Friday, March 26, 2010

How Doctors Feel About and Will React to Health Reform

It is difficult to get a fix, and perhaps too early, about how doctors feel about comprehensive health reform , as embodied in the just passed health reform bill.

It is even more difficult to ascertain how doctors will react – how many will gear up to take in the 32 million more insured patients, how many will become employed, and how many will quit or choose other careers.

What we do know, as indicated in a 2009 Physician Foundation survey of 300,000 doctors, and a just released survey of 1000 doctors by Athenahealth and, is that doctors are deeply unhappy about the present system and profoundly skeptical about the future, including more government involvement.

We know, from the four year old Massachusetts universal care experiment, which Obamacare is said to emulate, that higher taxes, higher premiums, longer waiting lines, increased ER traffic, decreased access to doctors, and resistance to national health reform, as exemplified in the Scott Brown election, lies ahead.

We know, as documented in today’s (March 26) NYT (“More Doctors Giving Up Private Practice’) that the health care landscape is already trending towards more care delivered within hospitals and large health care organizations rather than private physicians.

This trend, driven by young doctors seeking the security, tranquility, and benefits of salaried employment, and by older doctors escaping from the insecurity, turbulence, and economic insecurities of private practice, and the associated loss of morale, is accelerating.

We know demands for installing expensive, often money-losing EHR systems in private doctors’ offices, propelled by $20 billion in federal dollars, are a concern among private physicians . EHR systems are expensive, time-consuming, and disruptive, and their benefits accrue almost exclusively to large organizations.

We know costs are higher in large health organizations and hospitals, where a costly infrastructure is required to assure authorities of quality, safety, and system efficiency.

What we do not know at this point is the unknowable -how the public and voters will react to changes legislated from above.

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