The Rise and Fall of Hope and Change

The Rise and Fall of Hope and Change

Alexis de Toqueville

The American Republic will endure until the day Congress discovers that it can bribe the public with the public's money.
Alexis de Tocqueville

The United States Capitol Building

The United States Capitol Building

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The Constitutional Convention

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The Continental Congress

George Washington at Valley Forge

George Washington at Valley Forge

Tuesday, December 7, 2010

Lots Of Doctors Say They're Ready To Quit

From CBS News and Lou Dobbs:

Lots of Doctors Say They’re Ready to Quit

By Ken Terry
December 2, 2010

2 Comments .. Critical Condition

Ken Terry

Author Bio.BiographyKen Terry Ken Terry, a former senior editor at Medical Economics Magazine, is the author of the book Rx For Health Care Reform.

Physicians are unhappy about the direction their industry is headed and believe that healthcare reform will erode the viability of private practice, according to a large new survey from The Physicians Foundation. According to the researchers, the factors that upset doctors — including the transition to larger medical-practice groups — can be attributed as much to market forces as to the healthcare reform law.

But the fact that many doctors also suggest they plan to leave patient care over the next three years may present a much bigger challenge to reformers than anyone expected.

According to the survey of 100,000 practicing physicians:

Forty percent of doctors plan to stop providing patient care within three years. They will retire, seek a non-clinical job within healthcare, or leave the healthcare field entirely.

Seventy-four percent will make significant changes in their practice in reaction to reform.

Sixty percent of respondents say reform will force them to close or restrict their practices to certain subgroups of patients. Of these, 93 percent say that decision would affect Medicaid patients, and 87 percent say they’d exclude some or all Medicare patients.

Fifty-nine percent of doctors believe that reform will cause them to spend less time with patients.

Sixty-eight percent think reform will reduce the viability of their practices, and a whopping 80 percent say that it will hurt private practice specifically.

While 34 percent say that reform is the factor that will have the greatest impact on their practices in coming years, 36 percent say the same of Medicare’s current payment methodology, which threatens doctors with a 30 percent reimbursement cut in 2011.

The survey report doesn’t state what percentages of respondents are in practices of various sizes. But 59 percent are in physician-owned practices, which is higher than the overall percentage of doctors (48 percent) who remain independent, according to the Medical Group Management Association. So, the researchers admit, the results are slanted somewhat in favor of private practitioners. Large groups of employed doctors are more likely to favor reform because they’re better prepared for it. Tellingly, 68 percent of the respondents oppose payment bundling, which will work far better for large organizations than for small practices.

Doctors in private practice face a number of challenges that, subliminally, they may categorize under the heading of “reform.” Aside from the pending Medicare cuts, most of them have no bargaining leverage with health plans, so their incomes are not rising as fast as their costs are — a trend that’s at least a decade old. As hospital systems compete with one another and prepare to become accountable care organizations, they’re scooping up many private practices, making the rest wonder if they can survive.

Doctors are also being being pressured to spend large sums (beyond promised government incentives) on electronic health records, despite a lack of proven return on investment and the likelihood of near-term productivity losses. And specialists, in particular, expect to lose income because of the payment changes that the reform law promotes.

So it’s no wonder that physicians are becoming increasingly disgruntled and blame much of what’s gone wrong on the Affordable Care Act. But even if half of those who plan to quit medicine actually do so, this country is in for a world of trouble. A serious doctor shortage has been predicted because of the big expansion of insurance coverage in 2014; if 20 percent of doctors hang up their stethoscopes between now and then, we’re going to be relying on medical assistants to provide care to many patients.

And this, related, from The Heritage Foundation:

Side Effects: What Doctors Have to Say About Obamacare

No one is more familiar with the health care system than doctors. So what do they have to say about Obamacare? Nothing good, according to a recent survey.

The Physicians Foundation found that “rather than a sign of progress, the survey suggests that most physicians view health reform as a further erosion of the unfavorable conditions with which they must contend.” Furthermore, Obamacare “has further disengaged doctors from their profession, with potentially negative consequences for both the medical profession and for the quality and accessibility of medical care in the United States.”

Sixty-seven percent of respondents initially held a “very negative” or “somewhat negative” impression of Obamacare. When asked how their feelings had changed months after passage of the law, 51 percent said they felt the same, while 39 percent felt more negative. Furthermore, 86 percent of respondents said physicians’ perspectives were not adequately taken into account during the reform process.

Physicians also expressed concern that Obamacare will further erode the quality of health care in the United States. Only 10 percent of respondents expect the health law to improve quality of care, while 56 percent expect quality to diminish. As a result of the new law, a majority of physicians expect to spend less time with patients and restrict their practice significantly for certain types of patients, especially Medicare and Medicaid beneficiaries.

Sixty-five percent of the survey respondents confessed to holding a “somewhat negative” or “very negative” attitude toward the practice of medicine after passage of Obamacare, an increase from 49 percent before enactment. And no wonder: The new law darkens the future for practicing and aspiring physicians in several harmful ways.

According to the Physicians Foundation, Obamacare will exacerbate the pending physician shortage, making it more difficult for patients—especially those on Medicare or Medicaid—to access care. In addition, Obamacare will largely replace the private practice model by compelling physicians to consolidate or become hospital employees.

Heritage analysis shows that the new law will reduce physician autonomy, weaken the doctor–patient relationship, and increase the role of the federal government in medical decision-making. Physicians will also face more bureaucratic hoops to jump through, requiring the devotion of more time to meeting administrative requirements.

Finally, Obamacare fails to address growing concerns already facing the medical profession. According to Heritage health policy expert Robert Moffit:

It is hard to imagine how the health law will improve the prospects of the medical profession. … The medical liability problems that confront physicians in many states remain. Moreover, the existing system of administrative payment for doctors and other medical professionals under Medicare and Medicaid, a deepening problem for physicians, is re-entrenched with federal program coverage expansions.

The Physicians Foundation claims that health reform was “necessary and inevitable,” but Obamacare is the wrong way forward. By creating new problems within the practice of medicine and inflaming existing ones, Obamacare will succeed only at hurting the medical profession.

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