In these days when general internal medicine is barely extant, I write to say goodbye to my beloved patients, whom I treated for the past 21 years in Cleveland. The first 19 years were in private practice, and for the last two years I have been an employee with the Cleveland Clinic (Southpointe Hospital).
I always tried to do my best for my patients, starting my rounds at 2 a.m. in the hospital and opening the doors to my office at 6 a.m. I did not earn much money compared to my specialist colleagues, but I felt fulfilled knowing my patients were being attended to. I was able to make a living and support my family. Now I am told that, to remain a practicing physician in Cleveland, I must stop seeing one or two patients an hour and see three to four patients instead. This is not something I can conscientiously do, nor do I advise that any complex internal medicine patient be treated this way by a physician or by a mid-level practitioner.
I will move on to Phoenix, where I have secured a position in which seeing one or two patients an hour is still highly valued.
I will miss all my patients here in Cleveland.
Jack Rzepka, M.D., Warrensville Heights
I don't know Dr Rzepka personally. But it seems to me that this is the essence of the problem with American health care. We have committed, selfless physicians like Dr. Rzepka who are not allowed to practice medicine the way it ought to be done, either because of personal financial pressures or pressures brought on by giant, for-profit medical organizations like the Cleveland Clinic.
The more patients you have to see, the less thought, the less effort you can afford to expend on any one patient. So the specialist consult train starts and we never get off it. Next thing you know, all your type II diabetics are being managed by endocrinologists, your chronic GERD patients by GI guys, your asymptomatic anginal patients by cardiologists, with all the attendant excess testing and procedures that come with them.... Good luck to Dr. Rzepka.