To the Editor:

Unfortunately, “Is It Time to Reexamine Family Practice?” [September 2001, page 43] came too late for this 39-year-old former family physician.

After 10 successful years, I left practice because of demoralization due to managed care attitudes and policies, frustration over my patients’ changing mindset and genuine fear for my future security.

The PPO reimbursement in my area is atrocious, and our HMO payments are eaten up by the associated overhead expenses. When I left, eight employees in my office were doing work that wouldn’t have been necessary were it not for HMO rules.

The changing attitude among my patients was the largest disappointment. They came in less for my expert medical opinion than for referrals for an MRI or to other specialists. They paid less for their services and felt more entitled, and became less accountable for their own health in the process.

Lastly, I feared the marginalization of the family physician. I did 70 percent less than I was trained to do because of lack of time, patient pressures to see a specialist and lack of payment for my service. It became clear to me that I did little more than what a nurse practitioner or physician assistant could do. After coping with an overwhelming sense of loss, I decided to pursue another dream of mine in the pharmaceutical industry.

I admire those family physicians who have stayed to fight. But I believe the action plan is poorly aimed. The public needs to be educated about HMOs. They have enjoyed unopposed propaganda while we wage a time-consuming battle in our offices. The proposed patient bill of rights is grossly inadequate, and will result in a dramatic shift of wealth to the legal profession. The Academy needs to speak to family doctors on the front lines – not the ones quoted in the article with fancy titles who are paid by institutions.