulating how much time doctors can spend with their patients. Doctors saw a certain number of patients 10 years ago, but across most specialties they're being squeezed to see 25-100% more, in the same amount of time. Our doctors hate it. They're allowed less time with you than you'll get with your barber or hair-dresser. If you're wondering why it's harder to find a primary-care physician, or why you've just gotten to know your doctors — and then they're gone — now you know why. None of the problems I've discussed are unique to Cape Cod. There are many reasons why doctors might want to raise their families in a place like this, but rents and home prices are high enough here that when providers are being squeezed from too many directions, they may be forced to practice somewhere else. What can readers do? They can contact their senators and Congresspeople and demand fair reimbursements for medical services performed. Meanwhile, the CCPIC would love to hear from people in our local governments, including our County Commissioners. It's no longer enough for me to sing my doctors' praises; I had to tell you what's happening to them. Lawrence Brown is a columnist for the Cape Cod Times. Email him at columnresponse@gmail.com.