Will there be a doctor in the house?

Is There a Doctor in the House?

After the televised health care bore-a-thon Obama said, “Everything there is to say about health care has been said, and just about everybody has said it.” Whereas I am sure he believes that, it is not actually true. Conspicuously absent from all debate and planning on health care are the doctors. This seems to be another “don’t ask, don’t tell” policy and it is inherent in heath care legislation. This has been the case even as far back as ClintonCare discussions in 1992. No doctors need ever apply. Republicans have complained for months about being shut out. They are the belles of the ball compared to how physicians have been treated. Surely it has crossed someone’s mind how astounding it is to transform medical care delivery in this country without talking to the people who do the work.

A recent cartoon by Lisa Bensen provides the visual based on the well-known post-summit tableau of Obama behind the podium and an array of white-coated doctor human-equins behind him all against that ghastly bright bile-yellow curtain. Bensen’s version has the would-be docs tied and gagged. Indeed, all of us doctors have been virtually gagged because we have not been invited to participate to give information or ideas about taking care of patients, running a medical office, dealing with insurances or government medical programs or any other aspect of our daily lives in taking care of real live people with real medical problems. This treasure house of experience, knowledge and talent is laying wasted. All the drastic changes proposed for our own profession are being done without so much as a passing glance. This is reminiscent of an important meeting in 1938 in Munich. The maps were on the table and five politicians divided Czechoslovakia into pieces. The Czechs were not invited. Doctors know just how they felt. Politicians, lawyers, policy wonks and accountants are making up the rules by which doctors and patients must relate to each other.

If anyone would take the trouble to talk to doctors, they would be able see through some of the myths being accepted without question by most of the players in this yearlong debate. Since the start of this round of ‘free health care for all’ free-for-all, Obama has stated “if you like you doctor, you can keep him or her”. Has it never occurred to anyone that your doctor might not want to keep you? The Medicus Firm conducted the survey in December 2009 that attests to the fact that if ObamaCare passes upwards of 45 percent of practicing doctors will seriously consider retiring. Of the nearly 800,000 practicing doctors in the USA, that would amount to a drop of 360,000. It is a mere three weeks since the passage of the legislation and already there are doctors warning about the imminent closure of their practice and suddenly the angst du jour seems to be an “unexpected” doctor shortage.

This is not a new problem. Doctors’ morale has been falling for years and many have already retired early, but not nearly as many that wanted to. A 2002 survey by the California Medical Association prophetically entitled, “And Then There Were None” showed that about half of the doctors in California were so dissatisfied they planned to retire or move out of state within three years. Between 1995 and 2000, several counties showed a physician decline of 13 percent at a time when the general population increased by nearly 10 percent. The authors stated that if these trends continued, California would have a non-functioning health care system before long. That ‘before long’ is here now. The Medical Education Council of Utah had similar findings when they determined that a growing number of their physicians planned to retire 10 years earlier than the traditional age 65. More recently a survey of physicians by the Association of American Physicians and Surgeons showed that 66 percent of those asked plan to retire from active patient care at a younger rage than they had planned on 5 years earlier. This is true across the country.

What is causing this mass exodus by doctors? The same AAPS survey yielded results that could only be surprising to anyone but practicing doctors. Of the respondents, 66 percent said the main reason was government interference in the practice of medicine, 63 percent cited hassles with Medicare, 80 percent expressed fear of unwarranted investigation or persecution and 56 percent listed the reason as the reduced fees from Medicare. Those who bandy back and forth how great government run health care is have never tried to deliver medical care under it. Unless you are in it, you have no idea of the immense burden, down-right hassle and fear-provoking ordeal it is to have to work with the government in providing medical services and getting reimbursement.