LENOX -- For Dr. Andrew Schamess, who is leaving the area after nearly six years as a solo primary care provider at Lenox Internal Medicine, the sacrifices he's asked of his family -- his hours on the job and the amount of money coming in -- made staying in the area "hard to justify."
Under insurers' fee-based payments for procedures, according to Schamess, "they consider time spent with the patient to be a very minor procedure, so it's paid at a very low rate. ... We've designed a system that pays almost nothing for thinking and communication, and pays an enormous amount for procedures, and then we scratch our heads and wonder why we have a system where no one ever talks to the patient."
Schamess is no fan of "unncessary tests," and he worries about "patients who are shunted around from place to place and person to person and in the end, maybe you get a diagnosis or you don't. They feel alienated and wind up finding out more from the Internet than from the people taking care of them.
"As a society, we have to figure out how to place some sort of value on the time spent with patients -- it's the key element -- and beyond that, the knowledge, experience and human skills of the person spending that time."
The physician shortage looms large. "The area is on the verge of a huge crisis," Schamess said. "When you look at the economics of how hard it is to start a practice, to hire somebody, how easy it is to go under, it's really
"Primary care tends to be sort of a loss leader. Nobody really makes money from it," he continued. "Even the larger groups in family practice and internal medicine are struggling."
Schamess is calling for "reinventing the system."
"We need to do the research about time spent, human relationships, communications and the role in treating disease. That's what primary care physicians do, though we may have sort of forgotten that's what we do."
For him, the patient is front and center.
"So much of the battle is figuring out what's wrong, and that can be done much better with eyes, ears and hands than it can with a million fancy tests and instruments. All of this is very low-tech and not expensive. This is how medicine was always supposed to be, and somehow we've strayed from it."
Asked whether he is too idealistic, Schamess responded: "Oh, definitely. I spend too much time with patients, that's why it's not a good business. But you really have to wonder what sort of business it is to say the less time you spend, the better you do."