Many Docs Negative on Healthcare Reform

Many physicians believe healthcare reform won't reduce costs or improve access to care, but it will mean less income and autonomy for them, a new survey finds.

"One surprise was the level of denial and mourning that seems to be prevalent among doctors as they look to the future," says Paul Keckley, executive director of the Deloitte Center for Health Solutions and lead author of "Physician Perspectives about Health Care Reform and the Future of the Medical Profession."

The Deloitte study also finds that only 25% of physicians consider themselves "very informed" on the details of the Patient Protection and Affordable Care Act, while 71% consider themselves "somewhat informed."

Informed or not, Keckley says many physicians developed strong opinions on healthcare reform years ago and those opinions haven't changed.

That dates back into 2009," he says. "They were despondent that the PPACA did not fix the sustainable growth rate, liability wasn't fixed, and the law did very little to get people to live healthier lives. That has been embedded in medicine now for the last two years."

The national survey of 501 primary care and specialty physicians, conducted in July and August, shows that 73% of doctors are glum about the future of medicine and 69% believe the "best and brightest" who are traditionally drawn to medicine will consider other careers

"They are mourning the 'MDiety,'" Keckley says. "The profession seems to be lamenting that the best days of the profession are behind and there is very little blue skies on the horizon. It's understandable but it is surprising."

Only 27% of physicians surveyed believe the PPACA will reduce costs by increasing efficiency, only 33% think it will decrease disparities, and half say access to healthcare will decrease because of hospital closures that result from the law.

The docs are also very downbeat about the impact of healthcare reform on their incomes in the coming year, with 48% believing they will earn less, 48% saying their income will remain unchanged, and only 4% saying they will earn more.

Keckley believes doctors' opinions about the PPACA may be influenced by their reliance on specialty societies for information about the law. "They are listening to someone from their society filter the information that is relative to their specialty and say 'Here is what it means to you,'" he says. "I was not surprised about the low level of understanding, given that there was a resignation that it is a bad thing that's just going to make the problems worse."

Keckley says doctors have become gloomier since the shift away from the fee-for-service model, with the belief that their autonomy and respect for the profession is eroding.

"The two things we found progressively disheartening for doctors are more transparency—that more things about them will be made public. Second is more cuts in the average reimbursement increases that they expect," he says.

Even primary care physicians, who are expected to see increased reimbursements under PPACA, are not necessarily happy about the potential impact on their incomes, Keckley says.

The reason is they still feel it is unfair that they are paid so little when compared with specialists, and they think the law didn't take care of it," he says.

Despite dissatisfaction with their income, physicians remain among the highest-paid professionals in the United States. Keckley cites the Bureau of Labor Statistics 2010 report on median compensation, which lists primary care physicians at $170,000 and specialists at $450,000. That compares with a median of $52,000 to $56,000 for teachers, police officers, and firemen.

So yes, doctors are whining about their incomes because they believe they deserve the highest income that is paid a profession," Keckley says. "They are! But for their purposes it doesn't appear to be as much as it should be. That is a matter of perception.

"Doctors tend to measure themselves against other doctors," he says. "There is a lot of peer influence on what cars they drive, what clubs they belong to. If you look at it objectively, doctors' incomes are pretty good."

Only 35% of physicians gave the nation's healthcare system an A/B grade, and 60% graded it C/D. Keckley says the perceived loss of autonomy has caused physicians to take a generally negative view about the overall quality of the nation's healthcare system.

"Doctors consider a successful healthcare system to be one where there is no limit to accessing doctors, where there are no gatekeepers, and where doctors are not challenged around their clinical autonomy. Period," Keckley says. "The more regulatory oversight in standards of care or evidence-based medicine, and the more you introduce this third-party coverage with insurance, the more troubling that is for doctors. Clinical outcomes are not the basis for how doctors rate the system."