In a 2012 WSJ article entitled “Obama Care’s Lost Tribe: Doctors” by Daniel Henninger, the author questions Obama’s deceitful selling tactics of the sweeping overarching healthcare reform law that effectively became law on March 23, 2010. He goes on to quote Obama during a speaking engagement at the American Medical Association’s annual meeting, “No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period.” This could not be further from the truth.
Overwhelmingly, physicians are not in support of the bill and are progressively expressing their rebellion. We are not talking about strikes but responding to the upcoming scenario realistically. It is unrealistic to think that insuring 30+ million more Americans, mainly through the Medicaid program, will lead to greater access or even better quality care. In other words, healthcare coverage is not the same as receiving healthcare, particularly since physicians are accepting fewer Medicaid patients. It is also unrealistic to think a largely pay-for-performance model, an Obama Care staple, will succeed when so much of the state of medical practice is in the “intuitive stage” of development. Intuitive medicine, as articulated by Harvard professor Clay Christensen in his book The Innovators Prescription, refers to the impossibility of guaranteeing outcomes. This causes misalignment of incentives to outcomes. Most of medicine today falls into the category intuitive medicine, such as the specialty Interventional Pain, my area of interest. Other examples are those diseases that can only be addressed experimentally with different outcomes for different patients such as amyotrophic lateral sclerosis, and bipolar disorder. Intuitive medicine also includes those diseases with no known effective therapies such as multi-drug resistant tuberculosis. Only in those areas of medicine that are defined as precision medicine can healthcare providers properly guarantee outcome. Only outcomes that are measurable can be incentivized through a pay for performance plan. Precision medicine includes those diseases of which the etiologies and therapies are well understood, such as strep throat, Gaucher’s disease, and fractures, a small percentage of overall diseases.
It’s not that physicians are hateful, opportunistic, greedy or spiteful; they are just realistic in their analysis. They understand that Obama Care has made it unrealistic and burdensome to provide adequately for their patients. An environment that embraces misaligned incentives is an environment that ensures failure. To physicians, this is demoralizing. Unfortunately, demoralization has a cost.
On top of the looming physician shortage crisis, minimal attention to malpractice reform, and a constant threat of Medicare payment cuts (via SGR) each year, add Obama care to the mix and you get the physician fast track to rebellion. Many will be looking to retire early, cut back hours, move out of clinical medicine, or change careers. To give some perspective, there has been a 7% decline in weekly hours worked by physicians over the last 20 years. This is equivalent to taking approximately 35,000 additional physicians out of the workforce during a time when the American Academy of Medical Colleges has projected a shortage of 154,000 by 2025. With near universal coverage provided by Obama Care, the AAMC predicts an even higher deficit reaching close to 200,000 over the next decade. Furthermore, 24 states and 21 medical societies have projected physician shortages. Younger physicians (under 45 years) are working even less, averaging 50 hours per week. These are not good trends and have been found to be directly proportional to physician cuts in reimbursement. With further threats of reimbursement cuts, one can only deduce that physician hours will decrease further.
With 835 comments to Mr. Henninger’s article, the most I’ve seen regarding this topic, the physician rebellion is a realistic threat that is garnering an enormous amount of attention. This means that the water cooler gossip is in full effect amongst physicians and concerned citizens. Physicians, as the primary directors of U.S. Healthcare, understand that they must be aligned or else failure is inevitable. Most first year business students understand this simple concept. Unfortunately the Obama administration does not. Obama Care’s goals are reasonable access and good quality care at the lowest possible cost, but the nation will get the exact opposite: unacceptable access and quality of care with astronomical costs.
One of the comments to Mr. Henninger’s article may be a harbinger of the physician workforce challenges ahead: “As an attorney whose practice largely involved advising physicians, I sadly now advise young folks who ask me about a medical career: If you're smart enough to become a doctor, you should be smart enough not to become a doctor.” Jeff Endean-Saginaw, Michigan.
How can the administration force a partisan “system” upon the citizens of this great nation when those who are responsible for driving the “system” don’t believe in it? Physicians are concerned about the direction of the U.S. Healthcare system. You should be too.
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