Posted on Nov 27, 2008 by Sergio Ulloa
When Barack Obama became the President-elect of the United States, the discussion of health care reform gained momentum. One of the platforms Obama ran on was reforming the health insurance landscape by promoting better public health insurance and access to basic healthcare. Given The Lewin Group
's estimates that there would be a 54% reduction in the number of uninsured Americans under Obama's health reform plans that he talked about during the election campaign, this seems like a good thing right? However, a the results from a recent survey of primary care physicians in the U.S. revealed some disturbing trends that could severely impact any new healthcare reforms.
The survey, carried out by the Physicians
' Foundation, started in May and saw 300,000 surveys distributed to primary care physicians (PCPs being the usual first point of contact when you're ill, people like family doctors or general practitioners) and selected individual specialists. The idea behind the survey was to get the perspective of the frontline workers of the healthcare world by asking about the state of their practices, and whether or not they could preserve their level of care given the increasing hurdles of pricing and paperwork. The results were somewhere between disappointing and disastrous. It's hard to tell what effects this could have on Obama's universal health care plans, but they will need to be addressed in order for the new system to get off the ground.
The figures are quite telling of what the situation is for primary care physicians and how they're coping. A whopping 78% of the physicians who responded said they believe there is already
an existing shortage of physicians, and none of the other numbers inspire confidence that this will change for the better anytime soon. Pre-existing conditions aside, 49% which is more than 150,000 of America's practicing physicians, are planning on either cutting down the number of patients they see or just not practicing at all. This sharp drop in the numbers of physicians will have a heavy impact on any new system's ability to deliver quality services. What's worse is that not only is there a decreasing trend, but that 60% of people asked said they would not recommend a career in medicine to young people. You're really in dire straights if the majority of your country's healthcare
providers find their job so frustrating or distasteful they wouldn't wish it upon others.
So why have American physicians become so disillusioned with their jobs? What's odd is that it's not their job
they're upset about, provided you consider their job
to be the business of treating patients. When asked about what they find satisfying about practicing medicine, on a scale of 5, 1 being most satisfied and 5 being least satisfying, 50% of physicians said marked down 1 for patient relationships with another 27% marking the second highest level of satisfaction. So if the face to face time with the patients is one of the more satisfying aspects of the job, what is the problem? There seems to be a combination of three major issues for primary care doctors, all of them to do with the system in which they work.
One of the most widely agreed upon problems by doctors was the growing piles of non-clinical paperwork that primary care givers are forced to fill out. Out of the respondents, 94% of them said that time spent on non-clinical paperwork had increased over the last 3 years. Over 60% confessed to spending 11 hours a week or more on non-clinical paperwork. This has an obvious knock on effect for the doctors and their patients, as about two thirds of the respondents admitted that the growing number of non-clinical duties they have to do has forced them to spend less time on every patient. Given that 63% of physicians surveyed worked at least 51 hours a week (38% work 61 hours or more), 11 hours is a large part of your workweek spent on things not directly related to seeing and treating patients. So in the end, the patient care suffers due to a large part of doctors being forced to perform bureaucratic paper shuffling. While oversight and accountability are well and good, this goes beyond the pail and actually hamstrings doctors from doing their jobs as medical professionals, given that 63.23% of doctors polled agreed with the statement that they only "sometimes have time to fully communicate and treat patients."
Some of the other major problems for doctors are related, insofar as they relate to financial issues, and are certainly intertwined, but both are emblematic of a system that has become fundamentally unhealthy due to narrow-sighted, piecemeal changes and mismanagement. And in this case, both the government and the insurance
companies are to blame.
Once upon a time, becoming a doctor was seen as a responsible, respected career and decently lucrative to boot. Not so much these days. A growing number of doctors are feeling more financial pressure as they find themselves at the whim of government pricing and insurance underwriting policies. For public services like Medicare and Medicaid, the government reimburses physicians for their services rendered to patients under those plans. But the problem is that the government controls the prices that they pay physicians for each kind of ailment, and they are increasingly in the habit of lowering the amount of reimbursements to doctors. This has two effects: the first being that as the reimbursements to doctors and hospitals are cut, they have to raise the costs for privately insured individuals to recover the costs, which ends up raising the price of insurance premiums
in general; secondly, it leads to a problem where doctors can no longer remain profitable enough taking patients on public plans, over 33% of those surveyed said they had closed their practice to Medicaid patients and 12% have closed their doors to Medicare patients. Medicaid seems to be the worst perpetrator, with 65% of physicians saying Medicaid reimbursement is less than the cost of the care. What good is getting large members of the population insured if the coverage does enough harm to the doctors' practice that they won't accept it?
The problem doesn't seem to be getting any better either. Since most American doctors are privately employed, profitability is important. It's hard to keep your workers satisfied, take care of and expand your business to provide better services to more people if you don't have the cash. This makes the fact that only 17% of doctors rated the financial positions of their practices as "healthy and profitable" just that much more depressing. Over the last three years, 44.1% said their practice's income was flat, and 40.14% said it was declining. The U.S. Government seems intent on rubbing salt in their doctors' wounds by further decreasing reimbursement rates. When doctors
where asked how their overhead would be, under the assumption that a 10.6% cut in Medicare reimbursements, slated for October 1, 2008, and an additional reduction of 5% in 2009 would be enacted. The results were not promising with 81.64% saying their overheads would be unsustainable. Now if you're grumbling about greedy doctors, it's time to stop, as over 39.63% of practices provide more than USD $50,001 or more dollars a year on uncompensated care, with another 40.91% providing between USD $15,001 and USD $50,000. I imagine part of what irritates doctors so much is that as the number of hoops they are forced to jump through increases, and makes their business less profitable, insurance companies are having record years.
It will be interesting to see whether Obama's healthcare reforms can juggle the needs of patients, doctors and the insurance industry. There will need to be a greater effort to make it worthwhile for the doctors, possibly by finding a way to streamline healthcare administration and regulations, cutting down on paperwork for family doctors and physicians, or making it more financially worth their efforts, because America cannot afford to lose this many professionals that form such an integral part of the healthcare system. Then again, maybe it's a good thing we're not paying enough, seeing as 45% of doctors would retire today if they had the financial means of doing so.
As a side note, if you really want a better idea of about the state of medicine from the doctors' point of view, then I suggest you read the comments section of the report starting at page 43 (45 on the .pdf