During this last week of Thanksgiving, I began to reflect on the last year and the many good things that we have all been blessed with in healthcare. I have the opportunity to serve patients and their families every single day. I have the privilege of making a difference in the lives of others. However, As I reflect, I am greatly troubled by what looms in the year ahead for physicians and their patients.
As Obamacare continues to roll out (or stumble and crawl out as the case may be), other programs such as medicaid are expanding as well. In less than a month, already overwhelmed US healthcare systems are going to be flooded with new patients. Experts argue that the medicaid expansion will allow for “timely access” for all new patients. However, once again, the Obama administration has failed to look at one of the core problems with expansion–Who the heck is going to treat all of the new patients? The current expansion of medicaid (in concert with the Obamacare mandate) is likely to result in long wait times for primary care office visits, limited subspecialist access to those with the worst insurance (medicaid) and ultimately poorer outcomes for patients.
Some experts predict a significant shortage of physicians (both primary care and specialists) as we race to meet the flood of newly insured patients. During the design of the expansion of medicaid, no one with actual experience in caring for patients has seriously considered how the care they plan to provide will be delivered. Traditionally, medicaid reimbursement rates are significantly lower and the payment process is filled with bureaucracy, paperwork and red tape. As discussed in the Wall Street Journal this week, the medicaid expansion in California is underway. Over 9 million people will enroll in the medicaid programs expanding all across the US very soon. But many doctors will be unable to accept medicaid patients due to the low rates of payment included with the program–for example–in California where we have one of the largest medicaid populations in the US, only 57% of physicians will accept medicaid. Many subspecialists will not–financially it is not feasible to pay increasing overhead costs, increasing malpractice premiums and receive reimbursement rates that are even well under traditional Medicare rates. In fact, many physicians in California who have traditionally accepted medicaid patients will no longer be able to take on new ones. In response, the government has issued “incentives” to persuade physicians to accept new medicaid patients. These incentives include “higher” reimbursement rates for two years (then the rates revert back to the mean at that time)–what they do not tell you is that the increased rates are still below standard CMS medicare reimbursement.
How is this Changing the Landscape of Healthcare Delivery?
Clearly, we must provide care to all Americans. We must, however, do it in a way that makes good financial sense. The practice of cutting rates for physicians and expecting them to continue to work 60+hour weeks, sacrifice family time and meet increasing demands of electronic documentation and higher patient loads is unsustainable. As physicians, WE are part of a noble profession and we all care deeply for our patients. Our passion is to help others battle disease. We consider much of what we do to be SERVICE and the rewards for service to others are immeasurable. However, physicians sacrifice a great deal of time to become expert in their respective specialities. Some of us have endured as much as 10 years of post MD graduate training with low pay and long hours. Many have mountains of school loans and debt to repay.
From a business perspective, many physicians are finding shelter under the cover of large healthcare systems and hospitals–both private and university based. The private group or traditional private practice is becoming extinct. Competition is beginning to dwindle in many markets as hospital systems gobble up other institutions and other groups that once competed for patients–essentially forming monopolies of healthcare delivery. Add to the realignment of groups and hospitals the newly formed Exchanges that have limited choice and healthcare prices are no longer subject to free market competition.
What are the options? Healthcare is a business, right? Or is it simply another government program?
I certainly do not claim to have all the answers. However, I do recognize that the course that the Obama administration has set upon is unsustainable. We will soon be facing a crisis of physician shortages throughout the US. Medicine, although a noble and honorable profession, is no longer an attractive option for many of our brightest young minds. Of the physicians (like myself) that continue to practice and care for our patients with passion, burnout is common. If we continue to limit reimbursement and increase workload physician burnout will continue to rise at levels much higher than in the past.
Maybe the answer is for the government to create a federally run health service. In this model, the government selects prospective medical students and funds their medical training–pays for medical school and living expenses during internship, residency and fellowship training. Once training is completed, the young physicians are then obligated to practice in a government owned hospital or clinic for a number of years (commensurate with the number of years that they benefited from government support). The government would control their salary, their work hours and their practice location. All patients who are signed up for medicaid are then assigned a clinic and a physician from which they will receive their care. Those who choose not to participate in government clinics will most likely be a part of “boutique clinics” and concierge medicine.
Is this really what we want? A single payer, socialist society?
Free enterprise, entrepreneurship, and competition are what makes medicine in the US great. We must carefully consider the impacts that the decisions currently being made in Washington concerning our healthcare may ultimately affect our freedom. The time to get involved is now. Let your voice be heard. Advocate for your patients and your family. Let’s get back to practicing the “art” of medicine and re-focus on what matters most–the care of the person suffering with illness….