It was bad enough when insurers and health plans tried to impose limits on internists' referrals. As capitation expands to specialists, things are getting even worse. With internists receiving incentives not to refer and specialists being encouraged not to consult, patients find themselves between Scylla and Charybdis. We internists frequently find ourselves having to fight these restrictions and incentives to do what is best for our patients. Even hospitals, which physicians turned to as allies to address some of the inequities in managed care, are having serious problems.
Stories abound of hospitals operating at full capacity yet losing money.
I am not sure. To start, however, we and our patients need a meaningful patients' bill of rights. If anyone other than a patient's physician is going to influence the kind of medical care patients receive, he or she must be held accountable. We must also each decide how to deal with the unfair pressures placed on internists. Unfortunately, some internists have simply given up, taking early retirement or starting ancillary businesses.