IS THERE A DOCTOR IN THE HOUSE?

• Author: GRAHAM, SANDY

MANAGED CARE MAKING PRIVATE-PRACTICE A DYING ART

HIS PROFESSION'S BLEND OF SCIENtiffic and people skills drew Dr. Patrick Martin to medicine.

But six years after starting practice Martin found paperwork eclipsed patient care as he fought with insurance companies over slow payment and denied claims. The Denver-area physician reached a financial crisis in 1999.

"I was working 70 hours a week on average, trying to keep afloat. I didn't mind the work. I wanted to get paid," says Martin, who earned his doctor of osteopathy degree in Texas and completed a residency in internal medicine at the University of Colorado. "When it gets to the point you can barely pay your overhead, it's time to look at something else."

Martin's "something else" was leaving private practice to join the salaried ranks of health maintenance organization Kaiser Permanente of Colorado in June 2000. "It's great, says Martin. "I'm practicing medicine the way I was taught to practice it." He has time for patients, isn't swamped by numerous insurers' forms, and can prescribe the care he determines is needed.

Martin's private-practice travails are far too familiar to Colorado doctors these days. Many physicians, particularly those in primary-care fields such as pediatrics, internal medicine and family practice, are struggling in today's managed care environment. Government and private insurance programs pay doctors little, slowly or not at all, some say. Stories abound about doctors taking salaried jobs or administrative posts, retiring early or leaving medicine altogether. One Denver doctor reportedly left the state to run a ranch.

"There's tremendous frustration in the profession," says Larry Wall, president of the Colorado Health and Hospital Association. "Some physicians are just saying, 'I've had enough."'

It can be hard to generate sympathy for a profession that still earns most of its practitioners healthy incomes, and which contributed to its own woes. In the 1970s, health care costs exploded, fueled in part by doctors' unrestrained use of technology and treatments. Insurers, led by federal Medicare administrators, began to put the brakes on how much they'd pay and for what services.

The medical profession didn't react quickly, says Dr. Richard Krugman, dean of the University of Colorado School of Medicine, "If we'd been there 20 years ago and done something about (quality care at a reasonable price) maybe we'd be better off. ...We abdicated that process to the...