ObamaCare:

Fewer Doctors + More Patients = Rationed Care

David C. Stolinsky, MD
March 15, 2010

What if nearly half of all physicians in America stopped practicing medicine? While a sudden loss of half of the nation’s physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.
− Andrea Santiago, Medicus Firm study, 2010

Let me ask some key questions:

Would you give up major parts of your childhood and youth to intensive study?

Would you spend one-third of your life in school and training?

Would you saddle yourself with hundreds of thousands of dollars of school-loan debt?

Would you go through four, five or more years of postgraduate training, with sleep deprivation, job stress and military-style discipline, as well as unpleasant sights, sounds and smells?

Would you do all this, only to end up a virtual servant, following unrealistic, confusing and often contradictory directives from non-medical government bureaucrats?

Would you resign yourself to a life of less professional independence, less human satisfaction and less income?

Would you relegate your patients to inferior care dictated by bean-counters and paper-shufflers who have little medical knowledge, but from whom there is no appeal?

Or would you opt for a more rewarding career, leaving sick people to be cared for by doctors trained in other nations, as now is happening in Britain?

True, there will always be some who are so highly motivated that they would pursue a career in medicine, no matter how strong the disincentives. But a system must not depend on exceptional people to keep it running.

An army that relies on most of its soldiers being Medal of Honor recipients is not likely to win wars. A health-care system that depends on most of its physicians being saintly altruists is not likely to succeed.

On the contrary, saintly altruists would not want to be government stooges in a rigid, mechanical system, and might become medical missionaries in some third-world nation. There they could fulfill their desire to serve humanity, unfettered by pencil-pushers armed with the power of the state.

Does this picture seem too bleak? Read the survey. In all, 1195 physicians in various specialties, various stages of their careers, and various locations were included. The results are not encouraging. Almost one-third said they would leave medicine if ObamaCare were enacted. Even worse, almost half (46%) of primary-care physicians (family physicians and internists) said they would leave. Primary-care physicians are already in short supply.

The same shortage is faced by nursing. Years ago, “experts” closed most three-year nursing schools. Now we must import nurses from abroad, some of whom barely speak English. So much for the ability of “experts” to manage professions of which they know little.

But what did we expect? We increased the length and cost of nursing education, and we decreased the satisfaction of a nursing career. We have already increased the length and cost of a medical education, and ObamaCare will further decrease the satisfaction of a medical career. Then we will need to import doctors as well.

The population is growing and also aging. Even without ObamaCare, the number of physicians will have to increase sharply just to maintain current levels of staffing. The Bureau of Labor Statistics predicts a 22% increase in physician jobs between now and 2018. Medicine ought to be one of the most rapidly growing fields.

But talk to older doctors. Many will tell you that they intend to retire as soon as it is financially feasible. They are tired of fighting for insurance reimbursement − from private insurers, and especially from Medicare and Medicaid.

More physicians are opting out of Medicare. They endure endless resubmissions of claims, endless denials and endless appeals − and even demands for refunds months later. Question: How much of the Medicare “waste, fraud and abuse” that President Obama talks about actually represents valid claims for needed treatment that were arbitrarily denied?

If you think dealing with an insurance company can be maddening, try dealing with Medicare. When an insurance company denies a claim, you can go to court or appeal to your state insurance commissioner. Your chances are slim, but at least there is a chance. But where do you go when the federal government denies your claim?

About one-third of physicians say they will leave practice if ObamaCare is enacted. Some may not carry out their threat. But others, who do not now intend to leave medicine, will do so if they find a government-run system unbearable.

ObamaCare does nothing about curbing malpractice suits or reducing the cost of malpractice insurance. What do you suppose will happen if the bureaucracy denies a treatment? If the physician withholds it, the patient may sue him. But if he provides it, he may be charged with “waste, fraud and abuse.” We may be combining the worst features of government medicine with the worst features of private medicine.

Under ObamaCare, millions of people, including illegal immigrants, who now get mainly emergency care will now be eligible for more care. But to the best of my knowledge, neither the Senate nor the House versions provide one penny to train more doctors, nurses or medical technicians. That fact should raise alarms.

Providing more care to more people for less money − and with no more or even fewer physicians − may make an attractive campaign promise, but it makes no sense in the real world. Politicians have a habit of stretching the truth. But when truth is stretched too far, it has a way of snapping back and hitting us in the face.

It does not take a prophet to predict that more people seeking more care from too few providers will necessarily result in long waiting lines, delay of needed treatment, rationing − and therefore unnecessary suffering, disability and death. But to a leftist, what matters is not quality of care, but equality of care. A leftist would be happy if everyone got the same level of care, even if that level were second-rate.

Leftists praised health care in the Soviet Union, but how many new drugs did it develop in its 74 years of existence? In contrast, the United States, with 4% of the world’s population, earns over 60% of the Nobel Prizes in Medicine. They are earned both by Americans and by foreigners who come here because of the congenial environment for research. Many doubt that the quality of health care in general, and research in particular, will remain high under a government-run system.

And what about the quality of those who go into medicine? Now dedicated young people apply to medical school, hoping to become independent professionals, using their best judgment for the benefit of individual patients. But who will apply when graduates become functionaries, required to follow cookbooks (excuse me, “algorithms” and “guidelines”) that prescribe treatments for whole classes of patients?

I don’t believe the same type of young people will apply. A government employee in a white coat is still a government employee. Few of my medical-school classmates would have wanted to become government employees. If they had, they would have skipped medical school, internship, residency and fellowship − and instead taken the Civil Service exam, and be making good money at a 9-to-5 job, while I was still working 100 hours a week for next to nothing.

Are physicians reactionaries who insist on the status quo? Not at all. The study shows that only 4% feel that no change is needed. At the other extreme, 28% favor a public option. But an overwhelming 63% favor gradual change, with improvements meant to remedy specific problems. That sounds like a plan.

Whatever your theoretical notion of an ideal health-care system, you must admit that it can’t work without an adequate number of motivated, competent physicians. Politicians, economists, ivory-tower dwellers and worshippers of big government tend to forget that basic fact.

But cheer up. When your doctor from Outbackistan tries to explain “treatment guidelines” to your nurse who speaks mainly Wombosi, you won’t have to worry about your hospital bill. You won’t live long enough to run up a big one. Chalk up another “cost saving.”

The study can be viewed at http://www.nejmjobs.org/rpt/health-reform-may-reduce-physician-workforce.aspx  The survey was conducted by The Medicus Firm, For more information, contact survey author Andrea Santiago.

Dr. Stolinsky writes on political and social issues. Contact: dstol@prodigy.net.

www.stolinsky.com