Doctor’s View

Michael Ramirez Cartoon

 

You shouldn’t judge the Affordable Care Act based on headlines or by listening to politicians or talking heads. I tried for a while, but only heard wildly conflicting stories that seemed to have little basis in reality.

Instead, you should ask someone who actually deals with the law on a daily basis — a doctor, for instance.

The Physicians Foundation did exactly that in its “2014 Survey of American Physicians,” which was released last month. The survey, which reached over 80% of doctors in the U.S. and elicited responses from some 20,000, is doctors’ collective report card on the Affordable Care Act’s first four years.

The grades aren’t good. Only 25% of doctors give it an “A” or a “B” grade. Nearly half ( 46%) give it a “D” or an “F”.

I can help explain why so many of us are fed up with the law: In many cases, it shifts our focus from patients to paperwork, from finding cures to filing documents.

The survey indicates that physicians now spend 20% of their time on non-clinical paperwork. I now spend many hours at a desk or a computer rather than at the bedside assisting patients. This isn’t why I became a doctor.

Unsurprisingly, this shift negatively influences patients’ access to health care — doctors simply don’t have the time to see the same number of patients.

The survey indicates that 44% of doctors “plan to take one or more steps that would reduce patient access to their services.” This includes “cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking a non-clinical job.”

I would add another important effect based on my own observations: Spending less time with patients.

The ACA’s regulatory burden directly bears on these decisions. There are already at least 11,000 pages of government regulations related to the law. Some of it applies to insurers, some of it applies to doctors and some applies to the relationship between the two.

No matter who it applies to, it adds bureaucratic hassles to the health care process that may impact your doctors’ ability to attend to your medical needs.

It should come as no surprise, then, that 69% of physicians “believe their clinical autonomy is sometimes or often limited,” meaning they have a diminished ability to make medical decisions in consultation with patients.

And “limited” may be an understatement. The ACA’s implementation has also coincided with a dramatic decline in private practice — the small, personal doctors’ offices that have been in local communities for generations.

The number of private-practice doctors has dropped by nearly half in a mere six years, with the most dramatic drops occurring in the four years since the Affordable Care Act was signed into law.

According to the survey, 35% of physicians are now independent practice owners. In 2012, half were independent. In 2008 — two years before the ACA was passed — 62% were independent. In the last two years alone, the number of solo practitioners has dropped from 25% to 17%.

No wonder: Private and solo practitioners often lack the staff and the financial resources required to implement and keep up with the ACA’s dramatic changes to medicine.

The Physicians Foundation survey indicates that our country’s health care is still going in the wrong direction. Of course, it’s important to note that the Affordable Care Act is only one of many issues affecting doctors’ decisions and outlook.

But it is not a good sign that in the law’s first few years, physicians are seeing fewer patients, private practices are disappearing and nearly twice as many doctors believe the law is harming, not helping, American health care.

• Fodeman is an internal medicine doctor practicing in Tucson, Ariz. (IBD)

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s