Dr. Docia Hickey of Charlotte took over late last year as the 162nd president of the North Carolina Medical Society.
She’s the fifth woman and the 13th doctor from Charlotte to hold the position. And she comes with a list of priorities that include watching over some of the state’s poorest and most vulnerable patients.
Until she retired two years ago, Hickey was a neonatologist at Carolinas Medical Center, where she cared for the tiniest, sickest newborns who need intensive care. She had worked there for 36 years, first as a pediatric resident and then as a faculty physician, starting in the days when the hospital was still called Charlotte Memorial and before it was part of a 40-hospital chain called Carolinas HealthCare System.
By the time she left, the practice of medicine had changed. At 65, she’s among physicians who feel business and bureaucracy have taken over. “You hear it all over the state,” she said. “People are not happy with what’s going on.”
Early on, she joined both the state and the Mecklenburg County medical societies, believing doctors should organize to protect their own interests as well as those of their patients. Over the years, she watched membership decline. But Hickey feels strongly in the need for “organized medicine.”
“Physicians have to be in the forefront of leadership,” she said. “They’re the ones who make sure the patients are taken care of.”
A major issue facing the state medical society this year, Hickey said, is the state’s decision to reform Medicaid, the governmental health program for the poor and disabled, by turning it over to private, managed-care companies.
The plan is for several private companies to take over administration of Medicaid by 2018. Basically, they will contract with the state and get a certain amount of money to care for a certain number of patients. If they spend less, the companies keep the profit. If they spend more, they “take the hit,” Hickey said.
Her fear is that the companies might reduce reimbursement and deny services – to save money. “If it’s set up right, it won’t be bad,” she said. “We need to make sure patients are protected during this process.”
In Mecklenburg, Hickey said, many private physicians don’t serve Medicaid patients – or they limit the number they serve. In this county, many Medicaid patients are treated at four CMC clinics and C.W. Williams Community Health Center.
But in more rural counties, almost every primary care physician sees Medicaid patients because there are so many and the counties don’t have the same resources that Charlotte does, she said. In Rutherford County, for example, she said 70 percent of obstetrics patients are on Medicaid. In Gaston County, and other nonurban counties across the state, higher unemployment contributes to poverty which means more women and children are on the Medicaid rolls.
Medicaid also affects emergency specialists, anesthesiologists, pathologists, radiologists and pediatricians with subspecialties such as cardiology, she said. “Specialists all see Medicaid patients.”
Hickey had hoped physician-led organizations would play a bigger role in Medicaid reform, instead of the managed-care groups. But “we couldn’t get that” in the past legislative session, she said. “We got the best deal we could get.”
She and the state medical society will watch closely as reform rolls out. “Anything is up for grabs in the legislature,” she said. “We want to make sure that what we’ve got now stays and we can strengthen it even more. It’s something we’ve got to keep an eye on.”