Health Reform: Private Practice Endangered

Preface: The following report, dated November 18, 2010, appears at the Physicians Foundation website (physiciansdation.org). The report concludes doctors are unhappy with the reform law and may abandon private practice and decline to see new Medicare and Medicaid patients.

Nation's Frontline Physicians Unhappy With Health Care Reform Measures

The Physicians Foundation today released the results of a national survey of physicians that finds strong negative feelings towards the new health care reform law and fear that patient care will suffer in the months and years ahead. The survey was intended to gauge physicians’ initial reaction to the passage of health reform and to learn the ways in which they plan to respond to it.

The research, conducted by Merritt Hawkins, a national physician search and consulting firm, on behalf of the Foundation, comes on the two-year anniversary of the Foundation’s first national physician survey that found growing dissatisfaction among doctors as they struggle with less time for patient care and increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations. The new research reinforces those findings and shows that the new health care reform could intensify existing problems for doctors and worsen the shortage of primary care doctors, making it more difficult for patients to access quality care.

“Physicians support reform; in fact, we were the ones leading the fight against the status quo. But this new research shows that doctors strongly believe the law is not working like it needs to – for them, or for their patients,” said Lou Goodman, PhD, President. “For any health care reform effort to be successful, it must include the viewpoint of our nation’s doctors. Their perspective from the front-lines of patient care is critical in determining what’s broken in our system and how we can fix it.”

Notably, physicians also felt that Medicare’s Sustainable Growth Rate formula (SGR) had an equally large impact on their practices as health care reform. Proposed cuts have been repeatedly put off by Congress and in January will reach approximately 30% if not addressed. “Despite the high profile nature of the health reform discussion, physicians are equally concerned over the impact of SGR on their practices,” said Walker Ray, MD, Research Committee Chair. “The fact that SGR was not addressed as part of this year’s reform effort shows that we don’t have a comprehensive solution yet, and also that doctors simply didn’t have a voice at the table during the reform debate. That needs to change.”

Key research findings include:

• The majority of physicians (60%) said health reform will compel them to close or significantly restrict their practices to certain categories of patients. Of these, 93% said they will be forced to close or significantly restrict their practices to Medicaid patients, while 87% said they would be forced to close or significantly restrict their practices to Medicare patients.

• 40% of physicians said they would drop out of patient care in the next one to three years, either by retiring, seeking a non-clinical job within healthcare, or by seeking a non-health care related job.

• The majority of physicians (59%) said health reform will cause them to spend less time with patients.

• While over half of physicians said health reform will cause patient volumes in their practices to increase, 69% said they no longer have the time or resources to see additional patients in their practices while still maintaining quality of care.

• 67% of physicians said their initial reaction to passage of the 2010 Patient Protection and Affordable Care Act was either “somewhat negative” or “very negative” and a great majority (86%) believes the viewpoint of physicians was not adequately represented to policy makers during the run-up to passage of the law.

• Physicians are almost evenly divided over the relative importance of SGR (36%) and health reform (34%) to their practices, while 30% are unsure which will have the greatest impact.

The full research report is available as part of “Health Reform and the Decline of Physician Private Practice,” an expert analysis of the potential effects of reform on physician practices. The report is available at www.physiciansfoundation.org.

Richard L. Reece, MD, blogs a Medinnovation and has a website under constuction. www.doctorreece.com. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with but does not speak for The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at rreece1500@aol.com