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Readers discuss the prevalence of endometriosis and providing healthcare to the poor.

Medicaid helps the poor but not always the doctor.

I have just read the editorial “The poor are with us-and they want and need healthcare.” [April 2017 Contemporary OB/GYN] The authors insist that it is our duty to treat all patients, regardless of insurance status, and they imply that not seeing patients with certain insurances violates our Hippocratic oath. I disagree with this stance because in reality, medicine is a business, and economically, we all need to pay attention to reimbursements and costs.

The reality is that many of us limit our Medicaid exposure. The reason is purely economic.

An ob/gyn here in south Florida, for example, where rents and overhead are very high, cannot simply rely on heavy Medicaid reimbursement without going broke. The fee schedules aren’t just low; some of the payments are insulting.

Those in private practice have to limit the numbers of Medicaid patients we see; otherwise, we will not be able to pay our bills, let alone ourselves. Is this discrimination based on insurance? Yes it is, but it is the only way our practices can survive.

The state of Florida partially tackled this issue with providing increased payments (Medicare level) for primary care physicians who see a high level of patients with Medicaid. So far, however, specialists have not been afforded this opportunity. We hope that Florida (and other states) offers similar opportunity for specialists so that this “discrimination” will no longer occur.

Natalie Sohn Willis, MD, FACOG



Thank you for the comment. This article was not to imply that any provider should not limit or decide to take Medicaid or no insurance for that matter, nor that such a practice violates the Hippocratic oath.

The article clearly states that those with or without Medicaid want and deserve healthcare, and women and children have clearly benefited when it comes to Medicaid insurance coverage for primary and preventable health services.

Haywood L Brown, MD

Lucia DeVenere

NEXT: Endometriosis has always been with us


Endometriosis has always been with us

Endometriosis is not increasing in frequency; it has been common during my 4 decades of clinical practice. We, as a profession, have not recognized this cause of pelvic pain for 2 reasons: We have had a paternalistic, condescending attitude toward the issue of pelvic pain in women and we have allowed patients to have to see 7–10 physicians before a diagnosis is made.

No, the disease has been with us -we have refused to recognize it.

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