DR. BREWSTER may not be aware that part of the problem she cites was created by the Legislature, which passed a law mandating Medicare assignment. As a condition of their licensure in Massachusetts, doctors are required to accept Medicare payments as payment in full for services provided to patients insured by Medicare. Elsewhere, Medicare pays 80 percent of what it allows, and doctors are allowed to bill patients the remaining 20 percent.
Primary care doctors are low on the reimbursement totem pole, as Brewster notes. Mandatory Medicare assignment has meant that they have to see more patients per day in order to pay their expenses, pay off their student loans, and still have a reasonable level of income.
Clients know that time is money when they see a lawyer or even speak to one on the telephone; for patients this is not the case. Brewster's sense of having been emotionally shortchanged in her chosen professional career is shared by many primary care doctors.
Dr. PERRY KARFUNKEL
Andover
The writer is former president of the Massachusetts Society of Internal Medicine.
