[sjf911]

I too have spent many sleepless nights and suffered the loss of paying patient time at the expense of the indigent. It is the hidden dark side of the "business" of medicine. In the past, income from paying patients made this much more tolerable and also, the demand was less. Now, however, the number of indigent patients is climbing (legal or illegal) and reimbursement by "paying patients" (really third party insurers) has declined to the point that we are at a crisis. Many physicians are now exploring alternatives which typically mean specialty hospital association or no hospital affiliation at all. Many of us by virtue of specialty will always be tied to conventional hospitals and the associated demand for indigent services. Do not forget that the hospital is typically un-payed for this as well and this is where the dollars get very large.
Like all other social ills, this one does not have a simple solution. There are also competing interests especially with the illegals and the cheap labor demand that they fill. You cannot solve this without taking on much of what is ill with society, government, and "Big Business". We are all collectively responsible.