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
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
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
"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 balkanized. 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.