Dear patients on insurance company X:

I am very sorry to give you the bad news: effective immediately, we are no longer providers on your medical insurance plan.

I am sorry about this because many of my favorite patients are on your insurance plan. It will miss seeing you. I am also sorry because this makes your already short list of possible doctors even shorter, making it much harder for you to get good care. There is a reason there aren’t many doctors on your plan: it just doesn’t pay enough to be worth it.

I suspect that some of you must feel jilted, like you just got an unexpected “Dear John” letter. I hate giving this sudden bad news; I’ve been with many of you for more than 10 years, walking alongside of you through sickness and pain, births and deaths, sadness and joy.  But what I hate the most is that all of this is happening because of money; it makes me feel selfish or petty. Please believe that we did everything we could to avoid this situation.

Here are the things that drove us to this hard decision:

1. Your insurance was already paying us significantly less than average, and now wants to pay us even less.

2. Your insurance also requires us to do far more paperwork than most.

3. Their referral process is very complicated and frustrating.

As a primary care doctor, I make my living by what I get paid for office visits.  We don’t do a lot of procedures, we don’t see people in the hospital, and we don’t own a lab to make us money. The only source of income I have is the time I spend with you and other patients in the exam room. For whatever reason, your insurer (and many others along with it) don’t value this time.  They will pay for expensive drugs and procedures, which are many times more expensive than I am, but feel that their cost savings has to come off of my salary.

It is hard to understand why insurance companies try to save money by cutting the pay for doctors like me. My goal is to keep you healthy and keep you away from the things that cost the most: ER visits, unnecessary labs, hospitalizations, unnecessary procedures.  Isn’t that what insurance companies want?  If I can prevent a single day in the hospital by keeping healthy, I save more money than you will ever spend in my office for your entire life.

One of your insurance company employees told us that accepting lower payment is somehow a “civic duty” for us to help keep costs down; but I wonder if it would be better to to sack a few insurance company employees who increase cost by making things harder for everyone. No, my duty is to take good care of my patients, and increasing my patient volume to make up for decreased pay is the wrong way to do it.

This is exactly what is wrong with our system: The essence of health care is the interaction we’ve had in my office; yet we are the ones who are being caught in the middle. This is why things need to change: I want to see you, and you (hopefully) still want to see me, yet the system that is supposed to bring us together is now pushing us apart.

I hope that somehow this all works out and I can continue to be your doctor.  If not, it has definitely been a privilege to be your doctor.  I hope you do well, stay healthy, and please take this final piece of doctorly advice from me: Avoid our messed-up system as much as possible.

Thank you for being my patient.

Dr. Rob.

Rob Lamberts, MD, is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).