Survey finds health-care reform bad for patients, worse for doctors

January 18th, 2011
HCPlexus National Physicians Survey (NPS) links doctors' fears that their pay will go down under the Patient Protection and Affordable Care Act (PPACA), commonly called Healthcare Reform Act (HCRA), with their concerns that the quality of care will also deteriorate. The study includes responses from 2,958 doctors of varying specialties and practice types, from all 50 states plus the District of Columbia.

The NPS is the most comprehensive survey of physicians surrounding their thoughts on the future of healthcare, including ideas on the PPACA, Electronic Medical Records (EMR), and Accountable Care Organizations (ACO).

Lower Pay Means Lower Quality Care

The NPS data show doctors' fear that the quality of care will deteriorate under PPACA and that their reimbursements (pay) will go down as well. When asked about the quality of healthcare in the U.S. over the next five years, 65 percent of the doctors believed it would deteriorate with only 18 percent predicting it would improve. Interestingly, consumer perception is far more optimistic, with close to 30 percent of consumers believing care will improve under PPACA.

When asked who would treat the 32 million Americans receiving healthcare under PPACA, 55% suggested a Nurse Practitioner or Physician Assistant would administer care.

"It is likely that with increased demand for general surgeons, rising overhead costs and decreasing reimbursement, there will be many of us simply retiring or finding other opportunities rather than accept the risks of surgical practice and below minimum wage benefits," said a surgeon from Arizona.

Patient Impact Shows Slightly More Positive Outlook

But when it comes to patients, doctors have a slightly different view. When asked about the impact of reform on patients, only 58 percent were negative with 27 percent saying reform would be positive. They also believe that PCPs and NP's will end up treating most patients.

"I believe that specialists feel that the PCP's will allocate the majority of their time to the patients with commercial insurance or sources that have higher re-imbursements and leave the lower level payers for their PA's and Nurse Practitioners to manage the majority of the time. These patients also have a history of being less likely to take an active role in their own care and have more 'self inflicted problems,' i.e. smoking, obesity, etc," responded an Illinois-based orthopedic surgeon.

"It is clear that many physicians feel strongly that the proposed future state is counter to what they believe is the best way to serve patients," said Raymond Fabius, MD, Chief Medical Officer at Thomson Reuters. "As practicing physicians are genuinely concerned for the health of their patients and their ability to serve them, any sustainable efforts to reform health care delivery would benefit from their inclusion and support."

During the next 5 years, the quality of health care in this country will
improve (18%) stay same (17%) deteriorate (65%)

The Affordable Care Act will result in physician reimbursement becoming
more fair (9%) neither fair nor unfair (17%) less fair (74%)

Overall, the impact of the Affordable Care Act for patients will be
positive (27%) neutral (15%) negative (57%)

Overall, the impact of the Affordable Care Act for physicians will be
positive (8%) neutral (14%) negative (78%)

"The National Physicians Survey tells us that physicians have not been enlisted in the healthcare reform process," said David L. Shrier, CEO of HCPlexus. Shrier continued, "The message they've taken from healthcare reform appears to be 'Do more with less'. Doctors are telling us they feel disenfranchised and overburdened. In order for healthcare reform to succeed, physicians need to be engaged in dialog, and need to be communicated the benefits of the PPACA as part of a continuous messaging campaign."

In addition to the broad answers, the survey data includes breakdowns of responses in different specialty areas, including those in primary care (such as internal medicine, Ob-GYN and pediatrics), medical specialties (including cardiology, dermatology and psychiatry), and surgical specialties. The data also includes breakdowns by group practice size. A complete copy of the survey can be accessed through the HCPlexus website at http://www.HCPlexus.com/survey.

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