A new survey of medical doctors nationwide says that more than two-thirds are becoming disillusioned and disenfranchised with their profession years before retirement age because of ever-increasing burdens placed on them by the federal government.

According to the survey conducted by the Association of American Physicians and Surgeons, 66.2 percent of doctors say that they will "retire from active patient care at a younger age than they would have considered five years ago" not for financial reasons, but because of "increased government interference in the practice of medicine."

Decreased fees were cited by 56 percent of participants as a reason for considering early retirement from medicine.

Sixty-four percent cited "decreased control" over medical practices, while another 64 percent said increased bureaucracy from Medicare as the reason.

Perhaps most telling, analysts said, was that 61 percent of those surveyed said they were experiencing an increased fear of federal prosecution or unwarranted investigation as the reason they were considering early retirement.

There were 335 doctors surveyed; 96 percent of them were physicians who spend at least 20 hours per week in hands-on physician-to-patient contact.

Dr. Thomas Mueller, an otolaryngologist in Everett, Wash., and former president of the Washington chapter of AAPS, says rather than get out early, there are things physicians can and should do collectively to make the practice of medicine more patient- and physician-friendly.

"As rapidly as possible, as many physicians as possible need to end all third-party relationships," Mueller wrote in the May 2001 issue AAPS News.

That means, he said, that doctors should insist on legislative and insurance company policies and changes that would allow patients to pay physicians directly at each visit for services rendered.

Patients receive a receipt for payment, which they may submit to their insurance company for reimbursement, under the terms of their contract with the insurer, he said.

"Every other proposal falls short of accomplishing the goal [of restoring a free market in medicine] and does little to control the reign of bureaucrats," Dr. Mueller concludes. "Said another way, all other proposals are simply like rearranging the deck chairs on the Titanic."

Mueller said his proposal is basically the same as the AAPS Non-Participation Policy, adopted in July 1965. That policy, he wrote, is based on the fourth Principle of Medical Ethics: "The physician should not dispose of his services under terms or conditions which tend to interfere with or impair the free and complete exercise of his medical judgment and skill or tend to cause a deterioration of the quality of medical care."

Also, doctors and medical industry analysts say that such direct pay policies would eventually reduce the cost of medical care because physicians would no longer have to hire insurance coding and regulatory specialists to untangle the web of complicated rules, regulations and mandates, thereby reducing their overhead.

And, without middlemen and third-party agencies, doctors believe their insurance reimbursement rates would be better, which could lead to reduced fees that no longer must be inflated just to receive minimum payment amounts.

Congressional attempts at insurance reform have uniformly increased the number of uninsured, largely because they have increased costs -- which are already too high, AAPS News said in its May issue.

Mueller's proposal, the group said, would not require any new legislation -- only a "critical mass" of physicians demanding the changes be made, "which might not [have] to be that many."

Third-party payment is a major cause of excessive cost because it adds administrative overhead, the group said.

For example, Texas physicians will generally lower their price by 15 to 20 percent for "prompt payment," according to Donna Kinney, CPA, of the Texas Medical Association, AAPS said.

Moreover, the low perceived cost to the consumer spurs excessive demand for services worth no more than the co-payment to a customer spending his own money, AAPS said. Attempts to constrain demand lead to new methods of gaming the system, which lead to ever more intrusive regulation.

And, as costs rise due to federal regulation and insurance company mandates, more people become uninsured because they can't afford the coverage.

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