I didn't realize at the beginning of the summer just how divisive the debate over healthcare reform would ultimately become. As the rhetoric has heated up, it has sharply divided the country, Congress, and even the nation's physicians.
The House healthcare reform bill cleared a major hurdle when it secured the endorsement of the AMA—it is the nation's largest physician group and has been a vocal opponent of healthcare reform efforts (including the creation of Medicare) in the past.
But the AMA's endorsement has drawn a backlash from some physicians who oppose current reform proposals, particularly the public option. The AMA decided that eliminating the thorny Sustainable Growth Rate formula that keeps doctors on the brink of perpetual reimbursement cuts was worth the tradeoff. Not all physicians agree.
A group of 17 state medical societies and specialty groups has publicly dissented from the AMA's position, citing the creation of a public option as its main objection, and a few other physician groups have taken aim at the association as well.
A decent chunk of the difference of opinions between physicians (and everyone else in the debate, for that matter) can probably be attributed to politics and ingrained ideological differences. But beyond politics, there are real questions to be answered:
- Will reform ultimately help physicians more than it hurts?
- Will a public option decrease the burden of uncompensated care or pay so poorly that it doesn't matter?
- How will physicians fare if nothing changes?
These questions are difficult in part because reform won't affect all physicians equally. In thinking about different physician opinions concerning today's reform efforts, I'm reminded of a survey I wrote about last year that measured physician opinion on the more generic prospect of universal healthcare.
The report found that when asked simply if they support national health insurance, of the more than 2,000 doctors polled, 59% were in favor of and 32% were opposed, a significant jump from the previous poll in 2002.
But if you break that down by specialty, support ranged from more than 80% of psychiatrists to only 30% of radiologists. In fact, a physician's specialty seemed to be a pretty strong predictor of whether he or she supported national health insurance.
The specialties that most strongly supported it—psychiatry, pediatrics, and primary care—all make less than $200,000 (MGMA median levels) or, in the case of emergency medicine, often have patient panels with a lot of uninsured or Medicaid patients. The specialties most strongly opposed—radiology, anesthesiology, and surgical subspecialties—are some of the highest earners in medicine and the biggest beneficiaries of the fee-for-service model.
Are physicians basing these views entirely on compensation? Of course not. But reforming healthcare will affect physicians to varying degrees, and specialty affiliations can't be discounted.
There's been a lot of talk from the Obama administration about boosting primary care training and reducing ED overcrowding through reform legislation, but there has also been focus on reducing imaging payments and moving away from fee-for-service. There will be winners and losers among physicians.
Unfortunately, the survey that showed the specialty correlations came out a year ago, before tangible reforms had been proposed, and I haven't seen a study since that has broken down support by specialty.
But given physicians' allegiance to their niches and the wide gaps in incomes and practice styles, I'd guess there is a similar specialty divide in support for specific reform proposals today.