Most Pressing Issues Facing U.S. Physicians – The Hows and the Whethers

On its website, Physiciansfoundation.org, the Physicians Foundation has asked physicians to share their thoughts about the future. Here are my thoughts.


• How to care for the 8 million consumers who have signed up for healthcare.gov health exchanges, 5 million for mostly subsidized coverage and 3 million for Medicaid, given physician shortages and overworked primary care physicians.

• Whether to sign up for healthcare.gov exchanges with their lower reimbursements and with the knowledge that healthcare.gov may not include them as providers to be paid., given the glitches and misinformation of the back end of healthcare.gov.

• How to prepare for the future if the Sustainable Growth Rate (SGR) formula is followed and 25% cuts in Medicare fees occur.

• How to become more efficient and productive in wake of more ObamaCare regulations and demands for more electronic health record data, both of which steal time from taking care of patients.

• Whether to become hospital employees even though hospital owned-practice decrease autonomy and raise costs of physician care by charging more for hospital-owned facility fees.

• How to deploy the social media, Facebook, Twitter, other online sites, to market one’s practice and to compete with consumer-oriented sites and retail clinics, without compromising professional ethics.

• Whether to switch to direct pay/concierge practices to maintain incomes, take the risks entailed, abandon significant numbers of patients, in order to spend more time with patients and to practice in the fashion that one was trained.

• Whether to follow the dictates and provisions of the health law, which involve joining accountable care organizations, bundling services with hospitals and physicians, and “saving ” money for Medicare and ObamaCare.

• Whether to continue to accept Medicare and Medicaid patients even though reimbursements for those programs may not meet the costs of running a practice.

In the words of Lewis Carroll, author of Alice in Wonderland’ Through the Looking Glass, “the time has come to talk of many things: of shoes – and ships – and sealing wax- of cabbages and kings – and why the sea is boiling hot – and whether pigs have wings.”
In this case, the time has come for physicians to decide whether ObamaCare has wings, whether it can fly on one wing in our three pronged legislative system – executive, congressional, and judicial system – of checks and balances, and how to survive in a boiling political sea in which physician practices are potentially being cooked.