How Obamacare Affects Primary-Care Doctors: Charles Cutler

Sophie Novack
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Sophie Novack
Sept. 26, 2013, 4:15 p.m.

Dr. Charles Cut­ler has lived and prac­ticed medi­cine for his en­tire life in the same county he grew up in. He went to col­lege, med­ic­al school, and com­pleted his res­id­ency in Phil­adelphia. He’s been an in­tern­ist at a small prac­tice in a small town out­side Philly since 1979, al­though — he’s care­ful to point out — he moved to a dif­fer­ent of­fice a block away in 1986. “I start to per­spire in­cess­antly when I leave” the neigh­bor­hood, he says with a laugh.

Cut­ler, 64, jokes that he has trouble with change, but really, he says, stay­ing put has giv­en him a sense of per­man­ency about his prac­tice. This com­munity con­nec­tion makes Cut­ler par­tic­u­larly op­tim­ist­ic about the changes com­ing with the Af­ford­able Care Act. “The law is the best thing for my pa­tients throughout my en­tire ca­reer.”

In­tern­al medi­cine in­volves a lot of screen­ings and pre­vent­ive care, which, be­fore the ACA, many of his pa­tients would simply forgo. His is a work­ing-class mill town, al­though much of the heavy man­u­fac­tur­ing has closed down, and many blue-col­lar work­ers struggle to find jobs. They are proud people who don’t like to take things for free, the doc­tor says, so “they tend to hold back when they shouldn’t on their med­ic­al care.” This means put­ting off tests and pre­ven­tion — and then re­ly­ing on the emer­gency room.

Here Cut­ler sees dra­mat­ic im­prove­ments as a res­ult of the ACA, in both the lives of his pa­tients and the cost of care. Be­cause more people will be in­sured, they will be in­clined to vis­it the doc­tor reg­u­larly, and be­cause the law re­quires most health plans to cov­er pre­vent­ive ser­vices, he ex­pects more of his pa­tients to come see him be­fore an ail­ment gets ser­i­ous. “It’s so cost-ef­fect­ive to find something early in a screen­ing when it’s small and eas­ily cured rather than wait­ing un­til it’s big and in­cur­able or ex­pens­ive to deal with.” Of­ten pa­tients don’t know wheth­er a prob­lem is minor or ma­jor, and they’ll end up go­ing to the ER, which is very ex­pens­ive and taxes the sys­tem. “It res­ults in the ER filled with sub­acute or chron­ic con­di­tions; when people with really ser­i­ous situ­ations come, we get bot­tle­necks,” Cut­ler says.

His of­fice may see a small ini­tial in­crease in pa­tients un­der the health care law, but Cut­ler says the sys­tem will ad­just for it. “We’ll have more pa­tients early, but few­er with real ad­vanced ill­nesses that take up a lot of re­sources”¦. If we screen more people and pick up ill­nesses early, at the oth­er end there will be few­er pa­tients suf­fer­ing from bad dis­eases.”

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