The American Physician - On the Endangered Species List?
What the politicians on both sides of the aisle seem to have forgotten, in their often wonky approach to 'selling' health care reform in America, is this reform's real world implications for practicing community doctors. Without delving into the complexities of statistics and lengthy financial explanations, it bears importance to address several key issues about the physician dilemma in the context of the massive health care reform proposed by President Obama and recently passed by the Democratic Party.
Putting misconceptions aside, the public should appreciate that becoming a physician in the United States of America requires at least eleven--and sometimes as great as 17 or more--years of rigorous training, examinations, and sacrifice after high school. In fact, in most cases, the work involved in attaining a medical license starts in high school itself as students must demonstrate superior academic performance and dedication to get into acceptable pre-medical, college undergraduate degree programs. After their training, these physicians must contend with educational loan debt that can run into the multiple (read three or four or five) hundreds of thousands. These loans, accompanied by severely reduced insurance company reimbursement levels over the past two decades, and work weeks in excess of eighty hours, can take upwards of twenty years to pay off as well as significantly reduce lifestyle and family choices.
Physicians, without question, practice under incredible threats of malpractice actions for even the most slight of perceived infractions. The stress and cost and time of practicing 'defensive medicine'--and the shear financial burden of malpractice insurance--to protect against what are many times frivolous lawsuits can be unbearable. Many communities in America are without crucial medical practitioners because of the weight of malpractice costs, much of which is the result of a 'jackpot' mentality on the part of attorneys who sue in high numbers hoping for that one 'big hit' jury award that will make the attorney an instant millionaire. No one is arguing that the legal system does not play a crucial role in our democratic society, but when it favors a select few (e.g., note that there are no significant efforts to reign in malpractice attorneys in the current House or Senate health care reform bills written by predominantly attorneys themselves) then all of society loses. Ironically, if the United States does, as I predict, spiral toward a fully 'socialized/nationalized' medical system in the next decade, the government (now the sole payor of medical services) will no longer tolerate the egregious behavior of medical malpractice attorneys. In Great Britain, for instance, there are financial thresholds required to even file a tort lawsuit and the losing plaintiff often has to pay the legal costs of the defense--all designed to limit abuses to the medical malpractice system.
We can all agree that with regard to jobs with highly demanding, extremely selective, and incredibly education-dependent levels of practice and skill, the person who achieves that position should be incentivized and rewarded for the pursuit and performance of his or her role in society. Combine this with the fact that many medical specialties, such as anesthesiology, inflation-adjusted income levels have dropped by upwards of 70 percent over the past seventeen years. Anesthesiology is the application of 'controlled poisons' delivered with exact precision to take away patient pain and awareness; it requires incredible skill and knowledge and, by all accounts, patients have only become sicker, older, and more challenging (e.g., obesity, diabetes, etc.) over the past two decades. Anesthesiologists, like many medical specialists, deserve a fair income--and the public generally understands and endorses this notion. The real question is (with continued decreases in physician specialty reimbursement likely to occur under the President's health care reform legislation) whether physicians can afford to stay in practice and whether these important specialties can continue to attract the best and the brightest young medical students.
All of this comes down to why physician issues are relevant to the very dramatic health care reform package approved by President Obama and his minions in Congress. Consider that this bill was passed against the majority opinion of most Americans, and has not only outraged ordinary Americans (who mostly favor an incremental approach to reform) but will also further squeeze the very people who will be asked to deliver healthcare to the public. We're not talking about biomedical companies and pharmaceutical products here--that is for another discussion. And we're not talking about corrupt, rich insurance executives who squeeze both patients and physicians alike in their pursuit of profit. We're talking about physicians. And these physicians will have to deliver care to more patients, work more hours, and absorb even more cuts to their reimbursement levels under the President's health care reform law.
If America decides to adopt a European-style approach to health care, and likewise also pays for the complete medical education of its doctors and minimizes frivolous medical malpractice lawsuits, then this would at least be an honest demonstration of a desire to move toward socialized medicine in the United States. But to impose more strong-armed federal mandates and further cuts in allowable income for physicians, without any education or practice management relief, will result in an unavoidable withdrawal of many physicians from the Medicaid and Medicare programs. Physicians in large numbers will be forced to quit and retire early; and expensive, highly populated, and remote areas of America will all share one common denominator--a shortage of doctors. President Obama has planned for this contingency, as his 'socialized' medicine vision will constitute an unprecedented increase in physician extenders (i.e., physician assistants and nurse practitioners).
So, Mr. President, please know that the vast majority private practice physicians are behind you in your efforts to give health care insurance to all Americans. And ideas such as health insurance portability, elimination of pre-existing condition clauses, and anti-fraud efforts are to be commended and should be incorporated into law. But know as well, Mr. President, that your new health care reform laws will have real world, possibly devastating implications for the physicians upon whom we all rely to deliver America's medical care.
The good news is that many of the troubling taxes and provisions of this new health care reform bill will not be fully realized for several years to come. The real question is whether the American people and their elected representatives can wake up to the fact that 'good intentions' can sometimes lead to disastrous consequences. And, the Democratic-controlled Congress still has to find a permanent fix to the flawed 'SGR' formula, which currently has doctors taking a 21 percent cut in Medicare pay beginning April 1st. In addition, many corporations are just now voicing their concern that increased costs created by Obamacare may force cuts in jobs and employee benefits. Some say that India may be a beneficiary by forcing increased reliance on foreign 'outsourcing' of medical jobs and services. There are so many problems which threaten access to American's best doctors and the superb level of health care heretofore available to 85 percent of the population.
We still have time to revise and repeal certain aspects of this monstrous new legislation, especially those that further squeeze a soon-to-be endangered species, the American physician.
What the politicians on both sides of the aisle seem to have forgotten, in their often wonky approach to 'selling' health care reform in America, is this reform's real world implications for practicing community doctors. Without delving into the complexities of statistics and lengthy financial explanations, it bears importance to address several key issues about the physician dilemma in the context of the massive health care reform proposed by President Obama and recently passed by the Democratic Party.
Putting misconceptions aside, the public should appreciate that becoming a physician in the United States of America requires at least eleven--and sometimes as great as 17 or more--years of rigorous training, examinations, and sacrifice after high school. In fact, in most cases, the work involved in attaining a medical license starts in high school itself as students must demonstrate superior academic performance and dedication to get into acceptable pre-medical, college undergraduate degree programs. After their training, these physicians must contend with educational loan debt that can run into the multiple (read three or four or five) hundreds of thousands. These loans, accompanied by severely reduced insurance company reimbursement levels over the past two decades, and work weeks in excess of eighty hours, can take upwards of twenty years to pay off as well as significantly reduce lifestyle and family choices.
Physicians, without question, practice under incredible threats of malpractice actions for even the most slight of perceived infractions. The stress and cost and time of practicing 'defensive medicine'--and the shear financial burden of malpractice insurance--to protect against what are many times frivolous lawsuits can be unbearable. Many communities in America are without crucial medical practitioners because of the weight of malpractice costs, much of which is the result of a 'jackpot' mentality on the part of attorneys who sue in high numbers hoping for that one 'big hit' jury award that will make the attorney an instant millionaire. No one is arguing that the legal system does not play a crucial role in our democratic society, but when it favors a select few (e.g., note that there are no significant efforts to reign in malpractice attorneys in the current House or Senate health care reform bills written by predominantly attorneys themselves) then all of society loses. Ironically, if the United States does, as I predict, spiral toward a fully 'socialized/nationalized' medical system in the next decade, the government (now the sole payor of medical services) will no longer tolerate the egregious behavior of medical malpractice attorneys. In Great Britain, for instance, there are financial thresholds required to even file a tort lawsuit and the losing plaintiff often has to pay the legal costs of the defense--all designed to limit abuses to the medical malpractice system.
We can all agree that with regard to jobs with highly demanding, extremely selective, and incredibly education-dependent levels of practice and skill, the person who achieves that position should be incentivized and rewarded for the pursuit and performance of his or her role in society. Combine this with the fact that many medical specialties, such as anesthesiology, inflation-adjusted income levels have dropped by upwards of 70 percent over the past seventeen years. Anesthesiology is the application of 'controlled poisons' delivered with exact precision to take away patient pain and awareness; it requires incredible skill and knowledge and, by all accounts, patients have only become sicker, older, and more challenging (e.g., obesity, diabetes, etc.) over the past two decades. Anesthesiologists, like many medical specialists, deserve a fair income--and the public generally understands and endorses this notion. The real question is (with continued decreases in physician specialty reimbursement likely to occur under the President's health care reform legislation) whether physicians can afford to stay in practice and whether these important specialties can continue to attract the best and the brightest young medical students.
All of this comes down to why physician issues are relevant to the very dramatic health care reform package approved by President Obama and his minions in Congress. Consider that this bill was passed against the majority opinion of most Americans, and has not only outraged ordinary Americans (who mostly favor an incremental approach to reform) but will also further squeeze the very people who will be asked to deliver healthcare to the public. We're not talking about biomedical companies and pharmaceutical products here--that is for another discussion. And we're not talking about corrupt, rich insurance executives who squeeze both patients and physicians alike in their pursuit of profit. We're talking about physicians. And these physicians will have to deliver care to more patients, work more hours, and absorb even more cuts to their reimbursement levels under the President's health care reform law.
If America decides to adopt a European-style approach to health care, and likewise also pays for the complete medical education of its doctors and minimizes frivolous medical malpractice lawsuits, then this would at least be an honest demonstration of a desire to move toward socialized medicine in the United States. But to impose more strong-armed federal mandates and further cuts in allowable income for physicians, without any education or practice management relief, will result in an unavoidable withdrawal of many physicians from the Medicaid and Medicare programs. Physicians in large numbers will be forced to quit and retire early; and expensive, highly populated, and remote areas of America will all share one common denominator--a shortage of doctors. President Obama has planned for this contingency, as his 'socialized' medicine vision will constitute an unprecedented increase in physician extenders (i.e., physician assistants and nurse practitioners).
So, Mr. President, please know that the vast majority private practice physicians are behind you in your efforts to give health care insurance to all Americans. And ideas such as health insurance portability, elimination of pre-existing condition clauses, and anti-fraud efforts are to be commended and should be incorporated into law. But know as well, Mr. President, that your new health care reform laws will have real world, possibly devastating implications for the physicians upon whom we all rely to deliver America's medical care.
The good news is that many of the troubling taxes and provisions of this new health care reform bill will not be fully realized for several years to come. The real question is whether the American people and their elected representatives can wake up to the fact that 'good intentions' can sometimes lead to disastrous consequences. And, the Democratic-controlled Congress still has to find a permanent fix to the flawed 'SGR' formula, which currently has doctors taking a 21 percent cut in Medicare pay beginning April 1st. In addition, many corporations are just now voicing their concern that increased costs created by Obamacare may force cuts in jobs and employee benefits. Some say that India may be a beneficiary by forcing increased reliance on foreign 'outsourcing' of medical jobs and services. There are so many problems which threaten access to American's best doctors and the superb level of health care heretofore available to 85 percent of the population.
We still have time to revise and repeal certain aspects of this monstrous new legislation, especially those that further squeeze a soon-to-be endangered species, the American physician.
Physicians Against Obamacare 2010
