The Tale of the Vanishing Country Doctor

By T.J. Clemente

The East End has some jagged little pills to swallow. The sad truths are that the area has been having difficulty attracting new doctors as well as keeping the doctors that are already here. In a recent study by the Suffolk Community Council, a private, nonprofit organization that acts as the "voice of human services" for the county, it was concluded that this situation is due to the large difference between summer and winter populations, which causes periods of financial feast and famine for area doctors. Compounded by the long, narrow geography of the South Fork area, which isolates small communities (such as Montauk), it becomes difficult for doctors to establish a central office location. Finally, the absence of large employers in the area makes for a relatively low number of private medical insurance policies among residents, which is also a detriment. In addition, the report mentioned the issue of the rising cost of malpractice insurance.

With a "Freeze Bill" for malpractice insurance just signed by Governor Paterson, perhaps some temporary relief is in sight. This will be most helpful for high-risk specialists. A recent medical journal article about Long Island doctors listed, for example, that neurosurgeons on Long Island pay, on average, $310,000 a year for coverage, while obstetricians pay $170,000. Making that worse is the fact that the infant mortality rate in the Hamptons is 21 deaths for every 1,000 births. Shockingly, that is twice the national average.

The very fact that there is a gap in the care for the poor uninsured out here may be due to the fact that half of Southampton's doctors have refused to take Medicaid patients, according to a recent survey by the Suffolk Community Council. The organization also claims that housekeepers, fishermen, landscapers and waitresses just can't get the medical service they need for themselves and their families.

The bottom line is that money's tight, and doctors are inclined to practice elsewhere. One one these physicians is Dr. Semlear of Sag Harbor. "I can't afford to stay," he said. "It's a comment on the state of medicine today, and I'm not the only one having problems financially."

The well-liked Semlear has been treating local residents and visitors since 1983. Before that, his father practiced family medicine in Sag Harbor for 40 years, eventually retiring in 1992. Semlear stated that his main nemesis is low payment from health insurance plans versus his rising overhead. That is why the malpractice freeze is a step in the right direction. However, a logjam in the big picture has to be the rising cost of health insurance to businesses and individuals. Add to that the chorus of complaints from doctors who believe they are getting paid too little for their services. Clearly, something has to give. Some ask how health care costs can be going up 10 to 15%, while the amount doctors are being paid is going down. One look at health plan salaries for executives might shed some light on this. In 2007, H. Edward Hanway, Chairman and CEO of CIGNA Group, reportedly earned a $1.1 million annual salary, plus an additional $22 million in stock options and bonuses. Other health plan executives earn comparable amounts, and there's a good bet they have better coverage than the rest of us.

The health plan situation seems to be on the political agenda of both parties, and hopefully the burden will not continue to weigh on East End doctors struggling to make a living. The malpractice freeze signed by Governor Paterson is just a temporary band-aid. Hopefully, this situation, like all rising health care costs, can be harnessed. But if doctors, who are usually among the best and the brightest, can't make a decent living, bad times loom over the whole health care system in this country, not just out here on the East End of Long Island.

It's no wonder that Semlear was recently reported as saying, "The current system is evil and immoral." More and more people may be coming to the same conclusion. An overhaul is needed to insure that the country doctor does not become extinct.

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