Copyright ©2008 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

MADELEINE BRAND, host

This is Day to Day. I'm Madeleine Brand. Coming up, learning from ghosts of past, present and future in Rwanda. First, though, this season we're offering our listeners radio gifts. Today's was suggested by listener Kathleen Tacelosky. She wanted to hear a story about her sister, a doctor in Cape May, New Jersey. Here is reporter Joel Rose.

(Soundbite of telephone ringing)

KAREN: Dr. Crowley's office. Karen speaking.

JOEL ROSE: The name next to the door is Elizabeth Crowley, M.D., but many of Crowley's patients know her by her nickname, Boots.

Dr. ELIZABETH CROWLEY (Family-Practice Physician, New Jersey): Doc Martins.

ROSE: Always Doc Martins?

Dr. CROWLEY: Always. They're the most comfortable for me.

ROSE: Today, Crowley is wearing a pair of brown Doc Martins with faded jeans and an oatmeal-colored sweater. She says boots have been a regular part of her wardrobe for more than 10 years.

Dr. CROWLEY: When I was in medical school, I tried to wear, like, the regular, flat, like, girl shoes, and my foot started hurting. And so, it's really a comfort issue.

ROSE: For Crowley and her patients, including Carol Ravitz(ph).

Ms. CAROL RAVITZ: She doesn't wear a uniform that establishes a kind of barrier between herself and her patients. You just feel a rapport as a result of something is small as that, or what sounds small is actually very large.

ROSE: Dr. Crowley inspires fierce loyalty in her patients because she is approachable and because she doesn't rush them.

Dr. CROWLEY: Do you eat while you're working?

Ms. RAVITZ: Yes.

Dr. CROWLEY: OK. That's bad.

Ms. RAVITZ: I don't eat when I'm sleeping.

Dr. CROWLEY: OK, as far as you know.

(Soundbite of laughter)

ROSE: Visits to her office routinely last 30 minutes and often stretch to 45 minutes or more. In the age of managed care, Crowley says, that's a very long time.

Dr. CROWLEY: Giving people the time to tell their story gets the full story. It makes it so that they're able to tell you in their way what their issue is.

You're taking the Wellbutrin?

Ms. RAVITZ: Yes.

ROSE: Earlier this year, Crowley says she was often working 12-hour days and still had trouble paying her bills. The main reason, as she sees it, is the insurance companies. First, there's the endless paperwork her staff has to fill out. And even then, Crowley says, insurance companies are still paying less than it costs her to deliver care.

Dr. CROWLEY: The system pays you per patient, essentially. If you work within the system, you may get paid more based on how many patients you see. And that's fine to a point, but I would have had to see more patients per hour and more patients per day than I was comfortable seeing.

ROSE: So, Crowley did something drastic. In the fall, she told her patients she would stop accepting Medicare and insurance payments for office visits. Now she charges a flat fee of $100.

Dr. CROWLEY: It was purely financial, like, crisis. I had just had enough. I couldn't come to a fair, what I'd term to be a fair, negotiation with them. We couldn't agree on what was fair payment, especially in light of all the extra legwork and paperwork that was associated with dealing with them.

Ms. VICKY CANFIELD: I was scared at first because I thought, oh, gee, I'm going to have to find a new doctor.

ROSE: Vicky Canfield(ph) has been seeing Crowley for over five years.

Ms. CANFIELD: But then I thought, you know, Dr. Crowley is the type of doctor I'd like to stay with even though it's going to cost me a little more out-of-pocket to come see her.

ROSE: Canfield says she's willing to pay more for a doctor who really knows something about her life, for instance, the fact that she rides a motorcycle.

Dr. CROWLEY: So, you have a Harley? So, it's pretty stable.

Ms. CANFIELD. Yeah.

Dr. CROWLEY: Don't fall.

Ms. CANFIELD: She always has a way of putting your mind at ease. I think sometimes that's half the battle of healing, is the rapport you have with your physician. So, again, it's worth it to me.

ROSE: And Canfield isn't alone. Crowley says more than 80 percent of her patients decided to stay.

Does that surprise you? Were you expecting to lose more?

Dr. CROWLEY: I expected to lose more. Yes.

ROSE: Because $100 versus free, I mean, that's a big difference.

Dr. CROWLEY: Yeah, isn't that something?

(Soundbite of laughter)

Dr. CROWLEY: I'm not being sarcastic. It, like, amazes me that people are that supportive and appreciative. Like, to me, it says, hey, maybe you're doing something right.

ROSE: Of course, some of her patients did choose to leave. Some just didn't want to pay the new fee. Others found they were forced to leave because their insurance companies won't allow Dr. Crowley to order tests or refer patients to specialists. That was the case for Kim Nardy(ph).

Ms. KIM NARDY: Yeah, I do wish she was still was accepting insurance because I would have stayed as a patient, but I respect her decision to not do that anymore.

ROSE: Even though she is no longer a patient here, Nardy stopped in just to chat and to drop off a Christmas present for Dr. Crowley.

Dr. CROWLEY: Serenity tea leaf(ph) holder, and it's really pretty.

ROSE: Crowley says it was difficult having to basically turn away some of her longtime patients.

Dr. CROWLEY: For me, there was also this feeling of guilt to make a decision where you know you have to almost do something mean to people is hard.

ROSE: But Crowley doesn't regret that decision. She says the alternative might have been no practice at all. For NPR News, I'm Joel Rose in Cape May, New Jersey.

(Soundbite of music)

BRAND: There are some pictures of Dr. "Boots" Crowley and the letter from her sister that inspired the story at our blog, npr.org/daydreaming.

(Soundbite of music)

BRAND: There's more coming up on Day to Day from NPR News.

Copyright © 2008 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.