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It Is Time To Listen To Physicians

Posted Oct 10 2012 9:03pm

Stanley Feld M.D.,FACP,MACE

Physicians are getting tired of being blamed for the rising healthcare costs. There are starting to realize that they have to take action to preserve their professional integrity. In fact, six out of ten physicians said they would quit medicine in a recent study by the Physicians Foundation.

I believe physicians will have a hard time quitting because they love practicing medicine. I do believe physicians in their early 60’s are contemplating quitting. Many physicians are looking for viable exit strategies to avoid quitting.

The Physicians Foundation commissioned an extensive  survey  of nearly 13,575 physicians. Meritt Hawkins, the physician search and consulting firm, conducted the survey.

 “The survey found that  60% of physicians would retire today , if given the opportunity—an increase from 45% in 2008. And it's not just disgruntled and tired Baby Boomers who want to abandon their healing work. At least 47% of physicians under 40 also said they would retire today, if given the opportunity.”

The survey pointed out many major problem areas.

Two specific issues consistently agreed to were malpractice concerns and the need for tort reform as well as the lack of cohesive leadership among all physician groups to represent the vested interests of physicians and their patients.

This is an excellent and detailed survey that has heightened the awareness of physicians’ practice problems.

The Massachusetts Medical Society survey pointed out the scope of defensive medicine . I extrapolated findings of the society’s survey to the nation.

President Obama and his advisors have ignored tort reform and defensive medicine as an insignificant cost. Ezekiel Emanuel M.D. one of President Obama’s advisors thinks defensive medicine only raises the cost of the healthcare system between $26 billion dollars a year. Dr. Emanuel feel this is an insignificant number to deal with in a 2.7 trillion dolloar healthcare system. His metrics are wrong. This is a misguided bias.

The Physician Foundation survey notes that many policy makers, academics, and others identify fee-for-service reimbursement as a key driver of health care costs. Physicians believe that "defensive medicine is a far more important cost driver."
40.3% of the physicians surveyed said "liability/defensive medicine pressures" was the least satisfying aspect of medical practice.

The survey also reveals that doctors see as a major cost driver of healthcare liability/defensive medicine.

69.1% of physicians said defensive medicine is the "number one ranked factor" driving up healthcare costs. The survey described the ordering of tests, prescribing of drugs, and conducting of procedures done "partly or solely to drive a wedge against potential malpractice lawsuits."  

" Medical malpractice lawsuits are common, adding an additional layer of paperwork, expense, and stress in virtually every physician's work day," the report adds .

The government ought to be listening to physicians practicing medicine every day rather than ivory tower professors who have never practice a day in their lives.

"Physicians understand to some degree that's the cost of doing business, but the defensive medicine goes deeper than that, in the ordering of extra tests, doing the extra procedures, and extra scans to protect [oneself] against a malpractice suit.”

Medical malpractice is at the heart of overspending in American healthcare. President Obama and Obamacare have ignored it. Some states have addressed it and the cost of care has been decreasing slowly. I believe it will take time in those states.  If anyone was sincere about bending the healthcare cost curve they have to take defensive medicine seriously. 

According to the survey physicians felt that there is a lack of a forceful cohesive voice representing them.

"There is a systematic, endemic series of problems," Walter Ray M.D. vice president of the Physicians Foundation, says. " Everywhere their defensive medicine, regulation issues, reimbursement issues. We are all in the same boat. But physician representation is balkaniz ed. There is not a national organization that represents a majority of physicians."

When the survey asked which best describes their feelings about the current state of the medical profession, only 3.9 percent of physicians used the words “very positive,” while 23.4 percent of physicians indicated their feelings are “very negative.”

The majority of physicians – 68.2 percent -- described their feelings as either somewhat negative” or “very negative,” while only 31.8 percent of physicians described their feelings as “somewhat positive” or “very positive”.

The American Medical Association (AMA) represents only 15% of physicians, according to the Physician Foundation report. One of the reasons for the low enrollment is that physicians feel the AMA does not represent their vested interests.

 Sermo is another physician organization. It is an Internet social network. In less than 2 years Sermo had as many members as the AMA.

Sermo originally concentrated on socioeconomic issues. It also discussed difficult clinical cases.  

The socioeconomic activity has recently faded. Sermo’s power was using the social network to do instant surveys expressing physician’s opinions on healthcare policy and patient care hassles.

These surveys were quickly disseminated to the public as media stories of physicians’ opinions. It was done through public service announcements and daily press releases.

Physicians were able to let the public know how they felt about an issue instantly. It was very attractive. Somehow the initial vigor stalled. Physicians are now left without a vehicle or organization to express to express their feelings.

Government, the healthcare insurance industry and the hospital systems have little desire to listen to the concerns of practicing physicians. It is more important to tell physicians what to do. It will not work long term.

The Physicians Foundation Biennial Survey is valid and accurate . However it is not dynamic or evolving. Neither has it gotten much attention. It is a must read along with the Massachusetts Medical Society survey for those interested in physician concerns and behavior.

Patients’ problem with the healthcare system gets less attention. The government and insurance companies tell patients what they can and cannot do

Repair of the healthcare system will only happen when the American healthcare system evolves to a consumer driven healthcare system with individual responsibility and individual control by the patients of their healthcare dollars.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.


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