Obamacare

Doctors Agree: Their Jobs Suck, and the Government is Largely To Blame

|

Doctor with syringe

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,

NEXT: Paul Ryan Goes After Obamacare in Wisconsin

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. “That’s what governments are for – to get in a man’s way.”

  2. So established practices are selling out to hospitals and other large companies that can afford those compliance costs, and independent practices are becoming rare.

    And therein lies the true plan. The centralization of everything. Just as No Child Left Behind began the increasing Federalization of our education system, and how Obama’s bank reforms have lead to the extinction of small, independent mortgage bankers and lenders….the next step is health care.

    Education, Banking, Health care: the three pillars of the Nanny State.

    1. Don’t forget food programs

    2. I honestly don’t think there is a conspiracy there. People who haven’t been exposed, either directly or indirectly, to the travails of entrepreneurship simply have no clue how regulatory burden falls so disproportionately on small business.

      Obama is a perfect example of someone who is just plain clueless about how to help small businesses and people who are self-employed. I don’t think he wants to drive these people out of business (for the greater good of centralization), he just has no clue how his policies ARE driving them out of business.

      Sure, there are statists around who have an end goal of centralizing everything, but most of them are simply clueless about the wealth and initiative they are destroying.

  3. The usual left-o’-center commenters will be in here to proclaim “Remain calm! All is well!” soon enough. Or, “its Bush’s fault”. Somehow.

    I am glad my old man hung up the lab coat and retired – he thought he would miss it a lot, and found he only missed a small part of the job – practicing medicine.

    1. he could volunteer if he wanted to continue seeing patients. more medicine, less paperwork.

      http://www.ama-assn.org/ama/pu…..teers.page

      1. Doesn’t usually work that way, if you care to take the word of someone who has done it – with the hope of taking care of patients and practicing medicine. The medical NGOs generally give you only administrative, system planning and training roles and almost no opportunity to actually hands-on tend to patients. Not terribly satisfying to many of us.

  4. Telling ya, those seasteaders should be looking into medical tourism. Good money, and sympathetic human shields are part of the bargain.

  5. MNG already has all this worked out. Mandate that they have to see patients, keep practicing medicine and be paid whatever the government thinks they should be paid or throw them in jail.

    Of course, the next step will be forcing people to go to medical school… “1400 on your SAT? Med-track him! Use the shock-collar!”

    1. Proof that one person may only exist for the sake of another.

    2. really?

      1. If there was a job that basically required you to work your ass off while gaining crushing debt and will be paid barely better than jobs with far fewer requirements and “sweat equity,” no one with two brain cells to rub together will want it. So you either end up with a bunch of dumb doctors, or you lower the barriers of time and money to be a doctor (which makes for dumb doctors), or you decide that some qualified people have to do a stressful, low-paying, dangerous job whether they want to or not.

        1. Or you invent some dumb ass title like “medical technician” who has to do everything short of actual surgery while being paid slightly more than the janitor.

          1. “Nurse Practitioner” gets the job done as well. And you barely have to pay them more than RNs.

            (Please note that I’m not talking shit about NPs. I’ve liked every NP I’ve ever dealt with.)

            1. At this point NPs should just be doing everything that happens at the GP’s office. MDs can do surgery and other stuff that actually requires the level of training and education they get.

          2. There was a study done that showed that women are (financially) better off if they choose to become Physician Assistants instead of (primary care) MDs. Basically, since women doctors tend to work fewer hours/week and in some cases, give up practicing altogether, Med School isn’t really that good of an investment.

            http://www.forbes.com/sites/ge…..n-doctors/

            1. +1 for PA’s and NP’s. I’ve been happy with just about every PA I’ve been treated by, from the Army to my current doctor’s office. I think the level of care has been better too.

    3. Mandate that they have to see patients, keep practicing medicine and be paid whatever the government thinks they should be paid or throw them in jail.

      And fuck ’em if they can’t make their student loan payments.

      1. What? You’re obviously missing the point that all student loans will be paid off with increased taxes on everyone. After all, they have a right to that job.

    4. I think it should be a requirement for lawyers, to keep their licenses, to have to perform a minimum amount of pro bono each year. Say, 40 hours?

      (I can only imagine the wailing and gnashing of teeth from our lawyer-legislators over this proposal.)

  6. My sister, an oncologist, had to spend an entire day on the phone with the government so that she could prescribe Accutane (originally developed as a cancer drug) to a 6-year-old girl.

    Accutane is heavily regulated because of the chance of birth defects.

    1. Thalidomide, anyone? Naturally, they also had to stop men from taking it.

    2. She shouldn’t complain about being on the phone if she is an on-call-ogist. Tell her I said that.

      1. Dude, piss her off and she’ll give you cancer.

        1. Wasn’t that a movie? One Missed Call Oh Geez

          1. I can’t believe I just posted that.

            Preview is your friend
            Preview is your friend
            Preview is your friend

    3. I was given that a few times as a (male) teenager and, every time, was asked if I was pregnant before I received the prescription.

  7. We could always go back to the system we had in the 1950s–where there was no Medicare or Medicaid, and people paid cash for everything but catastrophic events. You know what insurance is actually supposed to be used for.

    Inside Access Healthcare’s long, rectangular, windowed waiting room, just left of the check-in window, is a feature uncommon in most primary care physician offices: a price list.

    Nearly every service, supply, and test is printed on paper behind a glass-covered stand. Office visits: $45; sports physicals: $25; ECG: $75; wrist splint: $40; lipid panel: $25. If those prices appear low, keep in mind that these gross charges aren’t reduced by health plan contracts or reimbursement errors, and Forrest’s collection rate is 99.8 percent.

    http://www.modernmedicine.com/…..?id=652945

    As for progressive goons who cry about “the poor won’t be able to afford coverage!!” all I can say is that they certainly can’t afford it now. Get rid of the government subsidies and monopolistic behavior of the current system, restore price transparency and cash as the primary method of payment, and eliminate insurance payouts on routine care, and I guarantee the price on all healthcare will drop to a level that most everyone can afford.

    1. Stop making sense

    2. Stop it. You’re making sense.

    3. It defies logic that insurance is the best way to pay for an ordinary dental scraping or a breast exam.

      What kind of investment is insuring something with a 100% likelihood of being used? Its like insuring a house and letting the owner burn it down twice a year.

      1. It’s so cute how you think people still know what “insurance” used to mean.

        1. Well, people still buy car insurance, liability and fire insurance. Those still work the way they are supposed to (mostly; car insurance can be pretty messed up in some states).

      2. I don’t think people realize how significant open pricing, the elimination of government subsidies, and limitation of insurance coverage would be.

        Imagine taking your car to an auto mechanic and, instead of getting a price on services before they tear your car apart, you simply drop it off and they send the bill to All State or Geico. A month or so later, you receive a statement from the insurance company stating what the service charge was and what you owe. In addition, for the poor and elderly, there are programs called “Autocare” and “Autoaid” that bill the government for the cost.

        Can you imagine how fucking expensive an oil change would be under this kind of system? In the 1950s, it cost about $30 to have a baby, and a private room was $19 a day–that’s a little over $600 inflation-adjusted for a two-day stay. According to webMD, the average cost today is about $10,000.

        Yeah, subsidizing and cost-shifting healthcare while eliminating cost transparency has been GREAT for costs!! :rolls eyes:

        1. Imagine taking your car to an auto mechanic and, instead of getting a price on services before they tear your car apart, you simply drop it off and they send the bill to All State or Geico.

          They have those, they’re called service contracts.

          1. And if those were common practice across the entire national auto maintenance spectrum, your post would be valid. As it is, you’re talking out of your ass.

            1. How is pointing out that something you mention as a crazy hypothetical actually exists “talking out of my ass”? Once again, the voices you hear in your head when reading the blog are not the comment author communicating with you telepathically.

              1. How is pointing out that something you mention as a crazy hypothetical actually exists “talking out of my ass”?

                Well, if you enabled your reading comprehension, you would have understood that if the practice of service contracts that you mentioned was common for most every auto purchase, then your attempt to equate that with using insurance to pay for nearly every healthcare service would be valid.

                Service contracts exist, but they aren’t used by nearly every driver when maintenance is required; otherwise, places like Jiffy Lube and Midas would be practically non-existent.

                Once again, the voices you hear in your head when reading the blog are not the comment author communicating with you telepathically.

                Maybe you should try making a coherent argument for once, Pozzy.

    4. I have an HSA, Im basically on that system.

      1. Same here. HSA, all the way!

        I figure I’m only slightly ahead (the tax deduction is worth slightly more than what we spend out of pocket), but I’m building a nice little tax-deferred savings account.

        1. It is unfortunate that legal creations like “health savings accounts” have necessity over something like a normal bank account that I can use to pay for medical services if I need to.

          1. It’s unfortunate, but in one sense it’s good since it gives people a designated pool of their own making to dip into.

            I’d much rather pay for stuff out of money I’ve already saved up as opposed to waiting six months to find out what the insurance company decided to cover.

  8. We have to pass it to see what’s in it. (Does that describe stool or Obamacare or both?)

    http://www.bloomberg.com/news/…..-plan.html

    1. As obvious as that analogy is, I can’t believe that I haven’t heard it until now.

      1. aw nuts

  9. But-but-but, all our healthcare problems are caused by the evil free market!! We just need more government regulation and control, you know, like Europe!

    1. What was the date that the NHS parade occurred at the Olympics? That was the day Western Europe finally died after a one hundred year coma.

      1. It might have lasted longer but it was snuffed out via the Liverpool Protocol.

  10. Doctors aren’t even necessary for a lot of the shit that legal protectionism and paternalism prevents other professionals from doing.

    1. As a highly-compensated member in good standing of a state-licensed professional cartel, I resemble that remark!

      1. A broader point of what I suggested above would be to suggest that every restriction we put on doctors and paying them for service ought to be placed on lawyers as well.

        Hell, I still think about Hillarycare’s “legal care alliances”. The government would have had her drawing up wills in Watertown, NY for a decade now. 🙂

    2. That fight is gearing up. the Nurse practitioners and family docs traded dueling letters/reports on scope of practice last week.

      1. That fight has been going on for at least 20 years that I know of.

        1. we’re a little slow inside the beltway. takes awhile to penetrate the bubble.

    3. I don’t know what impact it has on their health care costs but from what I’m told Germans and Italians do not go to doctors for minor complaints like a case of the sniffles, they go to the pharmacists, describe the symptoms and the pharmacist sells them something.

      Now, in Italy it’s more than likely going to be some homeopathic remedy and in Germany it’ll be an herbal remedy. But AFAIK, pharmacists are legally permitted to dispense a whole lot of medications directly without an MD’s Rx, including painkillers and anti-biotics.

  11. “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.”
    _

    prima donna *PRIVATE PRACTICE* docs dont care about their ER brethern

    1. Shorter Urine: I learned everything I know about the medical industry from Gray’s Anatomy!!!

      1. Even shorter urine: derp!

    2. prima donna *PRIVATE PRACTICE* docs dont care about their ER brethern

      Nothing remotely new about that. Then again, why should they particularly?

    3. Dood u watched scrubz too?

  12. My primary doc told me on the last visit – join his concierge med group or stand in line with the prolees – stand in line for a long time. It isn’t too expensive: $300 per year. So I’m still debating it. He said he was implementing it so he could get back to practicing medicine and spend less time managing an insurance payments/ government compliance office. Can’t blame him.

    1. Where’s your doctor? Why would you even debate that? Does that mean he’s going cash-only and members-only?

      1. I’m in Chevy Chase, Maryland.
        It’s kind of a hybrid system. He’ll keep his present patients and their insurance, but the ones on concierge-style group always go to the front of the line, have email access to him, have a Nurse practitioner on call 24/7, and a variety of other lesser perks. He won’t be taking any new patients unless they’re on this system – Medicare and medicaid patients get thrown under the bus.

        His goal is fewer patients, better service, and less insurance and government paperwork hassles.

        1. Fuck. Maryland is too far to drive from Denver.

    2. $300 is a bargain compared to what most concierge docs are charging.

  13. I wonder how many of these doctors would agree with abolishing the current employment-based insurance system, ending restrictions on who can practice medicine and getting rid of prescription requirements (which would also, incidentally, require drug legalization)?

    1. abolishing the current employment-based insurance system,

      At a guess, around 25%.

      ending restrictions on who can practice medicine

      None. OK, maybe 1%.

      and getting rid of prescription requirements

      None. OK, OK, maybe 2%.

    2. At least stop mandating insurance to cover routine shit, end protectionist approval of new practices and equipment investments, and allow more clinic type businesses and professionals other than doctors to take care of common things.

    3. I’d like to hear their take on that Certificate of Need debacle written about last week.

  14. Biden is going to be nearby tommorrow.

    I’m tempted to take the afternoon off, and go the event. Yell, ‘You speak for me, Joe! You speak for me!’

    And when I get his attention: ‘I’m just fucking with you, Joe. Just fucking with you.’

    1. Or, “I’ll take that free colonoscopy now big guy!”

      1. If you moon him after saying that, I will make a small contribution toward your bail.

        1. For Biden, it can only be goatse.

  15. WHo gets sued for this?

    An off-duty Burlington patrol officer accidentally shot herself in the ankle Sunday evening while cleaning a semi-automatic pistol, according to Milton police.

    The agency responded at about 7:34 p.m. Sunday to a report of an accidental shooting at the home of 27-year-old Leanne Werner, Milton police Sgt. John Palasik said.
    Werner was transported to Fletcher Allen Health Care in Burlington and treated for a non serious injury to her ankle, according to the sergeant.

    http://www.burlingtonfreepress…..f-in-ankle

    1. I keep hearing that everything is Bush’s fault.

      1. ” I was recklessly and negligently injured by the discharge of this city owned firearm”

        “But you discharged it”

        “I was negligent and I am prepared to testify to that in court”

        1. “I did not receive that proper training to clean the gun issued to me.”

          Oh, the PBA would love to set that precedent.

          1. I think what you’re describing actually happened in Boston back in the 90’s when they first got Glocks. IIRC a cop was looking under a car for somebody and “the gun fired itself” injuring him.
            Then there was the Vermont State Trooper who Glocked himself in the ass while stalking a raccon off duty.

            1. Well, it is a pretty obvious argument to make in a profession that can never, ever, ever admit it ever did even the smallest thing wrong.

              1. WHy do you get an ambulance ride to the ER for a “non-serious injury” something strange about that.

    2. Its impossible for a trained user to accidentally fire a modern firearm. You have to intentionally pull the trigger. This was a suicide attempt.

      Hey, Im consistent!

    3. Better question:

      Why should the taxpayers have to pick up her medical bills for this? Because they will. And probably a big tab for disability, also.

      1. If you shot yourself in the foot, would the police give you a pass? Would they at least seize the weapon? Maybe have your permit revoked?

    4. An off-duty Burlington patrol officer accidentally shot herself in the ankle Sunday evening while cleaning a semi-automatic pistol, according to Milton police.

      “The bullet passed through her ankle and ended up striking her dog, which is now dead.”

  16. It’s just beginning. Our ambulance company (I’m on the board) is getting Medicare reimbursements that don’t even come close to what we need to cover costs. And we can’t balance bill Medicare patients.

    And just recently the Feds changed the adminstrator, who’s screwed with the codes to save money. If the EMT recognizes a person has had a stroke and codes it as such, Medicare doesn’t pay, because a stroke doesn’t necessarily require transport. If you identify what kind of stroke it is, you get reimbursed. But you can’t identify it because an ambulance doesn’t have that equipment or the qualified personnel.

    So it’s going to be interesting when there aren’t any ambulance companies anymore because the Feds have bent the whole system so much.

    1. “because a stroke doesn’t necessarily require transport”

      huh?

      1. Ladies and gentlemen, your politicized and bureaucratized health care system!

        May you have the joy of it.

      2. Walk it off gimpy.

      3. “SMILE, asshole!”

        1. that reminds me. on more than one occasion i’ve seen cops mistake diabetic ketoacidosis for drunkenness

          1. Yeah, I’ve worried about that. Since both my parents are diabetic, I was caught early and have never experienced it. And I’ve seen a lot of people claim that DKA can make you blow a positive on a breathalyzer.

            I figure it will be low blood sugar that gets me tased. I am particularly belligerent when my sugar crashes out.

      4. Rub some dirt on it.
        Take a salt tablet.

      5. If I had a stroke, I would be more likely to want the ambulance to take me to the hospital rather than someone driving me, as opposed to something like being shot almost anywhere in which case I would be fine having someone drive me to avoid the ambulance bill.

  17. So you either end up with a bunch of dumb doctors, or you lower the barriers of time and money to be a doctor (which makes for dumb doctors), or you decide that some qualified people have to do a stressful, low-paying, dangerous job whether they want to or not.

    Or you end the medical cartel that artificially limits the supply of physicians, prohibits foreign doctors from getting accredited without going thru med school again, and prohibits people from accessing non-physicians for things that don’t require medical school to perform competently, such as getting a prescription for painkillers or antibiotics, or getting immunization shots, or whatever.

  18. 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.

    This, I can tell you is mostly due to the state of the economy. All of our clinic patient volumes are down significantly since 2008. When unemployment remains high due to Obama’s policies, women and minorities are hardest hit. People at the lower end of the economic spectrum are usually the first to lose their insurance as they often don’t have a spouse who can pick them up on a secondary.

    The price of all this, of course, is consolidation. We’re consolidating, just like everyone else is. And yes, we’re right there at the government’s teat, trying to get that sweet Meaningful Use money. Because it’s free.

  19. As a senior biochemistry major with intentions of going to medical school….well this may just change them

    1. Talk to some actual doctors first, we’re just a bunch of internet assholes.

      1. Doctors are too busy fiddling with the iShit to pay attention.

    2. Irony aside, take the military (HPSP) or Public Health Service scholarship. Do your time and then you can get out. You’ll be med school debt free. Practicing medicine will still suck thanks to Uncle Sucker, but at least you won’t be slammed by debt.

  20. 60.6 percent of physicians say they would retire today if they could (up from 45 percent in 2008)

    That actually seems pretty low. Most people only work because they have to, not because they want to.

  21. As I mentioned in the other thread on this, how much of this disatisfaction is actually due to government regulation, and how much is due to the consolidation that’s going on in the healthcare industry (the way it has in most other professions)? While the exact form of that consolidation is certainly be affected by government regulation, it would be going on in one form or another regardless due to market forces. I’m sure if you asked, say, a guy who used to own their own hardware store and is now stuck as a manager at a Home Depot, they’d say the hardware business sucks more than it used to.

Please to post comments

Comments are closed.