REGULATIONS STIFLE DOCTOR'S SOLO PRACTICE

Dr. James Dzur says it's hard to go solo with government regulations and mounting bureaucracy.

After 18 years of going solo in Cape Girardeau, Dzur closed his office Thursday in preparation for a move to a group practice in Idaho.

Dzur and his wife, Judith, plan to leave Cape Girardeau June 10. Dzur is scheduled to begin working in a 27-person group practice June 29 in Nampa, Idaho.

The city, with a population of 28,000, is near Boise.

"It's gotten to the point that so much of your time is dealing with paperwork," he noted.

There are federal workplace regulations that must be followed, in addition to dealing with the mountain of Medicare and Medicaid paperwork.

The administrative chores make a group practice more desirable, he said. "We can share the cost of having a lot of other people do the administrative work that my wife and I do in solo practice."

Dzur, who is in internal medicine and endocrinology, has operated his office at 53 Doctors' Park with his wife, plus three full-time and one part-time employee.

One of his employees is an office nurse. The others are involved in everything from charts to insurance paperwork to scheduling.

"If I didn't have them, I wouldn't do anything but paperwork," said Dzur.

The 50-year-old doctor said his office must deal with not only government forms, but paperwork for nursing homes and insurance companies. "It's just the general regulatory tenor of society."

Dzur, who graduated from Vanderbilt medical school in 1968, said he now must deal with federal occupational safety regulations and lab inspections.

"The government has really pushed the solo practitioners out," he maintained.

"There aren't too many people going into priority care medicine," said Dzur. He defined priority care medicine as family practice, pediatrics and internal medicine.

Dzur said that in addition to mounting paperwork, it's often more difficult for doctors in solo practice to arrange for other physicians to handle emergency calls.

"Basically, I am responsible for my patients 24 hours a day, seven days a week," he noted.

These days, a person who graduates from a medical school often starts out with a $60,000 to $80,000 debt, Dzur said. The doctor has to pay for malpractice insurance, costing as much as $55,000 in many cases. On top of that, he said, a beginning doctor in solo practice must spend $40,000 to $50,000 on equipment and operating expenses.

Joining a group practice, where the equipment is already in place, is financially easier on a beginning physician, he said.

Dzur said many of his patients are elderly and on Medicare. He also deals with Medicaid patients. The state's Medicaid program pays a flat fee of 33 cents on the dollar.

He said all the paperwork adds to higher medical costs.

Since he became a doctor in 1968, bureaucracy and the changing technology have been the biggest changes in medicine, said Dzur.

Dzur, who was born in Montana, said he and his wife are looking forward to the change of scenery. They enjoy outdoor activities such as hiking and skiing.

He said he won't miss Missouri's high humidity. "I've always said there are two things wrong with Missouri July and August."

But he said he will miss his patients and office staff. "We are sort of like an extended family," Dzur said.

"Personal relationships are still the most rewarding things in life," observed Dzur, pointing out that most people who go into medicine do so because they have a desire to help people.

"There are few things in life," he added, "that are probably as intricate and interesting as medicine."