Assessing a profession’s health
Retiring executive who’s also a physician is optimistic about medicine’s future
Growing up in Houston in the 1960s, Spencer Berthelsen wanted to be an engineer. He loved the problem-solving of math and science. But he worried that perhaps there wouldn’t be a job at the end of his schooling, so he began to think about what else could scratch his what-makes-things-work itch. That’s how he found his way to medicine.
After medical school in Dallas and residency in San Diego, Berthelsen landed at Kelsey-Seybold Clinic in August 1980. He never left, and has served as chairman of the board and managing director at Kelsey-Seybolds’s network of 21 locations across the Houston area, all while still seeing patients.
He will retire Friday after a 36-year run. The next day he turns 65.
Berthelsen spoke with the Chronicle about his career, changes he has seen in health care and the challenges ahead for medicine in a red-hot political climate. Edited excerpts follow.
Q: What is the first thing you will do in retirement?
A: I’m going to live life with imagination, which is a fancy way of saying I’ll make it up when I get there. I’ll be closing my internal medicine practice, but I’ll be serving at KelseySeybold as a special adviser to the board.
Q: Looking back, what do you see as the most significant change in health care delivery?
A: When I came out of training at University of California-San Diego and came to Kelsey-Seybold, our main job was to take really good care of patients. The business part
of medicine was not so much of an issue. It was all fee for service. It was mostly indemnity type of insurance. It was just easy to do the business part of medicine. Now, in addition to taking really good care of patients, we have to do it in a way that is conscious of cost and quality both. Part of that has been technological advance, some of it has been the aging population, and some just in increasing expectations on what we can do for patients.
Q: Is that new or has it built over time? A: It has really been going on since the early 1980s.
Q: Is this attention to the business side of medicine a good change or can it interfere with treating patients?
A: It’s a necessary change, and, I believe, overall it’s a good change. Even back in the early ’80s there were patients that couldn’t afford health care, and we probably should’ve paid more attention to cost than we were doing.
Q: Health care has become so politicized. Has the conversation always been so divisive?
A: Because it’s such a personal topic and you have the intersection of government with what’s perceived to be personal rights, it engenders a lot of controversy. I wasn’t in practice when Medicare was passed (1965), but at the time it was very controversial. Even among organized medicine it was thought to be a government takeover of health care. But it turns out that it is an indispensable part of American life. I’m turning 65 myself, and there are two really good deals in America: one is the $10 pass to national parks once you become age 63, and the other is Medicare.
Q: If we had a 24hour news cycle and internet back then, would Medicare ever have passed?
A: I think it would have.
Q: Considering the promises out of Washington to repeal and replace the Affordable Care Act and some even taking aim at Medicaid and Medicare, where do you see medicine heading?
A: I’m optimistic by nature. The way I view the current Affordable Care Act is that is version 1.0. It’s typically not until you get to 3.0 that the majority of us are happy with what we have.
Q: As a doctor, are you worried that the uninsured rate will rise, that people who are now insured will lose coverage?
A: The overarching goal for health care reform should be broad access to coverage because that is the way we get people treated before they come in with medical disasters. It’s very expensive, that kind of rescue care that we’ve done for decades. What we need instead is for them to have access to a physician’s office so that asthma attack can be prevented and avoid the hospitalization altogether and relieve the burden of the expense of that on you and I, who pay taxes to a hospital district. Why not pay for it in a way that is less expensive? Access to health care is a prerequisite to a well-functioning health care system.
Q: As a physician, are you nervous that we will go backwards?
A: Yes. I’m personally nervous, and there is plenty of reason for all of us to be concerned and anxious about what the outcome of this is. One reason to be even more nervous is if this is done in haste.
Q: Looking back on your career, is there something you wish you could have done differently?
A: I’m a primary-care physician, and as such I have a lot of advantages that a specialist does not have. I’m experiencing that right now as I get ready to retire. I have patients that I have literally had for 30 years, and every one of them, when I tell them I am retiring, have an emotional reaction. I have an emotional reaction to it as well. There are times when I think, should I have been a specialist? But I think overall that I prefer being a primary-care doctor.
Q: What advice would you give to a young person entering medicine now?
A: Many physicians in practice today would say it’s become so difficult and the business of medicine has become so crushing, too much paperwork, too much detail. My view of it is quite different. There has never been a better time to enter medicine than now. The reason is there has never been more that we can do for patients. The technology is advancing; it is becoming more precise. We’re doing things that cause less morbidity and more good.