A Private Physician's Viewpoint on Health Reform

Preface: Private physicians deliver most health care in the United States. They will be responsible for carrying out the health reform law's mandates. Yet, according to a Physicians Foundation survey of 2400 private physicians, 86% felt politicians ignored them during the process leading up to passage of the Accountable Care Act in March 2010. Here ,in a Healthleadersmedia.com article, Walker Ray, MD, head of the research committee for the Physicians Foundation, gives a private physician's view of the merits and demerits of health reform.

Physicians Harbor Outrage, Survey Shows

Joe Cantlupe, for HealthLeadersmedia.com , December 2, 2010

The nonprofit Physician Foundation bills itself as a "grassroots" organization that examines doctors' attitudes and takes their pulse. "We know pretty much what's going on," says Walker Ray, MD, head of the organization's research committee.

The foundation, a nonprofit grant making organization committed to improving the "medical practice environment" for physicians and patients, released a survey last month that took a look at physicians' opinions about the state of health care. Short version: not good.

The physicians' frustrations with health care reform, and a host of other issues, as Ray puts it, "tort reform not being addressed, the viability of medical practices jeopardized, the time spent with patients jeopardized, the SGR formula issue" are among the concerns addressed in the survey.

There's a "tsunami out there," Ray says. While many physicians want to leave practices, there is a pressing need for primary care, while younger physicians are "wanting a life" and not long hours and seeking to join hospitals. And in the years ahead, there is the looming reality of millions more now uninsured into the system, never mind the crunch of aging baby boomers eventually needing not only medical help but also government assistance.

The Physician Foundation's latest report, Health Reform and the Decline of Physician Private Practice, conducted and compiled by physician recruiters Merritt Hawkins, includes results from a national survey of 2,400 physicians, only 26% of whom said they would continue practicing the way they are in the next one to three years.

Instead, the survey and report predicts that physicians will become employees, part-time workers, and administrators, operate cash-only. The remaining 74% said they would retire, work part-time, close their practices to new patients, become employed and/or seek non-clinical jobs as John Commins reported Nov. 22 in HealthLeaders Media.

The importance of the survey /report was reflected in a simple fact: "We just want to get our viewpoint acrosss," Ray says of physicians.

It hasn't been?

Physicians don't think so, not before and during health care reform debate, at least, Ray says. The Physicians Foundation report noted that in its survey "physicians approached unanimity in believing their viewpoint was not conveyed to policymakers during the preamble to the health reform debate.

Years before Congress was considering health care reform, and he was helping with the report for the Physician Foundation, Ray was seeing the proverbial handwriting on the wall for his own medical career. It gives him a broader understanding of the responses to the Physician Foundation report.

Ray, who is based outside of Atlanta, GA had been in solo pediatric practice for 25 years and 13 years in a group practice prior to that. Three years ago, at age 67, still in good shape, playing tennis several times a week, he maintained that he loved working with patients.

But that year, he decided to retire, walk away what he had been doing for 38 years. "I could have gone on, but it wasn't possible," he says. He was still in good shape, playing tennis, and most importantly loved working with patients.

"The reimbursements were getting to the point that it was untenable" to continue working, Ray says. As he was dealing with personnel issues at the office a top assistant told him, "you are going to be broke in two years."

That didn't happen, but the fiscal climate prompted his retirement, or he might have considered concierge medicine. "I'm angry that I was forced to stop working," he says. "So many physicians don't want to work, and I was going 'til I almost fell over. I would have gone on several more years. Now I don't miss the hassle, but I miss the patient care."

But Ray keeps working for the Physician Foundation to keep getting the issues out front, that "viewpoint across," he says.

Of the many issues upsetting physicians, one of the most nagging is the SGR formula debacle in Congress. Congress has repeatedly put off proposed cuts, the latest reprieve for a scheduled 23% Medicare cut is now slated to begin January 1.

"It's been a broken promise from the government difficult feelings and mistrust, both parties have never stepped to the plate. Physicians cannot absorb the Medicare cuts. There needs to be a political will."

The largest group in organized medicine, the American Medical Association, has routinely criticized the SGR formula. Recently, the AMA asked Congress to stop the cut for a year. The AMA favors a repeal of the SGR to be replaced by a system that more closely tracks the Medicare economic index.

But the Physician Foundation's report notes that the AMA endorsed healthcare reform "though many physicians at the grassroots level were not in favor of the law." As a result, the report stated, there has been a "disconnect" between those physicians and the AMA, which has been essentially a disappointment in engaging physicians in the wake of healthcare reform, in Ray's view.

"It's so sad the AMA sold us out and how this legislation was rammed down our throats against the will of the majority," says one of the 1,200 physician comments submitted to the Physician Foundation for its report.

Others also criticized the AMA, but the organization was not the only target. "The state of medicine is in need of significant improvements but a rushed, sloppy policy that does not include the input of physicians is akin to malpractice," says another.

"No one," says yet another, "in the policy making world understands the problems physicians face. I wish they could follow me through my practice for one full week."

Physicians need to be heard, Ray says, not only to discuss the issues but also to influence others to be doctors, and physicians to stay on in their profession.

"By golly, I want people to be motivated to go into the medical profession," Ray says. "I'm 70 years old and I'll be needing a doctor myself."
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Joe Cantlupe is a senior editor with HealthLeaders Media Online. He can be reached at jcantlupe@healthleadersmedia.com.