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"The Winter of Our Discontent"
The novel by John Steinbeck, "The Winter of Our Discontent," seems rather apropos in characterizing the current state of the pressures on today's medical profession, especially in New Jersey in January 2004. We have, like our New England whaling ancestors of this novel, had for sure, seen much better times. Last year we were close to achieving real and significant tort reform and medical malpractice relief. Now, a new legislature has been sworn in and the entire issue is, again, up in the air and it may not see the priority status it had attained in the latter days of the last legislative session. I attended Assembly Majority Leader Joe Roberts swearing in and in his remarks he boasted that he had "beaten back" special interests groups, such as the doctors, in our state. That may be well and good for him politically, but what will Assemblyman Roberts do when his own personal physician stops providing complex, medical specialty services for him and his family in the years to come? Doctors are NOT a special interest group. On the contrary, we are a necessary, interested group who, unlike nearly any other group, perhaps, save for the clergy; seek to serve our patients and/or clients first and foremost, as outlined in the Hippocratic Oath. Yet, lately we are demonized, devalued and distrusted by whom of all people? The politicians. Now that would surely make John Steinbeck smirk a whole lot. So, what are we to do about this state of Medicine in 2004 that Governor McGreevey also seems truly not to comprehend? Innumerable colleagues of yours and mine seek the means in which to balance payroll and staffing needs for optimum patient practice against continued declining income and rapidly escalating overhead expenses, particularly malpractice premiums. Some of us withdraw in silence. Others speak and debate about it, amongst themselves, in doctor's lounges at our hospitals. These are understandable personal remedies but they serve no identifiable purpose except to vent bound up pressures. What I propose and I in fact DEMAND of you all, is commitment and involvement. We cannot and must not take last year's political events or the changes in the legislature's partisan makeup as any thing more than it is. We are the only true representatives for our patients, ourselves and in fact, the electorate as a whole. We can influence what happens in Trenton -- if we stay the course. As President of this County and previously as state President of my own specialty society I have heard from many, "We do not have time to spare." I know this myself. I serve as Medical Director for my own group practice and we too have been adversely affected by these events. Despite a nearly spotless record in private practice, our group was recently threatened with malpractice insurance non-renewal until we appealed and won reinstatement. Most recently, my partner Dr. Frank Iannetta and I have made the painful but necessary decision to curtail obstetrical services from our family medical practice after 18 years, purely for malpractice premium related causes- (please see the attached letter to patients). I have and I will continue to let the newspapers and legislators of our county and state be made aware of these events so that they can see the real and tangible results of this system if left unchecked for even a few more years. How many more FPs and OBs will stop delivering babies; how many orthopedists will limit their services and how many more primary care physicians will stop caring for their patients in hospitals before the newspapers and then the politicians take wind of this trend- this pervasive "discontent" within our own ranks? On a positive note-our own local Assemblyman, Alex DeCroce, is the new Assembly Minority leader and he and Assemblyman Joe Pennacchio both of the 26th District, are understanding and supportive of our current plight. To be sure, however, I do not wish this to be politicized or divided into a Republican versus Democratic fight. After personal meetings that I have had with Dr. Mark Olesnicky, our MSNJ President, I am convinced that we can strengthen many elements of Bill A-50 besides the important cap limitations, to attain a start at real and valuable reforms in this arena. Your Executive committee and I have monthly meetings about all areas that impact upon the proper and efficient delivery of health care in our state and the standing invitation to attend any or all of these meetings on the first Monday night of every month remains open. In April and May in Atlantic City our state society will conduct meetings including reference committees to discuss the means available to us to further advance our important goals. We are, and continue to seek delegates from our county to serve at these important sessions. We need to add ideas and elements that we all can agree upon to make Trenton aware of the crisis we and our patients face. |
 While I may, at times, appear troubled or disheartened by these events as I detail them for you, I certainly want to leave this report on a positive note. We are a strong, dedicated and capable lot. We have come a long in state leadership at capturing the attention of the politicians and the media even if we do not always carry their votes or their journalistic endorsements. The next step is to achieve just that; to educate them further until they see that what we say is NOT special interest but NECESSARY reform and change. I remain confident that the harsh chill that had descended upon us this winter can and will result in a thaw and fervor this spring amongst the Doctors of this state that will set John Steinbeck's novel on its edge. Arnold I. Pallay, M.D. Letter sent to the patients of Changebridge Medical Associates, P.A. Changebridge Medical Associates, P.A. has, since its inception in 1986 offered family-centered Maternity and Pediatric services relatively unique in Morris County. The ability to have prenatal care AND newborn health services provided by the same board-certified family practice physicians, while common enough nationally, is limited in the state of New Jersey. Drs. Pallay and Iannetta have provided these services at both St. Clare’s and Chilton Memorial Hospitals and have served as faculty teachers at area residency training programs as well. During these last 18 years, many families have come to enjoy the wholesome and personalized services provided by the office; some have had all of their children delivered by the doctors. Unfortunately today, New Jersey is in the grips of a Medical Liability Crisis like nineteen or so other states in the country. This has translated into annual 25- 50 % increases in premiums paid for medical malpractice coverage. Often times this is because of frivolous lawsuits and claims, especially when one’s own physician may have had little or no involvement in a “bad outcome”. Yet plaintiff attorneys name these hard working personal care physicians in negligence claims which lead to significant surcharges on premiums from the malpractice insurance carriers until they can be “dismissed” from such actions since no malpractice actions are actually taken. Sadly, the physicians at Changebridge Medical Associates, while hoping to remain uninvolved in the spiraling costs expenditures faced by our obstetrical physician colleagues and, indeed, by all physicians as a whole, have now been forced to take definitive action in this area. Consequently, effective February 1, 2004 this office will no longer be able, entirely due to medical liability crisis reasons, to accept any new obstetrical patients into our patient services panel. Naturally, as highly trained, and Board Certified and Recertified Family Medical providers we will continue to offer state of the art newborn, pediatric and personalized gynecology care to any and all of our patients requiring these important health care services. To be sure, Drs. Pallay and Iannetta have made this decision with a heavy heart; we have always enjoyed being a part of the miracle of childbirth for our many patients and will sorely miss performing deliveries for them. It is, however, a necessary element of the current crisis that has forced this change; we sincerely hope that you and your family can convince both the Governor and the state legislature to overhaul the current system. We need to enact safeguards in the tort system so that physicians, especially maternity services providers, who practice in our state, are able to offer these services in a high quality, yet fiscally solvent and cost efficient manner. Dr. Pallay as President of the Morris County Medical Society and Dr. Iannetta as Chairman of the St. Clare’s Hospital Department of Family Practice continue to be politically vigilant in seeking to improve the health care delivery system for physicians and thereby for all our patients. We hope you understand and support us in this unfortunate calamity of the malpractice crisis and we are happy to speak to any and all of you personally about the specifics of this decision. Good health to you all! Changebridge Medical Associates, P.A. Arnold I. Pallay, M.D. FAAFP
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