An Interview with SBCMS’ 109th President
Jay E. Shankar, M.D.
When did you decide that you wanted to be a physician, and why did you choose Nephrology?
I
was in high school and my brother was starting medical school. My family and
friends wanted to know what I wanted to be. I thought about it and decided I
also wanted to be a physician. After coming to the USA and finishing my training,
I was motivated to train further. Feeling that Internal Medicine was too broad
a field, I took various specialty rotations at Oakwood Hospital in Dearborn,
Michigan and also at Wayne State University and then decided to go into Nephrology
training at Henry Ford Hospital in Detroit.
What leadership experience do you bring to the presidency?
My involvement in organized medicine began in 1985 when I completed my training at Henry Ford Hospital and started practice at Oakwood Hospital in Dearborn, Michigan. Dr. Luis R. Zako from Oakwood Hospital was the President of the Michigan State Medical Society at that time, and I was one of the thousands of physician members of the society who volunteered to go to the state Capitol to march for malpractice reform. We were unsuccessful in initiating reform but I did not give up my involvement.
While I was on a sabbatical in India, I was involved in the operation of a dialysis and transplant program and helped start a branch of the Indian Medical Association. As Secretary of the Association I conducted successful CME programs and was involved in conducting a conference on Nephrology and Neurology in Bangalore, India. In 1988 I began my practice in the High Desert and joined the SBCMS, CMA and AMA. I have chaired various committees at the local hospitals and was Chief of Staff at Victor Valley Hospital 1995-1997.
What are your major goals for your term?
My main goal is to increase membership in SBCMS and CMA and encourage every physician to become a member and participate at various levels in the organization. I support CMA president Dr. Frank Staggers' proposal that each member attempt to recruit at least one new member. I am asking SBCMS' members to recruit a new member and to encourage less committed members to continue their involvement.
I want to raise physician awareness of the importance of participating in organized medicine. Membership is vital and essential to the future of medicine in California. By effectively communicating the value of membership we will retain members and entice nonmembers to join. We are a powerful physician and patient advocate with the courts, legislature, HMOs, and HCFA.
We must promote our successes:
q Achieved a Medi-Cal increase last year averaging 17% (largest in 15 years). We are proposing a 20% increase for 2001-2002. We would like the reimbursement raised to at least 80% of Medicare.
q Significantly involved in Medical Board initiatives, extending health care coverage to uninsured Californians, patient safety, improving access and standards of care for children, stabilizing emergency services, "making managed care work" through dispute resolution.
q Protected the Medical Injury Compensation Reform Act (MICRA) from trial lawyer assaults, creating an average savings of over $35,000 per physician in annual malpractice insurance savings.
q Pursued health plans to obtain unpaid claims owed to physicians.
q Prevented implementation of burdensome Medicare E&M guidelines.
What are your greatest challenges as a physician?
To regain the trust and respect of our patients and their families. We have improved the care of our patients, decreased their complications and increased the life expectancy of people suffering from many illnesses. Advanced technology is available in the form of CAT Scans and MRIs. We are successful in performing complex surgical procedures such as coronary artery disease and transplant surgeries. Yet we see diminished trust and respect from our patients. I feel we can regain our patients' confidence by being their advocates.
How is the practice of medicine changing?
Physicians are frustrated with inadequate compensation. Six health plans control over 80% of the health care market in California. This substantial market dominance enables health plans to hand down unfair and unreasonable contract rates, terms and practices that are harmful to patients and physicians. The average national capitation rate is $42 PMPM. The average California capitation rate is $32 PMPM. California rates are 32% below the national average. According to PricewaterhouseCoopers (PWC), capitation rates paid to physicians has significantly declined from a range of $40-$45 PMPM in 1993 to a range of $29-$36 PMPM in 1999. This represents a 35% reduction in rates in seven years. If adjusted for Cost of Living, the rates have declined by 55%.
In the Medi-Cal program, California has the lowest Medi-Cal capitation rates in the nation; we rank 50th. In overall health care spending per patient, California ranks 47th. There is an epidemic of physicians leaving the state, leaving the practice of medicine, or retiring early. California has difficulty attracting young physicians because of our cost of living, difficult practice environment and low reimbursement rates.
The government is not doing enough to address the impending collapse of our health care system. SBCMS and CMA are pushing for action by our legislators before California experiences rolling blackouts in medicine with health care delayed or no longer available. We must keep the momentum and pressure on our legislators to bring about solutions to these problems before it is too late.
What advice would you give young physicians starting out today?
I always encourage young people to go into medicine. It is a very respectable profession. There is an immense satisfaction in helping people with their health care needs. Physicians must help our political leaders and society to solve the issues of healthcare. We must create an atmosphere that encourages young people to want to go into medicine and become leaders.
What are your interests outside medicine?
I like history and read as much as possible. I enjoy spending time and traveling with my family. My wife Suguna and I have been married 26 years; she has always been very supportive of my work. My daughter Rashmi is in dental school at USC, and my son Varun is a junior at Granite Hill High School in Apple Valley. I am fond of animals; my wife and I enjoy taking walks with our golden retriever Dryfus whenever we can. I play tennis and golf but recently have had little time for either.
Feel free to discuss any other issues or interests that you would like to share with our readers.
I would like to thank those members who are participating in SBCMS’ various commissions and committees as well as those who participated in our annual Day in Sacramento. Nearly 40 physicians took time away from their practice and families so that the future of medicine will be better for our colleagues and our patients. Together we can win and continue the great tradition that has been passed on to us by our predecessors.
