WASHINGTON — Steven Polansky, who's been an obstetrician and gynecologist in Sacramento, Calif., since 1977, said he couldn't afford a 10.6 percent pay cut from Congress.
At 62, he said, he's working 60 stressful hours a week, making a little more than $200,000 a year. He remembers when he used to make a lot of money on surgery, but he figures he gets only $900 from Medicare for a hysterectomy these days.
"We haven't gotten a raise from anybody in centuries," Polansky said in an interview. "And it is becoming more and more difficult to run a private practice."
For too long, Polansky said, doctors have suffered in silence. But they'll be making plenty of noise in Washington this week as the Senate prepares to vote Wednesday on whether to rescind the pay cut, which is ordered by a decline in Medicare reimbursement rates in a move to limit federal spending.
Doctors say there's much more at stake than their pocketbooks. If Washington sends them less money, they say, they'll respond by treating fewer Medicare patients. And they warn that more patients may be forced to see "non-top tier" physicians who might not be their first choices.
"I think it's going to be a huge disaster," said Bill Sandberg, the executive director of the Sacramento Sierra Valley Medical Society. "It seems to me to be an awful serious issue to be playing politics with."
The pay cut was scheduled to take effect July 1. After public complaints, however, the Bush administration intervened at the last minute, suspending the pay cuts until July 15 to give Congress more time to act.
The House of Representatives passed a bill to stave off the pay cut. Senators, who began returning to Washington on Monday after a week-long July Fourth recess, are under pressure to act quickly.
On Monday, Senate Majority Leader Harry Reid of Nevada urged his colleagues to rally behind the bill, saying, "The stakes are too high for inaction."
Wednesday's vote promises to be a nail-biter: On June 26, the Senate fell just one vote short of ending a filibuster — extended debate intended to block passage of legislation. Since then, the American Medical Association has launched an advertising campaign in an attempt to win final passage.
Even if the Senate passes the bill, however, there's no indication that it could override a possible veto by President Bush.
On Capitol Hill, the issue is renewing the always-contentious debate over the federal government's role in health care. Opponents of the bill say that the best way to control medical costs is to have a more competitive system in which patients pay for their care and make their own decisions about where to receive it, and in which the pricing of doctors and hospitals is more transparent for patients.
"What in the world is government doing setting prices to doctors?" asked Scott Atlas, senior fellow at the Hoover Institution and professor at Stanford University School of Medicine. "On what basis? ... There is no reason to think that fixing prices will do anything other than limit access, inhibit technological innovation and in the end degrade the quality of medical care to Americans, just as it has done in places like Canada and Britain."
Many Republican opponents, including Bush, say that they don't object to rescinding the pay cut. But they oppose another feature of the bill, which would pay for the uncut reimbursements to doctors by trimming payments to insurance companies that offer private Medicare Advantage plans.
"This is an issue between multibillion-dollar health plans and insurance companies and senior citizens who see their regular doctors," said Richard Frankenstein, the president of the California Medical Association. He said the pay cut would force doctors to treat fewer Medicare patients: "I've already heard doctors who have said that they're not going to accept new Medicare patients. They can't afford to."
Unless Congress acts, doctors also will receive a second pay cut — of 5 percent — next Jan. 1. The government's complicated Medicare physician-payment formula hasn't kept pace with inflation and has kept average 2008 payments at about the same level as in 2001, according to the AMA.
Polansky said doctors were having a tough time making private practices succeed as the costs of labor, supplies and malpractice insurance rose with no offsetting increase in income.
"All these things are going up, and our salaries are either static or going down," Polansky said.
He figures he's been going backward financially for at least 10 years. After working 60-hour weeks for three decades, he said, his retiree friends ask him why he's still working so hard.
He loves the profession. He said he knew that he probably was among the top 2 percent of U.S. wage-earners but that there was a flip side: the high cost of a medical education, a low salary during residency and the tough work involved in getting a private practice up and running.
He said his job combined sweat "and at times sheer terror" in the operating room, where he was ultimately responsible for another person's life.
"This is scary stuff," he said. "This is hard work, hard, scary, stressful work."
He wishes members of Congress would understand: "There's nobody out there to carry banners for us. We have to basically suffer in silence and suck it up. But at some point, individuals begin to say we're not doing this anymore."