Seen from the extremes: Uninsureds' effect on medicine

A new analysis suggests that when a community's level of uninsurance is high, local physicians' job satisfaction is low. Here is a look at the day-to-day experiences of two physicians in areas on either end of the spectrum.

By Doug Trapp, AMNews staff. Jan. 7, 2008.

The sky is darkening outside the office of Terry Eska, MD. The rural Texas internist's appointments are finished, but his work isn't. A new nursing home patient needs inpatient dialysis, which isn't available at the local hospital, so Dr. Eska calls a hospital an hour away.

The hospitalist at the other end of the line is reluctant about accepting a Medicare patient who may need critical care, and this man might be "at death's door" anyway, as Dr. Eska puts it. But the hospital's kidney specialist believes the man has a chance and the patient's daughter isn't ready to give up, so the hospitalist relents -- after venting to Dr. Eska about the hospital's finances.

"He finally agreed to accept him after I got my lecture," Dr. Eska said.

These types of negotiations are a regular part of Dr. Eska's work life in Gonzales, a town of 7,500 people about 65 miles south of Austin.

A recent journal article concluded that some of the professional tribulations experienced by physicians such as Dr. Eska are related to practicing in places with many uninsured people. Texas has the highest average percentage of uninsured in the U.S. at 24.1%.

The article found that physicians working in areas where many people lack coverage have lower career satisfaction, more difficulty communicating with specialists and less ability to provide high-quality care without making financial sacrifices, compared with their counterparts in areas with few uninsured people. The analysis, "Physicians' Career Satisfaction, Quality of Care and Patients' Trust: The Role of Community Uninsurance," was published in the October 2007 Health Economics, Policy and Law.