The September issue of "Christophorus," a magazine for Porsche enthusiasts, is causing a kerfuffle among some California physicians and hospital leaders who e-mailed it to each other in a rage this week.
That's because the publication contains a 9-page glamour spread showing 10 blue-scrubbed physicians on staff at San Diego's 306-bed Alvarado Hospital, all touting their expensive Porches, which sit glistening beside them in the hospital parking lot.
"Calling 911 has a special meaning at Alvarado," the article begins. "Driving a historic 911 Targa through Southern California is the favorite pastime of Hugh Laurie, the British actor playing TV doctor Gregory House. But this passion for Porsche is easily topped by the top doctors of Alvarado Hospital in San Diego. You just have to check out the parking lot. And you can count for yourself. One, two, three..."
Don't these doctors know about the sustainable growth rate formula (SGR), and the Medicare pay cut's one-two punch scheduled for a 23% drop on Dec. 1 and 1.9% on Jan. 1? (On Nov. 2, CMS revised its estimate from 30%.) Physicians across the U.S. are desperately seeking to repeal it, even as some of them contemplate dropping Medicare patients. This kind of an article, coming now, is unseemly.
There is neurosurgeon Scott Leary, MD, leaning against his 2010 911 GT3. "I deal in a precise environment where there is no room for error, and I demand the same of my car," the article quotes him saying. The car helped him get to the hospital at 3 a.m., fast enough to help save the life of a patient suffering an acute brain hemorrhage.
"I was looking for a car to deliver the ultimate driving experience and performance," the article attributes to Afshin Bahador, MD, a surgeon specializing in gynecologic oncology, whose hand rests on the rear window of his 2009 Carrera with PDK. "I perform ultra-delicate surgery in areas of the body that demand precision. My Porsche, I feel, makes me a better driver."
Ramin Raiszadeh, MD, an orthopedic surgeon, told the writers that his 2009 Carrera 4S provides "performance, endurance, and elegance."
"Endurance? Dr. Raiszadeh performed an 18-hour spine surgery, 'where I had to be just as precise in the 18th hour as the first. I chose the AWD Porsche for the control it gives you, just as I have to have control over each step of spinal surgery."
And there is pediatrician Pedram Salimpour, MD, who owns the hospital with his brother, another pediatrician. Salimpour "is currently driving his third Porsche, a 2009 Carrera S," the article reads.
"There seems to be a direct connection between the brilliance of the Californian doctors and the brilliance of the German sports-car manufacturer," the article says.
The incensed doctors I spoke with describe the Alvarado physicians' involvement as "stupid," and "counterproductive to the move to repeal the SGR," because they think it enhances the stereotype of the super rich doctor who can afford to buy $100,0000 cars, and couldn't care less what happens to the Medicare fee schedule.
"I think people should be outraged," says internist and cardiologist Stewart Frank, MD, president of Mercy Physicians Medical Group in San Diego, who e-mailed the article to many colleagues.
"I don't begrudge that they drive nice cars, but to equate quality with the kind of car you drive, that's absurd. It focuses people on the materialism of healthcare providers, rather than how do we provide better healthcare at a lower cost. They should have never consented to something like this," says Frank.
"Readers of this article shouldn't get the impression that all physicians can afford Porsches, while we try to get Medicare to properly value our services," says Ted Mazer, an otolaryngologist on staff at Alvarado and a California Medical Association officer. He drives a Toyota, by the way.
"Many physicians are clearly dependent on the correction of the SGR to buy any vehicle, let alone a Porsche," he said.
On the quality issue, Mazer adds, "It's great that these doctors look to the excellence of a Porsche. But it does not mean that doctors who drive Fords are any less excellent than a Porsche driver. Nor does their ability to drive a Porsche reflect the rank and file physician's choice of a car."
Salimpour responded to my request for comment with this e-mail:
"As a physician and owner of Alvarado Hospital, I value the passion our medical staff brings to their professional and clinical work each day. That passion is reflected in their automotive hobbies, as seen in their choice to drive Porsches.
"That passion is also evident in the article that Porsche developed for other enthusiasts. It was never intended as a commentary on any aspect of the healthcare profession or the other 440 fine physicians at Alvarado whose automotive choices are entirely different. We sincerely regret any interpretation that suggests otherwise. As healthcare providers, we are focused first on our patients and their needs. That's the passion that matters."
Ok. But you've got to wonder. At a time when the healthcare industry is focused on evaluating doctors on meaningful quality metrics—the latest CMS physician quality reporting system rules are final as of Wednesday—whatever were these Alvarado physicians thinking?
In my opinion, the article was not just in poor taste, but its timing couldn't have been worse. If the SGR goes through, many doctors say they will reject Medicare patients altogether, cut their staffs, or resign from practice entirely.
Sent a copy of the article, California Medical Association spokesman Andrew Lamar in Sacramento weighed in.
"It would be wrong to assume that Medicare rates are adequate, or could be cut, simply because some private doctors who either don't participate in the program or serve almost entirely patients on private insurance, make a good living," LaMar says.
"The bottom line is a 30% reduction [revised to 25%] in Medicare reimbursements would be devastating to physicians and force many to quit taking new Medicare patients or drop out of the program altogether just to stay economically viable. There is little doubt that, as a result, seniors would have a tougher time getting access to a doctor," LaMar says.
Maybe these Alvarado doctors think this was just a fun and harmless diversion, compared with the tough decisions they make every day about patient care. But I think if they had thought this through to any degree, they might have at least waited until if and when the SGR issue is settled once and for all.