The IUSB Vision Weblog

The way to crush the middle class is to grind them between the millstones of taxation and inflation. – Vladimir Lenin

New England Journal of Medicine: 46% of physicians will consider leaving practice if ObamaCare passes – UPDATED!

Posted by iusbvision on March 19, 2010

UPDATE II – The IBD Poll from September 2009 showed 45% would consider leaving the practice if ObamaCare passed.

UPDATE – A reader notified me that NEJM pulled the article with this survey off its web site and replaced it with a short piece and indeed they have. I wonder why they did that… Here is the link where it was published – http://www.nejmjobs.org/rpt/physician-survey-health-reform-impact.aspx – After doing some searches to find the old text I found that Hotair.com copied some of the text that was originally on the NEJM page HERE. As we have seen with climategate, academics are greatly influenced by peer pressure. In journalism this is what we call scrubbing. NEJM does not even have the ethics to put an editor’s note saying the article was scrubbed.

[Editor’s note – if a reader finds any other posts with broken links are links to info that look nothing like the quotes please let us know, scrubbing is becoming a bigger problem now that blogs and Matt Drudge can draw so much attention to hidden pieces of big news, we may have to implement a policy that we screenshot any page we link to in order to archive it just to combat the scrubbing problem.]

Here is the full survey that New England Journal of Medicine article referred to:

What if nearly half of all physicians in America stopped practicing medicine? While a sudden loss of half of the nations physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.

The Medicus Firm, a national physician search firm based in Dallas and Atlanta, conducted a survey of over 1,000 physicians to determine their expectations as to the impact of health reform on their practices, income, job satisfaction, and future career plans. In discussing career plans as part of the recruitment process, physicians have increasingly expressed apprehension and uncertainty regarding health reform’s impact on their practices, and The Medicus Firm wished to investigate this trend further. Additionally, the firm wanted to determine how doctors anticipate health reform to affect physician supply and the quality of medical care nationwide, as these are issues that will directly influence the physician recruiting industry. These factors are in addition to health reform’s more obvious impact on patients and providers of health care services. A total of 1,195 physicians from various specialties and career levels in locations nationally completed the survey.1The results from the Medicus Firm survey, entitled “Physician Survey: Health Reform’s Impact on Physician Supply and Quality of Medical Care,” were intriguing, particularly in light of the most recently published career projections from the Bureau of Labor Statistics (BLS). The BLS predicts a more than a 22 percent increase in physician jobs during the ten-year period ending in 2018. This places physician careers in the top 20 fastest-growing occupations from 2008 to 2018. Meanwhile, nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.

“What many people may not realize is that health reform could impact physician supply in such a way that the quality of health care could suffer,” said Steve Marsh, managing partner at The Medicus Firm in Dallas. “The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients.”

It’s probably not likely that nearly half of the nation’s physicians will suddenly quit practicing at once. However, even if a much smaller percentage such as ten, 15, or 20 percent are pushed out of practice over several years at a time when the field needs to expand by over 20 percent, this would be severely detrimental to the quality of the health care system. Based on the survey results, health reform could, over time, prove to be counterproductive, in that it could decrease patients’ access to medical care while the objective is to improve access.

Furthermore, even if physicians are unable to act upon a desire to quit medicine, there could be an impact in quality of care due to a lack of morale in physicians who do continue to treat patients despite feeling significantly stressed.

Skeptics may suspect that physicians exaggerate their intent to leave medicine due to health reform. Some experts point to the malpractice crisis of years ago, when many doctors also expressed a desire to leave medicine. Some did quit; many did not. However, health reform could be the proverbial “last straw” for physicians who are already demoralized, overloaded, and discouraged by multiple issues, combining to form the perfect storm of high malpractice insurance costs, decreasing reimbursements, increasing student loan debt, and more.

Do physicians feel that health reform is necessary? The survey indicates that doctors do want change. Only a very small portion of respondents — about four percent — feel that no reform is needed. However, only 28.7 percent of physicians responded in favor of a public option as part of health reform. Additionally, an overwhelming 63 percent of physicians prefer a more gradual, targeted approach to health reform, as opposed to one sweeping overhaul. Primary care, which is already experiencing significant shortages by many accounts, could stand to be the most affected, based on the survey. About 25 percent of respondents were primary care physicians (defined as internal medicine and family medicine in this case), and of those, 46 percent indicated that they would leave medicine — or try to leave medicine — as a result of health reform.

Why would physicians want to leave medicine in the wake of health reform? The survey results, as seen in Market Watch, indicate that many physicians worry that reform could result in a significant decline in the overall quality of medical care nationwide.

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