Healthcare Reform: Survey of Physicians

IgnatiusTheKing

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Original poster
Nov 17, 2007
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Those are some astounding numbers.

62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.
link
 

Hmac

macrumors 68020
May 30, 2007
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If the senate's bill passes, it is a certainty that your primary care provided 5 years from now is more than likely going to be a Nurse Practitioner or a Physician Assistant. Those manpower shortages will become even more problematic in other specialties. Neither Nurse Practitioners nor Physician Assistants can take your appendix out.
 

Sydde

macrumors 68020
Aug 17, 2009
2,105
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If the senate's bill passes, it is a certainty that your primary care provided 5 years from now is more than likely going to be a Nurse Practitioner or a Physician Assistant. Those manpower shortages will become even more problematic in other specialties. Neither Nurse Practitioners nor Physician Assistants can take your appendix out.
Because that is how it is in Britain and Canada?
 

Thomas Veil

macrumors 68020
Feb 14, 2004
2,435
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OBJECTIVE reality
Whatever happened to this poll?

...A large majority of doctors say there should be a public option.

When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.

Most doctors — 63 percent — say they favor giving patients a choice that would include both public and private insurance. That's the position of President Obama and of many congressional Democrats. In addition, another 10 percent of doctors say they favor a public option only; they'd like to see a single-payer health care system. Together, the two groups add up to 73 percent.

When the American public is polled, anywhere from 50 to 70 percent favor a public option. So that means that when compared to their patients, doctors are bigger supporters of a public option.
 

freeny

macrumors 68020
Sep 27, 2005
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Location: Location:
^^^
ironicly, the major reason in the first poll as to why the doctors who said they would quit if health care reformed passed was because of "increased traffic due to more people being covered"...
 

IntheNet

macrumors regular
Oct 6, 2009
190
0
If the senate's bill passes, it is a certainty that your primary care provided 5 years from now is more than likely going to be a Nurse Practitioner or a Physician Assistant. Those manpower shortages will become even more problematic in other specialties. Neither Nurse Practitioners nor Physician Assistants can take your appendix out.
I agree and doctor/health care provider shortage is something neither the Senate or House bill address...imagine your doctor office (and every doctor office) having 30 million new patients amid shortages of physicians? Chaos! RATIONED CARE! I posted this New England Journal of Medicine survey in the Health Care Reform thread but it seems relevant here too...

Breaking news this afternoon on healthcare reform issue from The New England Journal of Medicine:

:eek::eek:

Almost 1 out of 3 Physicians May Leave Medicine
03/16/10 at 5:13pm by Professor Mark J. Perry
http://www.benzinga.com/176912/almost-1-out-of-3-physicians-may-leave-medicine
From a survey of physicians conducted by The Medicus Firm in December 2009, and appearing in the latest issue of the New England Journal of Medicine:

"If health reform passes without the public option, 7.4% of physicians stated that they would quit practicing medicine, unless they were nearing retirement, in which case 21.8% said they would retire early, bringing the total loss of physician workforce to nearly one-third of physicians leaving medicine.
 

.Andy

macrumors 68030
Jul 18, 2004
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imagine your doctor office (and every doctor office) having 30 million new patients amid shortages of physicians? Chaos! RATIONED CARE!
So your answer is to not treat those 30 million people? (p.s. all care is rationed. under every health system. It's a meaningless term and just empty politicking)

I posted this New England Journal of Medicine survey in the Health Care Reform thread but it seems relevant here too...
Perhaps it seems relevant to you because it's the same survey as in the OP.
 

IntheNet

macrumors regular
Oct 6, 2009
190
0
So your answer is to not treat those 30 million people?
All people need be treated. However, if neither the Senate or the House health reform bill address doctor/health care provider shortage solutions perhaps wise men/women in Washington will realize it is time to start over on health care reform rather than introduce laws that makes the problem WORSE!
 

eawmp1

macrumors 601
Feb 19, 2008
4,130
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FL
1) This is INSURANCE reform, not HEALTHCARE reform. That said, as I feel access to a basic level of health care is a human right, I am all for more people being covered.
2) We do not have HEALTHCARE in the US, we have SICKCARE. This is the best nation in the world to have something go medically wrong with you (unless it is a psychiatric problem). We are lousy at curbing preventable/delayable illness. This has as much to do with societal values as the healthcare system. One gets far more return on investment in preventative care/primary care than in cutting-edge procedures. Unfortunately, current reimbursement is upside down. This is the paramount reason for shortages in primary care.
3) There does need to be "rationing" of care. There will never be enough money in ANY sector of the economy to give everyone what he or she WANTS. Healthcare should be about what people need, not what they want or think they need. I'd rather pay for univeral immunization and prenatal care than artificially delay the imminent inevitability of someone's death in the ICU. A very sticky wicket, I realize, but choices HAVE to be made.

The issue of healthcare is far more complex than can be hashed out in a forum such as this. Suffice it to say, the general public is woefully underinformed as to the true workings/economics of healthcare. Therefore, the masses have been easly herded by the politicians in the past several months. Tough, unpopular choices must be made. Unfortunately, no one in Washington has shown true leadership in advancing the real issues.
 

.Andy

macrumors 68030
Jul 18, 2004
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The Mergui Archipelago
However, if neither the Senate or the House health reform bill address doctor/health care provider shortage solutions perhaps wise men/women in Washington will realize it is time to start over on health care reform rather than introduce laws that makes the problem WORSE!
What does the current reform bill have regarding training of new doctors/health care providers?
 

Hmac

macrumors 68020
May 30, 2007
2,128
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Midwest USA
3) There does need to be "rationing" of care. There will never be enough money in ANY sector of the economy to give everyone what he or she WANTS. Healthcare should be about what people need, not what they want or think they need. I'd rather pay for univeral immunization and prenatal care than artificially delay the imminent inevitability of someone's death in the ICU. A very sticky wicket, I realize, but choices HAVE to be made.
IMO you are absolutely correct. With physician supply falling, expensive technology becoming increasingly part of the standards of care, and the population increasing (and the over-50 portion increasing even faster)...there is no possibility to avoid the rationing of healthcare.
 

.Andy

macrumors 68030
Jul 18, 2004
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I remember this from a couple of years ago (we may have even discussed it here) so it's worth putting this current survey in context. US doctors have been fed up for a while.

CNN said:
(CNN) -- Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

Experts say if many physicians stop practicing, it could be devastating to the health care industry.

The survey, released this week by the Physicians' Foundation, which promotes better doctor-patient relationships, sought to find the reasons for an identified exodus among family doctors and internists, widely known as the backbone of the health industry.

A U.S. shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted at last week's American Medical Association annual meeting.

In the survey, the foundation sent questionnaires to more than 270,000 primary care doctors and more than 50,000 specialists nationwide.

Of the 12,000 respondents, 49 percent said they'd consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there's too much red tape generated from insurance companies and government agencies.

And if that many physicians stopped practicing, that could be devastating to the health care industry.

"We couldn't survive that," says Dr. Walker Ray, vice president of the Physicians Foundation. "We are only producing in this country a thousand to two thousand primary doctors to replace them. Medical students are not choosing primary care."

Dr. Alan Pocinki has been practicing medicine for 17 years. He began his career around the same time insurance companies were turning to the PPO and HMO models. So he was a little shocked when he began spending more time on paperwork than patients and found he was running a small business, instead of a practice. He says it's frustrating.

"I had no business training, as far as how to run a business, or how to evaluate different plans," Pocinki says. "It was a whole brave new world and I had to sort of learn on the fly."

To manage their daily work schedules, many survey respondents reported making changes. With lower reimbursement from insurance companies and the cost of malpractice insurance skyrocketing, these health professionals say it's not worth running a practice and are changing careers. Others say they're going into so-called boutique medicine, in which they charge patients a yearly fee up front and don't take insurance.

And some like Pocinki are limiting the type of insurance they'll take and the number of patients on Medicare and Medicaid. According to the foundation's report, over a third of those surveyed have closed their practices to Medicaid patients and 12 percent have closed their practices to Medicare patients That can leave a lot of patients looking for a doctor.

And as Ray mentioned, med school students are shying away from family medicine. In a survey published in the Journal of the American Medical Association in September, only 2 percent of current medical students plan to take up primary care. That's because these students are wary of the same complaints that are causing existing doctors to flee primary care: hectic clinics, burdensome paperwork and systems that do a poor job of managing patients with chronic illness.

So what to do? Physicians don't have a lot of answers. But doctors say it's time to make some changes, not only in the health care field but also with the insurance industry. And they're looking to the new administration for guidance.

One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American. But some health experts, including Pocinki, are skeptical.

"People who have insurance can't find a doctor, so suddenly we are going to give insurance to a whole bunch of people who haven't had it, without increasing the number of physicians?" he says. "It's going to be a problem"
 

Hmac

macrumors 68020
May 30, 2007
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So...what's your solution? Let poor people die?

Honestly, I'm curious.
Those physician extenders aren't going to let people die. At least not intentionally. What a silly question.

Relative to preserving the supply of real doctors, improving physician satisfaction is the place to start. More money, less intrusive regulation, tort reform, less bureaucracy.

What is far more likely to happen is that those medical provider resources that DO exist will have to be utilized increasingly more efficiently. That means rationing of care. It's inevitable. If we're talking about letting people die, it's not going to be letting poor people die, it will probably be that we end up having to let old people die.

That will be part of the eventual evolution. In the short run rationing will take the form of the Canadian health care system. It doesn't matter how much your hernia hurts you, it won't kill you, so your operation will be in two years. Those thirty million people will be covered, but YOU will have to surrender your spot in the health care queu. The line for health care will be a lot longer....it will take you a lot longer to get to the front.
 

Gelfin

macrumors 68020
Sep 18, 2001
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Denver, CO
What is far more likely to happen is that those medical provider resources that DO exist will have to be utilized increasingly more efficiently. That means rationing of care. It's inevitable. If we're talking about letting people die, it's not going to be letting poor people die, it will probably be that we end up having to let old people die.
Your assumptions are showing. The insurance companies are already utilizing medical staff as efficiently as possible. Your doctor is on a treadmill to get you in and out the door in as few minutes as possible. They're timed. Of course, on the other hand, they have to spend half their time justifying procedures and filling out paperwork to get paid for the work they do. They are working incredibly efficiently, but towards the bottom line of the insurance companies, not towards better health care service.

This is why a lot of doctors have already been leaving the practice, or leaving medical groups and becoming totally private cash-on-the-barrelhead practices, and why existing doctors have been openly discouraging young people from entering the profession. Doctors have been abused as much as patients under the tyranny of the insurers.

If you really want more and more efficient doctors, you'd support a universal single-payer system such that a single especially clever trained monkey could fill out all the paperwork required to trigger payment. Track that data centrally to identify, for instance, a doctor who orders way more CT scans than his peers in similar practices in the region, but apart from that, let doctors be doctors full-time. You will already have nearly doubled the supply of medical services available in the United States.

Make medicine a tolerable and reasonably well-compensated profession again, and increase the demand for health services by offering them to more people, and it will be seen as a growth industry, luring in talented students. The number of medical practices will expand to fill the demand.

That will be part of the eventual evolution. In the short run rationing will take the form of the Canadian health care system. It doesn't matter how much your hernia hurts you, it won't kill you, so your operation will be in two years. Those thirty million people will be covered, but YOU will have to surrender your spot in the health care queu. The line for health care will be a lot longer....it will take you a lot longer to get to the front.
We have 30 million uninsured, ten percent of the population. Not counting the underinsured, offering those people health care will increase the demand for health services by 11%. Even if we assume the number of practicing physicians can never grow, I am really unclear about how my handful of days waiting to see the doctor, plus 11%, equals two years. There's no chance this is exaggerated scaremongering, is there?

Plus, the UK already gets around this issue by still offering private insurance. You can wait your turn in the NHS, or if you have one of a number of very affordable private insurance plans, you can jump the queue into a private facility, usually run by the same doctors you'd see on the NHS. It serves your need to be able to buy your way the front of the line, but doesn't let poor people die by depriving them of health care altogether.
 

flopticalcube

macrumors G4
I find it odd that people feel that a transition to some form of nationalization would "let people die". Most developed nations with some form of nationalized health care (that is, everyone else outside the US) have longer life expectancies than Americans.

BTW, wait times vary by province. For example, the majority of hernia patients in Nova Scotia are treated within two or three months.
 

Hmac

macrumors 68020
May 30, 2007
2,128
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Midwest USA
Your assumptions are showing.
My assumptions are based on direct observation over the 25 years that I've been practicing medicine.

Manpower issues are increasingly problematic. We are already seeing wait times increase as medical provider groups lose providers and are unable to recruit replacements. With increasing and more demanding population and incressingly decreasing supply, the end result is pretty obvious, at least to those of here in the trenches providing that care. As opposed to those of you whose expertise comes from reading about it.

Your assumption that a single-payer system would lead to any kind of increased efficiency is pretty funny.
 

mcrain

macrumors 68000
Feb 8, 2002
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All people need be treated. However, if neither the Senate or the House health reform bill address doctor/health care provider shortage solutions perhaps wise men/women in Washington will realize it is time to start over on health care reform rather than introduce laws that makes the problem WORSE!
Ok, let me see if I have this right.

Health care reform would lead to 30 MILLION new paying patients.

There will be a need for new doctors, nurses and health care providers.

The ONLY way to fill this need is for the Health Care Reform Bill to address doctor/health care provider shortage?

Ahhh, the irony.

I thought the free market would fill any gaps. I guess not. Are you really saying we need a bill to encourage people to go out and pick a career in which they are almost guaranteed to get a job?
 

IgnatiusTheKing

macrumors 68040
Original poster
Nov 17, 2007
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das Fort
I thought this was interesting.


What a shockingly low number.

and this


Lots of unhappy doctors out there.
I agree. I don't think many people think that the current system is good, the argument comes in figuring out how to fix it. I, too, was surprised how high the number was for doctors not recommending medicine as a career regardless.
 

R.Perez

macrumors 6502
Feb 16, 2010
386
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Philadelphia, PA
My assumptions are based on direct observation over the 25 years that I've been practicing medicine.


Your assumption that a single-payer system would lead to any kind of increased efficiency is pretty funny.
You are really starting to show your colors.

The top 5 ranked health care systems in the world are single payer or close to it.

France is ranked #1 in health care in the world. I have had the pleasure of experiencing French health care for myself.

I have been to France on numerous occasions visiting family.

In the couple instances where I got sick, a doctor CAME to the house to see me personally. He was there in about an hour and a half, stayed for about 30 minutes and wrote me a prescription right there to take down to the corner pharmacy.

Total cost out of pocket for the doctor visit? $0

Total cost for the prescription? 5 Euro's.
 

leekohler

macrumors G5
Dec 22, 2004
14,162
19
Chicago, Illinois
Those physician extenders aren't going to let people die. At least not intentionally. What a silly question.

Relative to preserving the supply of real doctors, improving physician satisfaction is the place to start. More money, less intrusive regulation, tort reform, less bureaucracy.

What is far more likely to happen is that those medical provider resources that DO exist will have to be utilized increasingly more efficiently. That means rationing of care. It's inevitable. If we're talking about letting people die, it's not going to be letting poor people die, it will probably be that we end up having to let old people die.

That will be part of the eventual evolution. In the short run rationing will take the form of the Canadian health care system. It doesn't matter how much your hernia hurts you, it won't kill you, so your operation will be in two years. Those thirty million people will be covered, but YOU will have to surrender your spot in the health care queu. The line for health care will be a lot longer....it will take you a lot longer to get to the front.
And your evidence for this is? You may want to talk to our Canadian members, too.

No one has yet been able to explain to me why most of the world can make UHC work, but we can't.