With every projection predicting a physician shortage, there may not be much of an upside to the impact of the Affordable Care Act for patients.
Results published from two recent surveys of physicians, conducted by two separate entities, produced equally unnerving findings.
The most recent study was conducted by the Doctor and Patient Medical Association (DPMA), a relatively new non-profit advocacy group founded by Kathryn A. Serkes and Mark Schiller, MD. They published survey results indicating physicians have deep concerns about their ability to stay in private practice.
In full disclosure, the DPMA is dedicated to repealing the Affordable Care Act (ACA). “What's especially important to point out,” said Kelly Benedetti, DMPA’s executive director, “is that this was NOT a self-selected survey, as many in the physician-world are…the vast majority of these respondents had no communication or awareness of DPMA prior to this survey.”
The results were collected using a nationwide faxed survey to over 16,000 random physicians, which resulted in 699 physician responses made up of 23 percent primary-care providers (Internal Medicine and Family Practice), 10 percent general surgery, 11 percent hospital-based specialists, and 56 percent office-based specialists in active practice across 45 states.
DPMA reported that two thirds of respondents said that they are “just squeaking by or (are) in the red financially.”
Among other findings, in their words:
• 90 percent say the medical system is on the wrong track
• 83 percent say they are thinking about quitting
• 61 percent say the system challenges their ethics
• 72 percent say individual insurance mandate will not result in improved access care
• 49 percent say they will stop accepting Medicaid patients
• 74 percent say they will stop accepting Medicare patients, or leave Medicare completely (a review of the results indicated 42 percent)
To be sure, any organization that is openly liberal or conservative, particularly one with a stated purpose to repeal or preserve legislation conducting a survey, has the perception of potentially tainted results. What has my attention is that the second broad physician survey with similar results was conducted by MDLinx, a division of a global research company.
MDLinx had its own foreboding revelation: “Of U.S. physicians with ownership of practices of 10 physicians or less, 26.4 percent reported that given the financial environment, they could foresee closing their practices within the next year.” They also reported over 75 percent of respondents are in financial difficulty having instituted austerity programs, including cutting back personnel and services (49.1 percent), tapping personal savings to cover operating expenses (22.8 percent) and/or borrowing to cover operating expenses (20.1 percent).
In the MDLinx survey, 32 percent of the larger practice and hospital-based physicians reported suffering a cut in their personal pay while 53.1 percent of the smaller practice doctors have seen their incomes drop. One-third said they expect the trend to continue.
Survey responses indicate that, while the Supreme Court decision brought a measure of certainty (until the election), the certainty it seems to have delivered is today's difficult times for physicians look like hard times ahead.
Considering that the entire healthcare delivery system is centered on physicians, and every projection foresees a shortage in the near and mid-term before these survey results, there is a crisis bubbling near the surface and the people most critical to making the system work appear to believe that the system is not working for them.
If the surveys are representative of the general specialist population, it is time for Congress and the president to stop building legacies and address this problem, because the foundation their legacies are being built upon is appears to be crumbling beneath their feet.
CLARIFICATION: On July 8, I posted an article entitled "If ACA Survives, Many Small Medical Practices Will Fail" that may have been unclear. Medicaid reimbursement will increase to Medicare rates, but only for primary-care physicians, and only for 2013 and 2014.
Specialists are excluded and are facing reimbursement reductions. Secondly, a growing number of states have said that they are considering opting out, or will opt out, of the program, an option provided under the Supreme Court ruling.
The concern is that, while primary-care doctors will be paid Medicare rates for millions of new Medicaid patients, specialists needed for advanced care will not, forcing many to not participate in order to survive in practice.
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