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Is Your Doctor Getting Ready to Quit?

A new poll shows that 45 percent of doctors would consider leaving their profession if ObamaCare legislation passes.

by
Paul Hsieh

Bio

September 18, 2009 - 12:00 am

In a recent editorial published by Investor’s Business Daily, associate editor (and PJTV.com regular) Terry Jones revealed stunning poll data showing that 45 percent of American physicians “would consider leaving their practice or taking an early retirement” if Congress passed the proposed ObamaCare health legislation.

As a practicing physician, I’m not surprised. These numbers mirror the sentiments I’ve heard expressed by my professional colleagues. I’ve been in practice for over 15 years and I’ve never seen physician morale as low as it is today.

Older physicians have told me that they’re glad to be “getting out” and retiring soon. Medical students have asked me whether they should switch to engineering or pharmacology before it’s too late. Physicians in the middle of their careers are just hoping to survive any “reform.”

The same IBD poll also showed that an overwhelming majority (65 percent) of physicians were opposed to the proposed expansion of government in medicine. And they have every reason to be concerned, based on past experience.

One reason that many physicians are skeptical of the proposed “reform” is because they already know what government-run health care is like, in the form of Medicare. Medicare is “single-payer health care” for the elderly. Many proponents of universal health care want to create “Medicare for all,” claiming that it’s a model of efficient, compassionate care. But as the New York Times recently reported, more doctors are opting out of Medicare (or limiting the number of Medicare patients they are willing to accept) for two simple reasons: “reimbursement rates are too low and paperwork too much of a hassle.”

Medicare reimbursements are so low that many physicians could not survive if they relied solely on Medicare patients. Their patients with private insurance essentially subsidize their Medicare patients. Every time Congress passes another round of Medicare cuts, it merely worsens the problem as more doctors stop accepting new Medicare patients.

Physicians have also seen the problems in states such as Massachusetts that have attempted to implement universal health care, and the implications for the rest of the country.

The just-announced Baucus plan is based closely on the Massachusetts plan, including mandatory insurance, subsidies for low-income residents, and strict new regulations on insurance companies specifying who they must cover, what benefits they must provide, and what prices they can charge. As a result, insurance costs have skyrocketed, raising the costs of the state subsidies. In response, the state government has cut back on its payments to physicians and hospitals.

Dr. Katherine Atkinson, a primary care physician practicing in Amherst, MA, told the New York Times:

Every time I have a Medicaid patient, it’s like handing them a $20 bill when they leave. I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?

Because of perverse government incentives punishing physicians for taking patients covered by the state’s “public plan,” many patients face long waits for care — as much as a year for a routine physical exam in parts of Western Massachusetts. And this is despite the fact that Massachusetts “has the highest physician-to-population ratio of any state, in primary care as well as overall,” according to the New England Journal of Medicine. Expanding the Massachusetts plan to the national level would merely multiply this problem by fifty.

Finally, physicians are concerned that universal health care will compromise their ability to practice according to their own best judgment and conscience.

President Obama’s “stimulus package” included $1 billion for “comparative effectiveness research” in health care. Writing in the Wall Street Journal, Harvard professor Martin Feldstein noted that the government’s eventual goal is to use this research to cut costs and ration medical care by “implementing a set of performance measures that all providers would adopt” and by “directly targeting individual providers … (and other) high-end outliers.”

In other words, your doctor would be rewarded if he practiced according to federal guidelines and punished if he strayed too far from them. Such guidelines must necessarily be based on statistical averages that cannot take into account specific facts of individual patients. But good physicians must consider precisely these specifics when treating their patients.

If you have abdominal pain due to gallstones, who should decide whether medication or surgery would be “most effective” for you? The doctor who felt your abdomen, heard your heart murmur, saw your ultrasound, and knows your drug allergies? Or the bureaucrat who got his job by telling the right joke to the right person at the right Washington cocktail party?

Most physicians I know aren’t in the field primarily for the money, although they do expect to be fairly compensated for a job that requires four years of college, four years of medical school, three to seven years of internship and residency, and often one (or more) years of additional specialty fellowship training.

They do it because they love their work, including the ability to apply those years of training to benefit their patients. They passionately want to use their skills according to their best medical conscience. To practice good medicine, a doctor must therefore be left free to use his reason, his experience, and his judgment — i.e., his mind. ObamaCare would destroy your physician’s willingness and ability to use his mind for your benefit.

If ObamaCare passes, some doctors will grit their teeth and still try to do their best for their patients. But they will have to waste hours arguing with bureaucrats, while their less conscientious colleagues can just punch a clock and go home. How long will the better doctors continue working under a system that constantly punishes them for their virtues? And when the good doctors finally retire or quit in frustration, what kind of doctors will remain?

In Ayn Rand’s classic novel Atlas Shrugged, one of the minor characters was surgeon Dr. Thomas Hendricks, who explained his reasons for “shrugging” and quitting medicine as follows:

I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands? … Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe, if he is the sort who doesn’t.

The policies of our current president and Congress have turned too much of Atlas Shrugged from fiction into fact. The government has already assumed unprecedented control over the banking and automotive sectors of our economy. Health care is next in its sights.

If ObamaCare passes, thousands of doctors will follow the fictional Dr. Hendricks and shrug.

Will your doctor be one of them?

Paul Hsieh, MD, is a member of the Colorado chapter of Docs4PatientCare (www.Docs4PatientCare.org) and co-founder of Freedom and Individual Rights in Medicine (www.WeStandFIRM.org).
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