The latest feud between physicians and managed-care companies is playing out in the pages of the New England Journal of Medicine.
Last fall, the Journal published a study of managed-care organizations' use of financial incentives with primary-care physicians. The study reported that physicians believe some financial incentives compromise patient care. Appearing in the same issue was an editorial by Editor-in-Chief Jerome Kassirer, M.D., titled "Doctor Discontent." Kassirer chronicled physicians' dissatisfaction with the state of medicine and warned that "disgruntled, cranky doctors are not likely to provide outstanding medical care."
The study and Kassirer's editorial provoked a flood of letters, including a fiery response from the American Association of Health Plans that appeared in the Journal in late February. AAHP President Karen Ignagni accused the Journalof "fear-mongering, pure and simple -- an unsubtle message to patients that if your doctor should happen to be in a bad mood, it's some HMO's fault, and you are likely to receive substandard care as a result."
AAHP spokeswoman Susan Pisano says the organization felt compelled to respond because Kassirer's editorial presented a one-sided view of the managed-care world. "We think that there is a special responsibility for a journal as prestigious as the New England Journal of Medicine to be balanced, and we think how that pulpit is used is very important," she says, vowing that managed-care companies are working hard to shore up their public image.
Kassirer says he was not surprised by Ignagni's strongly worded letter. "People in managed care tend to be very hypersensitive about any criticism," he says. "I think they are on the defensive, and there are reasons why they're on the defensive. If they wanted to shore up their image, they'd be a lot better off trying to eliminate some of the problems within managed care."
