Is There a Doctor in the State?

LAST year at this time, the Massachusetts Medical Society (MMS) became the first organization of its kind to call its own state "an undesirable place in which to practice" medicine. And even though the MMS and the American Medical Association are both supposed to remain politically neutral, the hint was there. They blamed Gov. Michael S. Dukakis for the deterioration of health care in Massachusetts.

The half million doctors in this country are normally a Republican bloc of voters. But the word in the medical community is that they wouldn't have automatically voted Republican this year if Dukakis weren't the Democratic candidate.

"If [Sen. Lloyd] Bentsen were running, he'd get my vote. But since he's not, I'm voting for Bush," a doctor friend of mine told me recently. He wouldn't listen to the argument that voting for Dukakis was the next best thing. Nothing has alarmed him--and, I'm told, doctors across the country--more than the prospect of Dukakis doing for the country what he has done in Massachusetts.

The Dukakis campaign maintains that the number of doctors in the state has been stable since 1982, when Dukakis was elected to serve his second term. If doctors are leaving the state, the campaign would have us believe, then someone is taking their places.

But many doctors say it is ironic that while Dukakis advocates universal care on the campaign trail, some residents of his own state may go without it because of "spot shortages" of doctors, primarily in Western Massachusetts and on Cape Cod.

It's a tough call to make, but many watchers of Massachusetts medicine claim that the quality of medical care here has been in decline for some time. No self-respecting doctor, I'm told frequently, would choose to practice medicine in a state that some feel has declared war on doctors.

SO what has Dukakis done to alienate so many doctors? Well for starters, Massachusetts is the only state where a doctor must agree to balanced billing when he receives his license--that is, when treating Medicare patients he is not allowed to charge above what Medicare will pay, even if the patient can afford it.

But that's not the real reason so many doctors hate Dukakis, or why the state's hospitals are no longer among the world's elite. The long-running history of clashes between Massachusetts and its doctors every so often culminates in litigation. Most recently, the end of the summer found the Attorney General Jim Shannon suing two dozen Springfield obstetricians who were discontinuing their coverage by Blue Shield. Normally providers of Blue Shield are supposed to give Blue Shield one year's notice, and the doctors had simply decided they were unhappy with the coverage. But the state's assertion that the doctors had conspired to drop the coverage was laughable. Few agreed that the squabble justified a lawsuit.

During the past several years, Massachusetts revenue caps for hospitals--which put a ceiling on the amount a hospital can increase its budget in a year--have forced hospitals to juggle their budgets, often cutting important programs. Because of the stringent state caps, many local hospitals have done away with their "I.V. teams" or technicians responsible for putting needles and catheters into veins. Without I.V. teams, patients must let interns fresh out of medical school take their chances at hitting a vein.

And at some hospitals cuts in the physical therapy departments forced patients who wanted the amount of physical therapy they needed to hire private therapists to make special hospital visits.

The Universal Health Law Dukakis would undoubtedly pass if elected president would require employers to buy insurance for uninsured employees. Doctors do not pretend to be excited about what would bring this country one step closer toward socialized medicine, but by itself, the prospect of the law's enaction is not what will make them vote Republican, as some believe.

It should not be an issue that sways votes, and it is unfortunate that the small doctor population in this country will be blind to the merits of the Democratic ticket this year. But if doctors are Dukakis' enemies, then he has earned them.