What are the prospects for Obamacare and for American healthcare in general as government "reforms" and increasingly regulates the already tightly controlled industry? To judge by the responses to a survey conducted by the Physicians Foundation and released last week, you might want to front-load your doctor visits, since we're all likely to find appointment slots in short supply in the not-too-distant future. That's because a majority of physicians want to quit medicine, and even if they don't leave the field, they plan to limit patient access to their practices. In fact, doctors are already seeing far fewer patients than they did just a few years ago, even as demand for that increasingly elusive face time is expected to boom over the next few years when the the Patient Protection and Affordable Care Act recruits new customers without necessarily giving them anyplace to go.
A Survey of America's Physicians: Practice Patterns and Perspectives (PDF) comes to us courtesy of The Physicians Foundation, a 501(c)(3) "that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients." Among the survey's high points:
- 60.6 percent of physicians say they would retire today if they could (up from 45 percent in 2008)
- 33.5 percent of physicians say they wouldn't go into medicine if they had their careers to do over (up from 27 percent in 2008)
- Physicians are seeing 16.6% fewer patients per day than they did in 2008, a decline that could lead to tens of millions of fewer patients seen per year.
- Over 52 percent of physicians have limited the access Medicare patients have to their practices or are planning to do so.
- Over 26 percent of physicians have closed their practices to Medicaid patients.
- In the next one to three years, over 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
The top three concerns that drive doctors to to distraction about their trade are "Liability/defensive medicine pressures" (40.3 percent), "Dealing with Medicare/Medicaid/government regulations" (27.4 percent) and "Reimbursement issues" (27.3 percent). "Uncertainty/changes of health reform" gets an honorable mention, named by 21.5 percent of respondents as a concern.
In answer to a separate question, almost 85 percent of physicians agree that their profession is in decline, with 79.2 percent of physicians tagging "too much regulation/paperwork" as a reason.
Regulatory concerns are a big deal because, as the survey points out:
PPACA seeks to reduce Medicare fraud and overpayments as a cost savings measure. The new law requires physicians to follow more stringent deadlines for identifying Medicare overpayments, exposes physicians to penalties for even unintentional violations of the law, and imposes a number of other compliance measures …
That is, doctors are about to get a whole lot more of what they don't like — which is probably why 59 percent of them "indicate passage of the Patient Protection and Affordable Care Act (i.e., "health reform") has made them less positive about the future of healthcare in America." Incidentally, PPACA is intended, in part, to control healthcare costs, to which the "defensive medicine" mentioned above contributes in large part. But the law's approach is through regulation and controls on reimbursement, instead of by reducing the liability concerns that drive doctors to practice defensively.
I can add from personal experience that bureaucratic requirements can drive independent physicians to screaming fits. My wife, a pediatrician, embarked on a 15-minute monologue this morning about the idiocy of the federal government's Vaccines for Children program, which suddenly decided that all vaccinations since January 1 of this year must be entered in a database. She now has an employee doing only that for 15-20 hours per week. Yes, she could just disengage from VFC, and may eventually do so, but that's just one red-tape headache one regulation among many.
Another is the Health Information Technology for Economic and Clinical Health Act which mandates electronic health records systems for many providers, with penalties for non-compliers. Even for small practices, EHR systems cost tens of thousands of dollars, so the federal government offers incentives to off-set the cost. But the paperwork hurdles for receiving incentive payments are … impressive, as is the wait. And while EHRs are implemented by medical practices, the incentive payments follow physicians — meaning a doctor changing jobs takes the money with him or her, while the old practice still foots the bill for the EHR.
Not surprisingly, compliance costs in terms of time, money and regulatory sophistication are rising, and small practices find it increasingly difficult to remain viable. So established practices are selling out to hospitals and other large companies that can afford those compliance costs, and independent practices are becoming rare. The Physicians Foundation reports that independent physicians declined from 57 percent of the total in 2000 to 43 percent in 2009, with 33 percent projected for 2013.
Do I have to mention that, even as one branch of the federal government pushes physicians to band together into ever-larger groupings, another branch penalizes them for doing so? That's right. Consolidation may assist compliance with PPACA, Medicare, Medicaid and other sources of regulation, but it raises red flags with the Federal Trade Commission.
Only 60 percent of doctors wish they could flee the business now? I'm surprised it's that low,