Voting Obamacare: Health Care Law to Drive Doctors to Retirement
If President Barack Obama is reelected, it seems certain “Obamacare” will be fully implemented. Dr. Rick D. Schoeling, a primary care physician in Pittsburg, Kansas, tells PJM that if he were in the position of considering medical school today, he would choose to avoid medicine entirely:
Oh no, no way. Nine out of 10 physicians right now recommended that their family not become physicians. It used to be families would all be in medicine; not anymore.
Schoeling, who graduated in 1986 from the well-regarded University of Kansas School of Medicine, said the effects of Obamacare, if it were to be fully implemented, would be far-reaching and detrimental:
We will lose a lot of the patient/physician relationship, in that instead of me recommending to the patient what kind of screening test or things like that, it’ll be much more of a cookbook kind of thing.
That fundamentally isn’t the expensive thing, but that’s been the thing that most physicians treasure, most patients treasure — that ability to have that open communication and that control over your patients’ health care.
Many critics of the legislation say millions of people will move from private insurance — already expensive for doctors to manage — into the Medicare and Medicaid systems. It’s a move which will put a strain on doctors, who already struggle to break even on the Medicare and Medicaid patients they have.
Schoeling said he expects a rise in Medicare and Medicaid patients if Obamacare is fully implemented, and while he currently continues to see the Medicare and Medicaid patients he has, he’s not accepting new ones:
If we’re (lucky Medicaid is) 20 to 30 cents on the dollar from what we get from insurance rates. Obamacare cuts $716 billion from Medicare. The way that’s implemented is it will be a 27.1 percent cut in reimbursement in Medicare and Medicaid patients to private physicians and hospitals. Medicare is about 35 percent of my total practice and it affects internists even more because it’s almost 70 percent of their total practice.
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My doctor warned me several years ago that this would happen. He has since retired.
I have retired as well, and my spouse will as soon as the youngest is out of high school. And we’ve told my college-age daughter to forget about medical school.
On my website we have been warning about the doctor shortage and worse ever since Obamacare was debated and then furtively passed. See http://clarespark.com/2012/10/10/obamacare-one-last-time-james-pagano-md/.
I work in Overland Park, KS. My long-time doctor here is already planning to retire should Obamacare be implemented. He says there is no way he can continue to give quality care under the Obama dictatorship’s mandates.
These scare tactics are crap. How about some facts to back up your assertions. Would you rather have your treatment controlled by a company whose only goal is to make a profit. Ask the over 200,000 people who were denied care because of ‘pre-existing conditions’ to say nothing of the doctors who prescribed treatment which insurers denied.
Four years ago, my liberal doctor couldn’t understand why I didn’t like Obama. Now he is despondent. *sigh*
I have lost two doctors since the bill was enacted. This is bad because we are 70 and have to go on Medicare. They will be hard to replace.
Large organizations are easier for the government to control than small business. In fact, increasing regulation and reporting requirements are a big competitive advantage for established firms over upstarts. So it is no accident that health care providers are being forced into big groups and the solo or small group practice is practically dead. My spouse, an M.D., made the jump three years ago.
Concierge medicine will bail out the lucky few for a while. But I am already seeing rumblings in the press about the government needing control over all providers to “bend the cost curve”. There will be a move to abolish private pay altogether for a truly “egalitarian” system, as they had in Britain until public outrage forced a retrenchment. That will be the next battle.
Once the government controls all of health care, heaven help us. There seems to be an obsession to control costs, as if the government or anybody else knows what level of medical expenditure is optimal.
Exactly, and there is precedent. Chiropractors already MUST accept Medicare if they perform a Medicare covered service on a Medicare ELIGIBLE patient. No opting out. As you say, it will all be in the name of fairness.
Do you think it might be because physicians in private practice have, for a heavily educated population, tended to be more conservative? So really this is the elimination of a group of class traitors.
People get government they deserve. Today we can reverse course.
Well, fewer doctors is a feature, not a bug, under Obamacare. The legislation essentially promotes nurses and physicians to medical doctor, on the laughable assumption that a couple of years of training is equivalent to several years of physician education. They don’t know what they don’t know.
In addition, Obamacare relies on a mandatory Electronic Medical Record (EMR) system, which will ultimately provide care by protocol…great if your disease has read the book, not so great if it hasn’t.
Under protocol medicine, certain medications, tests, etc. will be forbidden by the EMR based upon your age, sex, etc. Lesser trained individuals will follow protocol medicine right into the ditch.
The fewer doctors will be employed by the ACO…and will be discouraged from practicing in a patient’s best interest or costing too much money.
Obamacare must be repealed.
“Obamacare must be repealed.”
Yes.
But first – Obama.
If you compare the incomes of doctors elsewhere in the developed world to those here in the USA, you’ll see that US doctors earn far more than do their counterparts in the rest of the developed world. However, there are two major differences that should be considered: Malpractice insurance is a tiny fraction of what it costs here in the USA, and a doctor’s education in much of the rest of the developed world is often almost completed “covered” by the national government. So there are no massive student loans to pay off, malpractice is hardly a consideration, which means doctors are willing to practice medicine for much less money. We could do the same so far as education is concerned, although controlling the legal profession (which the rest of the developed world does) isn’t done here and would arouse a great deal of opposition as lawyers here in the US feel that they “rule” and can do almost anything they want and make the rest of us put up with it. A Constitutional Amendment that would prohibit anyone in the legal profession from holding “any” elective public office would go a long ways in solving this problem. The justification for such a Constitutional Amendment could be based upon “conflict of interest” since lawyers deal with the laws passed by Congress and allowing lawyers to hold public elective office and make laws that other lawyers profit from is certainly without doubt a prime example of “conflict of interest” here.
The government has NO right to tell me nor anyone else how much income we are allowed to make. That is the first flaw in your premise. Health care costs are out of control in this country because of this idiotic idea that health care is a RIGHT, as if medical resources are magically produced from leprechuans and unicorns dancing in circles over a rainbow bridge. Other countries have medical delivery systems that are inferior to ours. Why should we settle for lower quality medical care simply because other countries do? People come to the US from all over the world to get care they cannot get at home.
Putting government price controls on physicians will get the same result it gets any other time government tries to control prices…you will have much less access and much lower quality. Get the government out of health care, other than the licensing process for physicians and the FDA to work on quality control of meds, and let energetic, hard working and motivated physicians figure out how to improve efficiency and lower costs.
I have long argued that all physicians should refuse to provide medical care to any politician and their family members who A) Voted for Obamacare and B) Are malpractice attorneys.
And for those of you who want to hurl invective and bile at me, calling me a whiner and greedy and all the rest of the garbage the leftists typically hurl at me for speaking my opinion as a physician, I encourage you to get your college degree, then apply to medical school, get through medical school, do your residency and subspecialty training in the field of your choice, and hang up your shingle to practice medicine under the auspices of socialist dictatorship. Oh…and miss 60-70% of your kids’ school functions, sports games, and at least that much family time getting called back into the hospital to take care of other people’s family members. All while having jackasses tell you how greedy and selfish you are for expecting to earn a fair amount of compensation to make up for all your hard work, while paying outrageous malpractice insurance rates even though you’ve never been sued, and being told by government bureaucrats with absolutely NO medical training what meds you can use for your patients, what treatments you can offer them, and being forced to accept literally PENNIES on the dollar of what it actually costs you to care for a patient.
And people seem surprised that doctors warn of retiring from medicine in droves if Obamacare isn’t repealed? Really? How would you like being a slave to an ungrateful master who attacks you at every turn and rewards you with crumbs from his plate? because that is EXACTLY what the general public will be doing to doctors if Obamacare is not completely and utterly repealed. The Democrats are revealing themselves to be the same Orwellian pigs at the end of 1984…please get that and stop voting for them. Democrats are NOT interested in helping you with anything other than the proper wear of slave chains and shackles.
To all doctors, for years you benefited from handsome private insurance reimbursements. You loved it because you did not need to deal with the unpleasantness of the market. You know things like competition on price and service. You didn’t go to medical school and suffer through residency only to have to get out and struggle because the guy down the block is advertising a procedure you do for 50% less then you. You chose to play it safe and collect the 3rd party payments instead of hanging a menu board of procedures and service that would allow patients to pay in cash or credit. It worked out great as services and procedures skyrocketed and nobody noticed because insurance companies could spread out the costs. But now with private insurance at $12,000 dollars a year for a family the game is over. The government is stepping in to limit your income because the average person cannot afford it even with insurance.
If you would have accepted the market initially you would of discovered the value of your service very quickly and either competed harder for higher profits or accepted the level that the market provided. Please chose the market and fight like all other business professionals do on a daily basis for profits. Only then will you understand what your skills are worth financially.
Jason, I take it from your comment, that you don’t work in the medical field and are not very familiar with how things work within it. You act like all this is the doctor’s fault, and that doctors are the reason medical care costs have increased, which is NOT true. Costs have increased because of paying for the technology (medical devices, etc) and the pharmaceuticals. Do you even know how many THOUSANDS of dollars it costs to implement an electronic medical record system? Or how about the hundreds of thousands of dollars to research and test a new device that can be used (that can save lives)? When that device gets made, do you know not only does the device itself cost a lot, but then the person who teaches the surgeon to insert the device makes tons of money. Not to mention the rest of the overhead that offices/hospitals have (supplies, cleaning, etc). I just wish it was as simple as the doctors, but it isn’t. Couple this with the fact that doctor’s have to order certain tests to cover their tails from getting sued. It’s all of these reasons and more that costs have increased.
I would say you are correct, with caveats. When I finished my training in 1999, I had about 80 grand in school loans which I have since paid off. All I wanted was a stable job. I got a great offer for 125 k per year. As I got on my feet, I thought about going on my own. The problem is dealing with insurance. If I could only deal with cash paying patients, that would be great. It is not possible to do so. The difference in medicine, from saying opening a grocery store, is that almost everybody has some type of insurance. Who would pay me $40, when they have insurance that only charges $10 for a copay? It would be like opening a grocery store, and everybody is on food stamps. I did not create the dynamics that led to our current system of Medicare, Medicaid, and health insurance paying for everything in healthcare. I agree, if never had these programs, most of healthcare would be affordable for most people. In fact, that is the way it was back in the 50′s. Doctors would still make an above average living, and they would be happier. The patients would not need insurance for regular visits either. I remember asking an old doctor how much he made in the 50′S and he told me it was about 50 k yearly. A lot of money back then. It was all paid in cash. Trying to convince people to give up employer based or government based insurance would be impossible. Therefore, doctors and hospitals try to carve out an ever shrinking pie for themselves. These dynamics were created by a juxtaposition of the government and insurance paying doctors and hospitals whatever they charged back in the day with patients paying nothing for it. Now, no one understands how we got here, nor does anyone understands how to get out. Yet, it will only become more expensive and no one will be happy. If you want to blame doctors, you need to go back to the 60′ s . My generation did not allow this to happen. But what would you have done back then if someone paid you for whatever you charged?
So, Romney, who implemented Romney care, is going to repeal Obamacare? Are you people serious? That’s funny! I’m hoping that Willard wins and his party runs the table. Watching the “conservatives” screw over their supporters at every opportunity during next four years are going to be hilarious.
ERIC: it’s called FEDERALISM.
What may be good for Massachusetts is not necessarily good for Idaho or Florida or Texas (where we have excellent torte reform, which caps punitive damages at $300K, and which allowed ObGyns to move back into the Rio Grande Valley; for a while, there were NONE in the valley, thanks to all the frivolous lawsuits by the local Abogados).
Justice Brandeis (he’s from your tribe, surely you’ve read his opinions?) praised federalism as a laboratory of democracy in New State Ice Co. v. Liebmann, 285 U.S. 262, 52 S.Ct. 371, 76 L.Ed. 747 (1932):
“To stay experimentation in things social and economic is a grave responsibility. Denial of the right to experiment may be fraught with serious consequences to the Nation.
It is one of the happy incidents of the federal system that a single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.”
WHOA. Sounds like RomneyCare, don’t it ERIC? Unlike the SOVIET SYSTEM, under which everybody was nominally exactly the SAME, and folks said “We pretend to work, and they pretend to pay us”, the US Federal System doesn’t subject everybody at once to what may be a miserable idea.
Did we learn something here today, children? OK, now get yer fat asses outside and vote. For Federalism.
My wife is a physician and has already moved to work only part-time on a fill in basis, in part because of the hassles coming with Obamacare. It’s a shame because she’s a graduate of a top-10 medical school and did her residency at one of the top 2-3 in the world in her speciality – her department chair at the time wrote most of the major text in her field. She’s working on a per diem basis and leaving the billing and compliance hassles to others.
If you look at what the law madates, it spells the end of private solo practice. My guess is that you will need to be in groups of 20+ physicians to spread the regulatory costs over a larger group. And expect major problems with the electronic medical records systems. Data loss, interchange incompatibility, etc. are just the tip of the iceberg.
It’s pretty clear that the end result will be a handful of large group practices in each urban area working under a single pay system where your gatekeeper will be a nurse, not an MD/DO. And this is what they have planned all along.
One question, why in hell is this article being published now? When it is probably too late to change anybody’s mind about Obama. I agree with almost all of these comments, but I get outraged when those who could make a difference suddenly come out when its too late.
Because it took me until Friday of last week to find a doctor who wasn’t too afraid of the potential consequences to go on the record.
I’ve been a physician for 39 years (am age 64). No longer in family practice, which I did for 20 years, but my overhead used to be about 70% for office rent, staff salaries, liability insurance, equipment, supplies, etc. Hence, my “profit” was 30% before taxes. If Medicare drops reimbursement 20%, my overhead doesn’t change, but my income drops by two-thirds (i.e.–30% “profit” to 10% “profit”, as rent, staff salaries, etc. remain the same–the paperwork will actually increase). So only if I’d be willing to see three times the number of Medicare patients, with three times the work, would my income not drop. Not gonna happen. Most docs with any savings will just quit.
I’m an academic physician (age 57) and used to run a medicine subspecialty fellowship program. The issue cited, finding enough physicians to cover for all the ones who threaten to retire early (assuming they do) is a real issue.
Our country graduates about 16,000 MDs/DOs a year. We have about 23,000 medical residency positions for these doctors to pursue their advanced training. That leaves a gap of 7000 positions, filled with international medical graduates (IMGs, previously foreign medical grads or FMGs). We currently have ~800,000 docs in the country; training about 23,000 new docs a year keeps us in steady state (~260 docs per 100,000 population) for our population and expected retirements. If some appreciable proportion of them retire on top of the usual replacement rate, we will not be able to train enough new docs quickly enough to keep the pipeline filled.
Why? Two reasons — first, it takes time to train new docs. It’s four years of med school plus at least three years of residency training (for FPs), and up to 8 years of training for specialty surgeons. That means 7 to 12 years to train additional cadres of doctors once you make the decision and have all the pieces in place to do so (extra residency positions take time to create).
Second, the expense. Training doctors is expensive; the federal government defrays much (not all) of that, and as we all know, the federal government is broke. States will not do this, and local/university hospitals can’t afford to expand their residency programs without subsidy. Medical schools are in a similar situation. Further, to expand training you need training sites, and most of the good hospitals around medical schools are already affiliated. To expand you either get them to create more positions (not easy since they have limits as to the numbers of patients they have) or go to other, perhaps less-good, hospital programs.
So the time lag, expense, and resource limitations hamper us from expanding residency programs and medical schools. It’s why we already import 7,000 IMGs a year to our country (a new form of cultural imperialism; we in the west steal the best and brightest from third world countries). Expanding further could be done but it will take a fair bit of political will and capital to make happen. I don’t see that.
This is what you call a bubble. Doctors are saying we are going to lose money so we are going to quit working. The med schools cannot continue to charge huge tuitions because the investment won’t pay off in the future plus the government won’t subsidize the cost of tuition so the entire medical complex shrinks. Sounds like a familiar pattern.
So, what to do??? Well, allow medicine to participate in the market. For the first time in several decades the doctors will not have a guarantee of large sums of money. Therefore, med schools can’t charge huge sums for tuition and the whole system adjusts to the harsh realities of the market.
Like all market based professions the doctors will be rewarded not by completing med school but by competing in the market.
Don’t worry, if I am re-elected I will hand out free ObamaMD licenses to all those who got Obamaphones. What doctor shortage?
As miserable as the hand is that is being dealt all the doctors, I’ll have to say that they so richly deserve it.
They have conspired for so many years by means of AMAs, hiding their pricing, being inaccessible, not answering their phones, failing to advertise cash discounts and relying on insurance and gummint Medicare and Medicaid. They will deserve every bit of the misery that befalls them.
I am a non-believer in insurance of any kind and I am familiar with CPT-codes and ICD-9s and all the other private monopoly information that docs don’t share with their patients. Being fluent in Spanish, German and Portuguese, and having homes overseas, I will feel so privileged to be able to seek medical care outside the USSA. May the Amerikan docs suffer so much that they throw in the towel! Then maybe we can someday create from the ashes some decent, decently priced medical care like the Chinese tools we buy from Harbor Freight and the cars we get from Korea.
I have to say I agree with you. Despite the fact that most physicians say that they are not AMA members, they are, nonetheless, members of their locals county or state medical societies, which are spokes emanating from the AMA hub. I am one of these by dint of the fact that I am required to be a state medical association member in an indirect way because the hospital I work at makes being a member of the county medical society a prerequisite for attaining privileges therein. We all indirectly support the AMA whether we consciously desire to or not, most of us simply do not pay formal dues directly to it. That said, you are quite correct in you observation that the medical profession is screwing America over and deserves every bit of backlash it receives when the revolution comes. And come it will.
Jimbino, most docs do not have membership in the AMA, try to work hard and do right by their patients. Many have tried to be accessible, but can’t even talk on the phone except to say “Go to the ER” for just about anything, as they can be sued for advice given over the phone. Most docs don’t know that the CPT codes are owned by the AMA, don’t really understand how the government took over health care, just try to get by the best they can.
Yes, some docs are guilty as you write, but the majority? No clue. So, fault ‘em for ignorance, perhaps, but it’s not out of a willful desire to hurt anyone or game the “market” or even out of greed. This bullshit of blaming all the doctors for all the problems of the medical care system is just…bullshit. It’s wrong and asinine. Blame the government, blame the lawyers, blame the patients with unreal expectations, blame the libs who gave us really bad laws (and Medicaid/Medicare), blame the insurance companies, blame the drug companies…I”m serious, I think there is enough blame to go around.
Government-run healthcare will prove to be a mess everywhere…Canadians put up with it when they are healthy, as it’s great if they don’t have urgent needs..if they do, they want less wait times. The British? The nightmare that the NHS is becoming is well-documented.
We need real reforms here, and yes, that will include doctors having to make changes..but I think most doctors would be willing to if those changes would bring back autonomy and a better relationship with patients and less interference from the govt. and insurance companies. There are ways to make medical care cheaper, more accessible and better than it is now, but if you want to solely demonize doctors, you will get a crappy system even worse than now, and it will just spiral down until we are left with doctors who don’t give a crap, won’t work hard (no incentive)…and I’m sorry, if you want to say that’s what we have now, you are simply a liar.
This is a terrible situation, but it is not all the fault of some nebulous “system”. The primary cause is the umbilical cord between government and medicine otherwise known as licensing. A hundred years ago my (our) professional predecessors engaged in a regulatory capture of our industry under the pretext of doing so for the public good. Until this act of treachery is undone, and licensing is eliminated, we will continue to go down the road to perdition.
Let me tell you this!
The fight is not only to take back the US, it is to take back the future of the entire human race.
It will continue, not only for our entire lifetimes, but until the end of time.
That’s why we blog.
I hope they have to spend more extra money for complete implementation of Obama Care. They already spending 30 percent of their budgets.
Maybe I’m a Pollyanna, but I kept – and keep – thinking that if I explain the pitfalls of ACA to average folks, they will see the horrors this law will enshrine. But no, all I hear, over and over again, is about the goodies they’ll be getting (pre-existing condition coverage, more people covered, kids on their parents’ policies, etc – the stuff that’s already happening….funny how all the goodies happened right away, but that’s another argument for another day).
I guess the problem is that no one who is not a provider, or who understands providers’ needs, cares to hear how hard it will be for patients to continue to receive the kind of care they may be accustomed to. I can’t convince ANYONE who loves this bill that we are destined for a massive shortage of physicians. It might not be for another 5 years or so, but my argument that having coverage doesn’t matter if there are no docs to see you, or if the wait is incredibly long falls on deaf ears. WHY doesn’t this message seem to matter to people? Why do they not believe it?
I have posted in my social media areas and others, information regarding IPAB, RAC, ACO and the tax on medical devices (these are the things I’ve read up on the most, although I know there are lots of other taxes and regs looming). I get(if there’s any interest at all, which there generally isn’t): “There are 2 docs in my karate class and they’re happy about this.” Well, yeah, they’re in NYC and already part of huge practices. My husband is in a small practice of 4 physicians. They are dermatologists and have zero interaction with the hospitals (outside of the rare consult). ACA is trying effectively to force docs into either hospital-owned or large practices. That model in no way will help my husband, his partners or patients.
I’m so frustrated by the lack of interest by the general public in knowing anything more about ACA beyond “what’s in it for me.” I cannot understand how ANYONE thinks a massive bill has only those 4 frequently cited goodies in it and nothing bad, or at least nothing bad that affect “them.” Medical care affects EVERYONE….why don’t people get that? This law will have an adverse affect on so many things – physicians’ ability to get government out of the exam room, ruin of our nation’s economy as we collapse under the weight of the associated costs, rationing of health care (I hear, “Oh, no, it expressly forbids that!”..um, it might, but it will be an unavoidable unintended consequence), and a severe shortage of doctors in the not-so-distant future.
For a long time, my only drumbeat was the looming shortage of doctors, but people don’t believe this or shrugged it off. After Tuesday’s results, I have gotten an appointment with an internal med guy just so I will be an established patient, even though I have no medical problems. And this guy is young, so hopefully he won’t bail soon.
People are so cynical about so many things…why do they NOT question this? I’m so frustrated by this an it makes me profoundly disappointed in the Americans who so unquestioningly think this is all a good thing.