With the Affordable Care Act(ACA) you would think that physicians would be ecstatic. They will have more covered patients; that is less, patients without insurance coverage. So, why are they “miserable”?
Daniela Drake in her article in The Week magazine stated that “Being a doctor has become a miserable and humiliating undertaking.” Caring for the sick used to be prestigious and everyone admired the profession. That is except for the doctors themselves, who started seeing the changes. Today the physicians, and especially the primary care doctors, have more work to do then ever before. They work extra hours in a hectic, thankless, unsatisfying profession, which is now dominated by insurers and with the ACA, more government control, government bureaucrats, and as usual the malpractice lawyers. She further states that “many doctors feel that America has declared war on physicians,” and her research shows that nine out of ten doctors say that they would discourage others from entering their profession. In fact of my five children and their friends, I have discouraged then from considering the practice of medicine.
I know that many people have very little empathy for the doctors, since most of the non-physicians believe that all physicians enjoy the sky-high incomes of the Hollywood plastic surgeons and Medicare-mill ophthalmologists. But research shows that the life of the primary-care physician is neither “privileged” nor especially lucrative. In fact, it is not only the primary-care physicians who are “suffering” from the discounted pay scale and denial of payment, with an increase in their workload. We see the general surgeons, cardiologists, ENT, pediatricians, etc. all suffering in the new health care model.
Physicians must now cram in 24-30 or more patients a day to pay the overhead due to regulated fees and cost of filling out insurance forms, which averages $58 per patient. The addition of the Electronic Medical Record software and hardware adds, on average, $30,000 per practitioner per practice. Also, don’t forget the high malpractice premiums that physicians must pay out just to see even one patient.
If you look at the average primary care physician patient visit, the visit lasts about 11-12 minutes per patient. The ACA is now adding even more bureaucracy and pressure to cut costs. With the new pay for performance, physicians will be penalized if they don’t improve the health of their patients or see their patients more than the allotted visits without showing improvement in the care of the patient.
How then do we attract the best minds to choose medicine as a profession and to convince the good physicians to stay in practice? As Ms. Drake summarizes, “the well-being of America’s caretakers is going to have to start mattering to someone.”
We will continue this discussion as we look at both sides of the picture-the perspective of the physician as well as the patient. The shorter visits create a toll on the doctor-patient relationship, which is considered a key ingredient of good care and may actually represent a missed opportunity for getting patients more actively involved in the own health, including preventative care. This goes back to our discussion regarding changing patient as well as doctor behavior.
The question is America, are you starting to see how complex the problem is and that with poor planning the system is already broken. We must all consider the future options and how we will all force our politicians to modify the health care system to benefit all.