I escape to the office, seeing it as a restful place. I prefer not to call it "going to work." Rather, I view my time in the office as an opportunity to do what I love best: serving patients.

That's not to say the 19 years I've spent in solo practice at the same address have been completely carefree. Like many of you, I've watched managed care affect my practice negatively.

Even though I've felt the pinch of managed care, I don't think the health maintenance organizations (HMOs) alone are at fault. Independent Practice Associations (IPAs) that negotiate contracts on behalf of physician groups must also be held accountable for poorly written contracts that include inadequate capitation rates.

The bottom line is who suffers -- our patients.

Until late 1994, patients could see nearly any doctor they selected. But in 1995, managed care began to penetrate the marketplace. I still remember that year. My patients would come up to my reception window and become bewildered after hearing they had chosen a plan that narrowed their contracted doctors to a group of seven, instead of the 70 metropolitan area ophthalmologists they once had access to.

That's why, for the past 7 years, I've fought for healthcare reform. At one time, I would let the press use my materials and thoughts, but I told them not to use my name. Now, I have a desire to educate my colleagues and patients. I'm proactive rather than reactive.

In addition to educating patients, my staff and I treat each patient like a Kennedy. When I see patients who've been with me since the first year my office opened, I always thank them for their loyalty. They're grateful for an established relationship, and I'm thankful that I know them without first having to review my chart notes.

What also gives me immense satisfaction is seeing patients who really need to be seen, such as the uninsured and those on public assistance -- patients who are rejected by insurance plans because they're too unhealthy.

Treating the underserved fills me with such joy. They're the patients who always say, "Thank you," and mean it, because without my care they may have become unemployable. I find that extremely gratifying.

Thanks to legislative efforts by state medical associations, and media awareness, HMOs are starting to recognize the needs of the underserved and giving patients a larger choice of physicians. But it's up to us, the physicians, to stand up, decide what's fair and reject the rest. Along with our negotiators, we need to take responsibility for what we've agreed to, and do our best to make things better.

Churchill said it best: "We make a living by what we get; we make a life by what we give."

Remarkably, I've more than survived, and quite happily so, because of the diversified types of patients I serve. Just like a diversified investment portfolio, a diversified practice is very satisfying, and certainly adds security as HMOs come and go.

I urge you to diversify your practice and work to make things better for your patients. You'll find yourself going to work with a smile that's almost impossible to wipe away.

Want to tell your story? CALL

John Osborn at (215) 643-8055, E-MAIL to
osbornjs@boucher1.com, FAX to 215-643-3902, or WRITE to 1300 Virginia Drive, Suite 400, Ft. Washington, Pa. 19034. Offer a few thoughts, and we'll take care of the rest.