Sunday, July 19, 2009

An old school doc says goodbye to Cleveland

Dr. Jack Rzepka wrote a letter to the Cleveland Plain Dealer that was published in today's Sunday edition. Here's the entire piece:
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.


Joseph Sucher, MD FACS said...

We can't get off this train because we are held to the standard of "the specialist".

Many physicians feel as if they can't afford to miss the rare or subtle abnormalities on EKG.. so they get a cardiologist for every patient over 65. They can't afford to miss some rare infectious problem, so everyone with pus gets an infectious disease consultant. They can't afford missing some subtle underlying kidney disorder, so everyone with a creatinine over 1.0 gets a nephrologist.... I think my point is clear.

We all know that many physicians feel very compelled to consult a specialist for every organ system. Until there is meaningful health care law reform.... Until our society is able to accept that health care is imperfect... this behavior will continue. It is not practical to tell the physician community to just be stronger and stand up against this behavior. I know many good doctors that practice this way. They are just players in a game who's rules they don't control. The rules must change.


AB said...

I wonder if he's headed to Phoenix to work for the Mayo Clinic. I know they have a hospital in Phoenix and a satellite campus in Scottsdale.

rlbates said...

Good luck to you Dr Rzepka.

Jessica Bond said...

Phoenix seems to be a popular place to move your practice. Wonder how long the greener grass of PHX will last?

Anonymous said...

He Starts his Rounds at 2am??????
1 patient an hour????
So why did he leave his Private Practice????
Phoenix is pretty cool, could do without the 115 degree days...
Probably beats Cleveland though...


Anonymous said...

I suppose he left his private practice because he could no longer afford to see 1-2 patients an hour either. Thought that a guaranteed salary would be just what the doctor ordered.

Seriously though, if as a PCP you can't see an average of 3-4 patients an hour, including return visits. Something doesn't seem right. They can't all be complicated can they?

I have friends in private practice telling me they have to see 1.5-2x that just to make ends meet.

DKV said...

1-2 patients per hour for primary care actually seems right. At least in my idealized vision of primary care.

We took our daughter to her pediatrician last week, and it was an hour appointment. Granted, our daughter is "complicated" but I think the PCP gets a much better sense of the "whole" person in a longer visit. What their social stressors are, their barriers to care, etc. All those mushy subjects that I routinely ignore but that play a real role in health care.

Anonymous said...

let's assume he is a very good clinician, but c'mon--how did he afford to practice with 1-2 pts per hour? even concierge physicians can't afford that probably.

going somewhere else will drain the resources of whoever employs him. if a large group, it will engender bad feelings in the group.

LEP said...

My husband Lenny and I were patients of Dr. Rzepka for 15+ years and are very sad that he has moved. Everything he said in his Blog was true. It was not unusual for him to come to see me in my hospital room at 3:45 am, or for him to return our calls and 1:15 a.m.! And, yes, he never rushed us out of his office and was always not only professionally concerned about us as patients, put never failed to ask about our family, by their names, even though he never met some of them personally.

Jack is dedicated to his practice and Cleveland has lost one of the best internal medicine M.D.'s it will ever have. We wish him all the best life has to offer.

Linda Piazza