February 1, 2012

Dear Friends:

Every year, I like to write a letter to the patients of Treasure Coast Dermatology (TCD).

There are a couple of reasons for writing this letter. First, is to announce the date and time of our annual party. The second reason is to let everyone know what is going on with our practice and in our community.

If you are not familiar with our party, each year, TCD hosts an appreciation picnic for our patients. This tradition started in 1999 and has been going strong ever since. The employees and doctors of TCD throw this party in order to show you how much we appreciate your trust.

Your trust in our practice is a big deal. Like many other things, as medicine becomes more and more “efficient” and computerized, it has become more impersonal as well. We hope to avoid this. We care about our patients, and we care about doing the best we can for them as individuals. It is our intention to show this every day by treating our patients as we ourselves would want to be treated: with respect and dignity.

We often have the pleasure of meeting new patients due to one common reason; the waiting list to see their regular dermatologist is too long. It’s funny – we’re frequently asked two things: 1) why don’t we have a waiting list, when everyone else seems to have one? and 2) why do we have more than one office for each doctor?

The answers to these questions are simple. We choose not to participate with insurance plans that we feel will overtly interfere with the care of our patients. As many of these insurance plans dictate where their insured should go for care, we must spread our net wider.

There are many large insurance companies that offer plans in our area; so why do we partner with so few? That goes back a little bit. My father was a well-known and respected doctor. He actually started the first academic dermatopathology lab in the country (at the University of Miami School of Medicine), and he was its first Director. Nowadays, every academic dermatology lab from Harvard to Yale to – well everywhere – has a dermatopathology lab. When my father left academics and started his own laboratory outside of the University, he was pretty successful – at first. Then, in the early days of managed care, some major insurance companies said they would not allow their networked doctors to refer cases if he did not immediately agree to accept large reductions in what they paid him. As a cost-cutting measure, these insurance companies would refer elsewhere.

My father was proud of the quality of his work and thought that his time, his energy, and his expertise were worth something. He refused several managed care offers and almost went bankrupt. Overnight, the majority of his practice disappeared. Physicians who had referred cases to him for years were no longer permitted to use his lab.

Although my dad was able to slowly rebuild his practice, he implored me not to make the same mistake. My father would not sacrifice good medicine and care for quantity and money, and though he almost went out of business, to this day, I agree with his philosophy.

It’s true: we are not primary providers for many insurance carriers. This, of course, comes with some financial disadvantages, as we’re limited from seeing a large number of potential patients living on the Treasure Coast. As I’ve learned, the practice of medicine is also a small business and has certain fixed expenses. Whether you have one patient or 100, the cost of your malpractice insurance is the same. So we try to stay busy, but neither choose nor want long waiting lists for our patients. That is not a badge we wish to wear. We hope that you also share our ideals.

On a more personal level, some information about the doctors at TCD: After many years of trying, hoping, and praying, my wife Cammy and I had a baby girl. Cammy Andrea loannides was born on September 1, 2011. She weighed 6 lbs, 2 oz, and is healthy. We are so happy and proud. We thank you all, our extended family, for your prayers. I’m not one for public displays of affection, but I am going to have pictures of our beautiful girl in all of my offices. Feel free to tell me how pretty she is. She makes my day every time she smiles at me.

Dr. Sanders and his wife Niki are also doing well. As his patient population was quickly growing, Dr. Sanders is now mainly working from his offices in Indian River and Okeechobee Counties. In addition to being closer to his lovely wife, which I am sure played a part in his decision, I believe Dr. Sanders shares my philosophy on patient care, which is to be available and provide focused attention to all of his patients.

In saying that, he is leaving his Port St. Lucie practice in very capable hands. Dr. Sanders and I are pleased to announce the addition of Dr. Laura Destefano to Treasure Coast Dermatology. Laura has taken over the care of Dr. Sanders’ patients in our Port St. Lucie office.

Dr. Destefano is also sharing our Stuart location with me, seeing her patients on alternate days. I could tell you a lot about Laura – how she is Board Certified in both Internal Medicine and Dermatology, how she attained the privilege of being Chief Resident during her Dermatology training, and what a gifted and careful doctor she is – but believe me, these titles and distinctions do not convey the warmth and skill she brings to our practice.

Please, at the picnic, go out of your way to meet her. We are proud to have brought someone so capable to work with us on the Treasure Coast.

Now for some general things:

As you may already be aware, Medicare is under attack. I have believed for years and have mentioned before in my letters that we, as a generation, have a responsibility to care for the generation above.us and help educate those younger than us.

Recently, in The Wall Street Journal, I noticed the title of an article that seemed to say it all:

Aging and Broke, More Lean on Family
Money Crunch Reshapes Relationships; ‘I Worry About Being a Burden on My Son.’

This article relays the true difficulties the elderly in our population are having. The triple whammy of wiped out pensions, devastating losses in home equity, and wholesale losses of retirement funds because of the stock market crash is destroying the lives of many elderly – financially, emotionally, which of course all take a physical toll.

Now, seniors’ health benefits are under attack. In some ways, this attack is obvious; in others, less so. Let me give this example: due to low payment schedules, Medicaid, another government administered health program, has just one dermatologist who participates on the Treasure Coast. The government doesn’t need to ration health care, if there aren’t any providers around who can afford to open offices and provide patient care. Restricting access by making it financially difficult for physicians to accept government plans (and open practices) is, in fact, a form of rationing.

Don’t think this is happening already? We look at the field of dermatology and recognize that, in the past several years, there is not one new dermatologist who has opened an office on the Treasure Coast without first being supported by a more established practice. Physicians come to our area, join practices, and after establishing a strong patient base, open their own offices. It ‘s no longer affordable to establish a practice the way I did – by starting off on my own.

I mention the above, because once again, this adversely affects the elderly community.

To us at TCD, it comes down to two simple concepts: pride and dignity. Many Medicare-aged Americans are too proud to be a burden. And their dignity is damaged as they suffer.

We can’t expect others to take care of us when we get older, if we do not offer compassion to those in the generation above us.

Things can change for the better. We can fix this problem.

There has been talk about slowly raising the starting age for Medicare. This is easily adopted. People my age can start Medicare at 70 years old rather than 65. This gives Dr. Sanders and me more than two decades to prepare for this change. This is enough time for us, and those our age, to marshal our resources so those of you who sacrificed, in order to protect and serve our country decades ago, do not suffer now.

Another way to make a positive difference is by controlling drug costs. The profit margins on medications are huge. I am not a fan of Canada’s socialized system of medicine as a whole, but they do some things right. Drug prices are one of them. Here’s a clip from another article I recently read: a patient can have a 20-90% savings on “brand name drugs ordered from a certified Canadian pharmacy.” NINETY PERCENT.

Drug companies spend TWICE as much on marketing than on research and development.

Several times in my past letters, I have relayed a story about turning away a drug company representative who wished to bring lunches to my offices. She accused me of being insensitive to my employees. She explained that as a “rich doctor,” I could afford my own lunch, but I was depriving my employees of a good, free meal. Since then, every day, I have bought my employees’ lunch. Next time you see a drug rep in your doctor’s office, please know that the money used to pay for those lunches and gifts to the doctors are coming out of your pocket. At TCD, we have never accepted meals, gifts, or “honorariums” from drug companies. As a patient, where’s your free lunch?

Let me say further, many of my colleagues don’t like our position on this matter. They refuse to refer patients to us. Most of our patients come by word of mouth, and we like it better that way. Colleagues and drug reps themselves have told me pointedly that I was not a “team player” and “that’s just the way the system works.”

The times I have attended a drug company sponsored dinner, I’ve soon after donated $150 to a local charity, which more than covers the cost of my meal. From the beginning, I’ve seen it for what it is. It is payola coming from your hard-earned dollars. I guess I’m not a team player. In my defense, many academic institutions have now adopted similar policies of not accepting drug company payouts.

Though we are all facing certain challenges, I don’t want to end on a pessimistic note. I just brought a daughter into this world, and Cammy and I plan on having more children. This country, at times, seems like it ‘s really messed up, but in my heart, as crazy and mixed up as our country seems, we’re still less crazy and mixed up than the rest.

I know the ingenuity, hard work, and compassion of the United States of America, along with a little common sense, will get us through these uncertain times.

Because of these attributes, when my daughter is my age, I truly believe this country will be a better place than it is today.

I hope you feel that way as well. If you don’t, that’s okay too; we’re all in this together. Either way, please vote for those you think will represent what you feel is best for you, your neighbor, and your country.

I look forward to seeing you at our picnic.

Best wishes to all,

Tim Ioannides, M.D.