Dr. Semlear to Leave Town
 Morgan McGivern
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(8/21/2008) South Fork residents will lose another family doctor when Dr. Robert Semlear, whose office is in Noyac, moves upstate at the end of the month. Dr. Christina Chen, a specialist in internal medicine, will take over his practice.
“I can’t afford to stay,” he said last Thursday. “It’s a comment on the state of medicine today, and I’m not the only one having problems financially.”
Dr. Semlear has been treating patients in the Sag Harbor area since 1983. His father practiced family medicine in Sag Harbor from 1952 to 1992.
The younger Dr. Semlear cited declining insurance reimbursements, skyrocketing costs, and regulatory burdens as the main factors in his decision to move on to Columbia Memorial Hospital in Hudson, N.Y., a town outside Albany.
Despite his efforts to branch out into “medi-spa” treatments such as laser hair removal and Botox injections, the economics of running a private practice here simply did not work out, he said. “We have rural reimbursement rates and city prices,” he explained.
“Insurance companies are denying claims. We’re rejected constantly,” Dr. Semlear said. “We spend hours of staff time and our own time to get authorization for tests, consults that they say are not medically necessary. Then why did we go to medical school?”
Often he suspects something is wrong and wants to order a test, but the insurance company says no, he said. “It’s not fair to the patient or the doctor. The H.M.O. C.E.O.s are raking in millions and the rest of the system is falling apart.”
At Columbia, his practice will be part of a network administered by the hospital. The setup offers the hospital and physicians strength in numbers when negotiating with insurance companies, as well as freeing practitioners from administrative and billing responsibilities that are centralized at the hospital.
Meanwhile, Southampton Hospital is sponsoring Dr. Semlear’s replacement. Marsha Kenny, a spokeswoman for the hospital, said that it typically supports new doctors who have admitting privileges until they can get “on their feet.” Each arrangement is different, she said, but often they involve finding or providing housing.
Ms. Kenny said that Columbia sounded like a much larger hospital than Southampton. “We have 240 medical staff and less than half are attending,” that is, spending time with patients at the hospital, she said.
“We really wanted to keep Dr. Semlear in the community,” Ms. Kenny said. “The hospital met with him and worked with him to the extent we could. We don’t want to lose physicians.”
Two years ago, Dr. Semlear said, he might have benefited from the hospital’s support, but during the intervening time he went “too deeply into debt trying to keep the practice afloat.”
He left Sag Harbor in 1995 to take an academic medical position at a teaching hospital in Michigan, but he and his family decided to return to the Sag Harbor area after four years. “I moved previously by choice. This is not by choice,” he said last week.
He will miss his patients most, he said, adding, “It’s been an honor and a privilege to take care of them.” Not surprisingly, he favors a single-payer system of health care. “The current system,” he said, “is evil and immoral.”