Sun, Oct 23, 2005
Dear Patients, Colleagues, Friends & Family:
As of 7/1/06 I will no longer be delivering babies! I know that many, in this fast-paced world, prefer to know how the movie is going to end before they even begin watching it, and so for you, you may now delete this e-mail. For those of you who want more, please continue to read on.
That 1st sentence is going to be painful to some, but none more than me! I know that many have relied on me and that special patient-doctor bond has kept me going. I like helping and have spent my life trying to avert hurting so to know that something I am doing is causing you pain, pains me more. I believe I was darn good at my OB (obstetric) skills and it also pains me to know that a skill set that was passed down from my father as well as my mentors (you know who you are) will cease to bear fruit. This was a painful internal struggle, but ultimately it was the objective that won over the subjective.
Though there are many factors behind this decision including family, I could not start anywhere else but with medical malpractice liability insurance premiums; they are out of control! In the early & mid 1970s physicians went out on strike because of a similar crisis and in California they came up with a cap of $250,000 that could be awarded in a court case for pain and suffering, with as much as was needed being awarded for past, current and future medical and other needs. This was called M.I.C.R.A. It is M.I.C.R.A. that is somewhat protecting our current rates in this state, and is what is needed in other states. While just my medical malpractice annual premiums have gone from $40,000 to over $65,000 in the last few years, with no end in sight, my ‘brothers and sisters’ who practice OB in Nevada, New York, Florida and other 20 other states have premiums over $180,000 or sadly go without insurance or stop practicing OB altogether.
A national discussion is needed. President Bush’s legislative reform proposals, to address the medical liability crisis, are available online: http://www.whitehouse.gov/infocus/medicalliability. This is not meant to endorse or condemn President Bush, but rather to keep this above the political fray and realize that in order for tort and insurance reform to succeed it will need to be discussed at this high level with grass roots support. There is a new national organization, Common Good: Restoring Common Sense to American Law, www.CGood.org which is trying to tackle the issue. Americans today are afraid the law won't protect sensible decisions. Doctors practice defensively instead of using their professional judgment. Teachers cannot maintain order in their classrooms, or even put an arm around a crying child, and leaders from across the aisle are coming together to fight this head on. ACOG (American College of Ob/Gyns) have been fighting this battle with a campaign called, “Who is going to deliver my baby?” A medical liability survey reaffirms that more Ob-Gyns are quitting obstetrics can be found at http://www.acog.org/from_home/publications/press_releases/nr07-16-04.cfm.
Though it is the malpractice premiums that put a dagger through my finances it was my family that put a dagger through my heart and actually got me thinking about this. A year ago, we went on a summer vacation down to San Diego. For a whole week I was away from my pager, though my wife will point out that I continued to check in with my office at least daily and was doing the same with my SECURE patient e-mails. There was the S.D. Padres baseball game, Sea World, S.D. Zoo, Legoland & S.D. Wild Animal Park amongst other things that were family fun activities. On the drive back home, I asked Ruth, Madelynn & Danny what was their favorite part. My nearly 6 year old son Danny (going on 26), said, “Being with you, Dad!” That nearly caused me to swerve off the road as the tears muddled my vision of the road. Please, don’t get me wrong, everyone (I hope) wants to spend more time with their family, and I know that I do not have a unique situation. The never being able to commit to anything and always running late because you were a slave to that beeper which in an instant could cause you to drop everything and head (no pun intended but still appreciated) to the hospital, is why I always said, please do not take pity on me, but rather on my family.
So why did I choose 7/1/06 and why did I choose now to tell you? The recent Chatsworth fires got me again thinking about this issue, so I renewed my investigation and I just got word on Friday 10/21/05 afternoon that my insurance company approved the reduction in premiums with my reduction in activities. It is a rather involved process because you still need to have coverage for years to come in case someone sues you 18 years from now for a delivery you did yesterday. My insurance gets renewed every July 1st. That is why I waited and for the last few weeks, while I have been waiting, I have been looking at faces that I know want me to do deliver their 1st or next baby, and have not been able to say anything because of the uncertainty of whether or not this was going to be feasible. To them, I especially apologize!
As of this date, there is nobody I know who is pregnant who will have a due date that will preclude me from delivering them. If your last period started on or after 9/18/05, I will not be able to deliver your baby. There are many fine doctors who I will be able to refer you to depending on demographic, insurance and other needs, but some of them include in West Hills: Dr. Lillian Morris (818-887-5008) & in both West Hills & Tarzana Dr. James Danielzadeh (818-884-1700 & 818-907-8761). I will continue to be able to see you for your 1st OB visit to confirm that you have a healthy pregnancy, do an ultrasound around 8 weeks from your last period and make appropriate referrals then. I will also be able to assist those who are trying to get pregnant in that pursuit. Fertility assistance will continue to be one of my areas of expertise, and I look forward to helping you in that endeavor as long as you can promise me that when you do ultimately deliver you e-mail or snail-mail me a picture of the baby/babies!
So how is this ultimately going to benefit the majority of my patients? As of 7/1/06, there will be less chance that I will be called in the middle of office hours to go to the hospital. Delivering babies is cause for most of the unscheduled hospital visits, but GYN (gynecologic) problems still may potentially do the same. Hopefully that means a continued streamlining of my office hours. I have continued to schedule less than average amount of patients per hour so that I can spend more than average amount of time with each patient. I will still not abandon an office patient who needs continued time beyond that allotted in favor of keeping a tight schedule. One day that patient might be you and you will be glad that I am true to my TLC (Tradition of Listening & Caring) motto!
I believe that menopausal management has gotten the short end of the stick, losing out to the OBs, when it comes to Ob/Gyn emphasis to their patients; that is going to change! Those who are 44-55 years old are going through a change that must be demystified. I will continue to make strides in being on the forefront of menopausal management, whether it be in minimally invasive procedures or hormonal (both manufactured and bio-identical/natural) and non-hormonal replenishment. Too often physicians resort to one pill fits all or when in doubt, yank it out philosophy. There must be alternatives to hysterectomy, there must be alternatives to what we have been fed in the past, but we must not throw the baby out with the bath water!
In conclusion I will be there for you when you are an adolescent high-schooler and need a gentle GYN exam, I will be there for those routine annual Pap smears, I will be there when you go through menopause, I will be there for you when you go into Medicare, and I will continue to be there for you in person or online, but unfortunately, after 7/1/06, I will not be there for you when you deliver your baby. G-d bless you and keep you safe and healthy and thank you for reading my rant!
Ian H. Taras, M.D., Ob/Gyn