Healthcare Reform or Not?

I have seen two ladies in the past month with what is known with a recto-vaginal fistula.  One of them was from an injury during childbirth and one after radiation for rectal cancer.  Both of them have a horrible problem, caused by a connection between their rectum and their vagina.  This is a horrible way to live.  Can you imagine having stool come out through the vagina?

The problem is that both of these ladies have had trouble finding a surgeon who will fix them.  They have been told by their cancer and colon surgeons that they need a plastic surgeon to fix their situation.  While some of these can be fixed by colon surgeons, sometimes a reconstructive procedure is needed which is best performed by a plastic and reconstructive surgeon.

Plastic surgeons are trained in all aspects of reconstruction.  We don’t simply do liposuction and breast implants.  While over 90% of my practice is certainly cosmetic surgery, I was trained by arguably the best reconstructive surgeons in the country and certainly am able to do these reconstructive procedures.  I continue to do these procedures because it is the right thing to do– not because of the small portion of my income that it provides.

I fixed one of these ladies last month, and plan on getting the second one surgically repaired in the next week or two.  They will hopefully be able to continue their life as they had prior to their injury and/or illness.

Still, these ladies had a major problem finding a surgeon who was willing to see them.  Their insurance carriers told them to find a doctor in their network.  The one doctor they were told to call at the local university told them both that there was a 3 or 4 month wait for an appointment.  Every other plastic surgeon in this area that they called (at least 5 calls that each of them made) told them that their practice is purely cosmetic.

If healthcare reform continues to cut physician payscales, there will be even fewer surgeons willing to do this type of work.  When you get reimbursed by a factor of 10 for operating on people for cosmetic procedures versus difficult reconstructions such as this, there is little to be gained.  The liability is high when it is a difficult problem to fix and the “healthcare reform” does nothing to address “tort reform.”   Why risk a lawsuit doing a difficult case when you are simply trying to help someone?  What is the upside?

More and more doctors are leaving the core training that they had in order to make a better, easier living.  Family practice doctors are doing laser treatments and botox.  Vascular surgeons stop doing arterial bypasses and set up leg vein laser centers.  Plastic surgeons stop doing much needed reconstructions.

It will be very interesting to see what happens today.  Americans want quality healthcare.  Americans want to receive the treatments they need.  Heathcare reform could have been a good thing but the current proposals are lacking and misguided.

Like it or not, at the end of the day the physician is the healthcare provider.  Treat them as they are treated in the current “healthcare reform” and it will drive current physicians out of healthcare and stop the next generation of qualified, intelligent students from going into medicine.

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