According to the Board of Medical Examiners, we now have 3,627 licensed doctors in Montana.

That number is growing at 10 percent per year. We have 172 in Lewis and Clark County. Some of these may not be practicing and some may be Veterans Administration, but even then we certainly have a growing number of doctors. So what is the big deal? It is money. I have been told in Montana that the average Doctor's practice bills from $250,000 to $300,000 per year. Primary care doctors bill about half that and specialists twice this amount and many even more. That number does not go down as we add doctors.

Doctors are not economic fools. They locate in places that have high family income and a good portion of the population insured. Lewis and Clark County has to look good from that perspective. The problem is that more billing requires more insurance payments and higher insurance rates. Even those that have insurance have bigger and bigger out-of-pocket co-payments and deductibles to pay. Therefore there is a huge transfer of money from the public to the medical profession. This is something like having too many cows on too small a pasture and making them clip the grass very short to get their share. We are getting great care, but at what cost?

Now let me assure you that I have nothing but the greatest respect for the doctors that I know. I have been treated initially and on referral by seven doctors and dentists including skin, prostrate, and eye specialists this year. They are great people and wonderful professionals. I did not have any big problems, just ordinary maintenance for a guy my age. My insurance company certainly lost money on me this year.

The policy issue for the state is that we are paying the University of Washington Medical School $3 million a year to educate even more doctors. We get 20 slots a year for Montana students. Half of these come back to Montana. Given the growth in the number of physicians we have in the state, should we continue to buy more every year? If so, should we buy primary care or specialists? Should we require these doctors to serve a few years in isolated communities? Should we keep putting more cows in the same pasture? Should we put the money into some other needed profession such as teachers? Just wondering and I do hope I don't get sick this winter!

Sen. Dave Lewis of Helena represents Senate District 42.