First of II Part Series: Doctors Speak Out About Health Care Reform
By Terry Jones
Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington. Hundreds of thousands would think about shutting their practices or retiring early if it were adopted a new IBD/TIPP Poll has found. The poll contradicts the claims of not only the White House but also doctors own lobby the powerful American Medical Association both of which suggest the medical profession is behind the proposed overhaul. It also calls into question whether an overhaul is even doable; 72 of the doctors polled disagree with the administrations claim that the government can cover 47 million more people with better-quality care at lower cost.
The IBD/TIPP Poll was conducted by mail the past two weeks with 1376 practicing physicians chosen randomly throughout the country taking part. Responses are still coming in and doctors positions on related topics including the impact of an overhaul on senior care medical school applications and drug development will be covered later in this series.
Major findings included:
- Two-thirds or 65 of doctors say they oppose the proposed government expansion plan. This contradicts the administrations claims that doctors are part of an unprecedented coalition supporting a medical overhaul.
It also differs with findings of a poll released earlier this month by National Public Radio suggesting a majority of physicians want public and private insurance options and clashes with media reports such as Tuesdays front-page story in the Los Angeles Times with the headline
Doctors Go For Obamas Reform.
Nowhere in the Times story does it say doctors as a whole back the overhaul. It says only that the AMA the association representing the nations physicians and what many still regard as the countrys premier lobbying force is lobbying and advertising to win public support for President Obamas sweeping plan.
The AMA in fact represents approximately 18 of physicians and has been hit with a number of defections by members opposed to the AMAs support of Democrats proposed health care overhaul.
- 4 of 9 doctors or 45 said they would consider leaving their practice or taking an early retirement if Congress passes the plan the Democratic majority and White House have in mind.
More than 800000 doctors were practicing in 2006 the government says. Projecting the polls finding onto that population 360000 doctors would consider quitting.
- More than 7 in 10 doctors or 71 the most lopsided response in the poll answered no when asked if they believed the government can cover 47 million more people and that it will cost less money and the quality of care will be better.
This response is consistent with critics
who complain that the administration and congressional Democrats have yet to explain how even with the current number of physicians and nurses they can cover more people and lower the cost at the same time.
The only way the critics contend is by rationing care giving it to some and denying it to others. That cuts against another claim by plan supporters that care would be better.
Finding that many doctors could leave business suggests rationing could be more severe than even critics believe.
Rationing is one of the drawbacks associated with government plans in countries such as Canada and the U.K. Stories about growing waiting lists for badly needed care horror stories of care gone wrong babies born on sidewalks and even people dying as a result of care delayed or denied are rife.
In U.S. number of doctors already lagging population growth.
From 2003 to 2006 the number of active physicians in the U.S. grew by just 0.8 a year adding a total of 25700 doctors.
Recent population growth has been 1 a year. Patients in short are already being added faster than physicians creating a medical bottleneck.
The great concern is that with increased mandates lower pay and less freedom to practice doctors could abandon medicine in droves as the IBD/TIPP Poll suggests.
Under the proposed medical overhaul an additional 47 million people would have to be cared for an 18 increase in patient loads without an equivalent increase in doctors. The actual effect could be somewhat less because a significant share of the uninsured already get care.
Even so the government vows to cut hundreds of billions of dollars from health care spending to pay for reform which would encourage a flight from the profession.
The U.S. today has just 2.4 physicians per 1000 population below the median of 3.1 for members of the Organization for Economic Cooperation and Development the official club of wealthy nations.
Adding millions of patients to physicians caseloads would threaten to overwhelm the system. Medical gatekeepers would have to deny care to large numbers of people. That means care would have to be rationed.
Its like giving everyone free bus passes but there are only two buses Dr. Ted Epperly president of the American Academy of Family Physicians told the Associated Press.
Hope for a surge in new doctors may be misplaced. A recent study from the Association of American Medical Colleges found steadily declining enrollment in medical schools since 1980.
The study found that just with current patient demand the U.S. will have 159000 fewer doctors than it needs by 2025. Unless corrected that would make some sort of medical rationing or long waiting lists almost mandatory.
Experiments at the state level show that an overhaul isnt likely to change much.
On Monday came word from the Massachusetts Medical Society a group representing physicians in a state that has implemented an overhaul similar to that under consideration in Washington that doctor shortages remain a growing problem.
Its 2009 Physician Workforce Study found that:
- The primary care specialties of family medicine and internal medicine are in short supply for a fourth straight year.
The percentage of primary care practices closed to new patients is the highest ever recorded.- Seven of 18 specialties dermatology neurology urology vascular surgery and (for the first time) obstetrics-gynecology in addition to family and internal medicine are in short supply.
- Recruitment and retention of physicians remains difficult especially at community hospitals and with primary care.
A key reason for the doctor shortages according to the study is a lingering poor practice environment in the state.
In 2006 Massachusetts passed its medical overhaul minus a public option similar to whats being proposed on a national scale now. It hasnt worked as expected. Costs are higher with insurance premiums rising 22 faster than in the U.S. as a whole.
Health spending in Massachusetts is higher than the United States on average and is growing at a faster rate according to a recent report from the Urban Institute.
Other states with government-run or mandated health insurance systems including Maine Tennessee and Hawaii have been forced to cut back services and coverage.
This experience has been repeated in other countries where a form of nationalized care is common. In particular many nationalized health systems seem to have trouble finding enough doctors to meet demand.
In Britain a lack of practicing physicians means the country has had to import thousands of foreign doctors to care for patients in the National Health Service.
A third of (British) primary care trusts are flying in (general practitioners) from as far away as Lithuania Poland Germany Hungary Italy and Switzerland because of a doctor shortage a recent story in the British Daily Mail noted.
British doctors demoralized by long hours and burdensome rules simply refuse to see patients at nights and weekends.
Likewise Canadian physicians who have to deal with the stringent rules and income limits imposed by that countrys national health plan have emigrated in droves to other countries including the U.S.
Tomorrow: Why most doctors oppose the governments plan in their own words.
who complain that the administration and congressional Democrats have yet to explain how even with the current number of physicians and nurses they can cover more people and lower the cost at the same time.
The only way the critics contend is by rationing care giving it to some and denying it to others. That cuts against another claim by plan supporters that care would be better.
Finding that many doctors could leave business suggests rationing could be more severe than even critics believe.
Rationing is one of the drawbacks associated with government plans in countries such as Canada and the U.K. Stories about growing waiting lists for badly needed care horror stories of care gone wrong babies born on sidewalks and even people dying as a result of care delayed or denied are rife.
In U.S. number of doctors already lagging population growth.
From 2003 to 2006 the number of active physicians in the U.S. grew by just 0.8 a year adding a total of 25700 doctors.
Recent population growth has been 1 a year. Patients in short are already being added faster than physicians creating a medical bottleneck.
The great concern is that with increased mandates lower pay and less freedom to practice doctors could abandon medicine in droves as the IBD/TIPP Poll suggests.
Under the proposed medical overhaul an additional 47 million people would have to be cared for an 18 increase in patient loads without an equivalent increase in doctors. The actual effect could be somewhat less because a significant share of the uninsured already get care.
Even so the government vows to cut hundreds of billions of dollars from health care spending to pay for reform which would encourage a flight from the profession.
