Even if your favorite doctor happens to work with your new plan, you still may not be able to keep him/her – your doctor may leave you. Here are two reasons that they are dissatisfied.
Doctor’s Sword of Damocles: “The Doctor Fix”
Back in 1997, congress passed the Balanced Budget Act that included a formula for calculating fees paid to doctors providing services under Medicare. Called the Sustainable Growth Rate (SGR) formula, it used a complicated method to compute how much Medicare would reimburse doctors for various procedures. This was supposed to slow the rate of growth in expenditures to a more manageable level and reduce Medicare’s negative impact on the deficit.
Up until 2002, the formula appeared to work; the impact on doctors was minimal and the adjustments seemed to be working. But in 2002, the formula dictated a reduction of 4.8% in doctor’s payments – and that got everyone’s attention.
The following year, when the formula dictated an additional 4.4% decrease, physicians complained loudly and Congress relented and overrode the Balanced Budget Act rules, approving instead, an increase of 1.6%.
That action set a precedent that’s continued to this day. In each year since 2003, despite the statutory formula that would have led to a fee cut, Congress has instead either granted a small increase or froze the rates and prevented a decrease. These were always short-term adjustments and simply delayed when the reductions would ultimately take effect.
And so it’s continued; each time the temporary override is about to expire, Congress enacts a new override. Here’s a striking example: in 2010 an accumulated 21.3% reduction was scheduled to be imposed on physicians – until Congress, once more, overrode it and granted instead, an increase of 2.2%.
It’s happened 14 times so far.
In other words, Congress keeps kicking the can down the road. Surprised?
Despite repeated congressional intervention to prevent rate cuts, the formulas that dictate these cuts haven’t been revisited. Each time Congress has increased payments, it has specified that the updates for later years should be computed as if it had not acted to increase those fees, so the planned reductions keep accumulating.
So now, the “chickens are (once more) coming home to roost.” On January 1, 2014, unless “fixed” by Congress, physicians can expect a reduction in their payments for treating Medicare patients of nearly 25%. That’s twenty-five percent!
How do you think doctors will react to a 25% reduction in revenue?
For years, doctors have been living with this “sword of Damocles” over their heads, never knowing when the full impact of the SGR might strike and inflict drastic reductions to their Medicare reimbursements. The uncertainty, as another expiration date approaches, can be stressful.
And that’s only part of the story.
Retirements and Change of Profession on the Horizon
Before the Affordable Care Act (ACA), there was already a shortage of physicians. One reason for the shortage is the aging of doctors, but many physicians are also questioning the longevity of their chosen profession. In a recent survey of 13,500 U.S. doctors, more than 84 percent said the profession was in decline. Nearly 60 percent said they wouldn’t recommend medicine as a career.
More than 75 percent said they were overworked and to compensate, nearly 6 percent of doctors said they were working fewer hours than they did in 2008. They are also seeing fewer patients than they did in 2008.
Many physicians – seeing the changes in their profession that lay ahead – are talking their children out of going to medical school. The ACA is expected to continue to reduce physician compensation, while doing nothing to stop lawsuits or malpractice premiums from rising. Doctors will have to see many more patients each day to meet expenses, all while dealing with new electronic health records (EHR) requirements and mountains of paperwork mandated by the healthcare law.
With a hefty student loan of (on average) $300,000, eight years of college and medical school, and three to seven years as underpaid, overworked residents, a prospective physician in the ACA era would be starting a career at age 30 in a job that requires working 70-80 hours a week in an assembly-line fashion to earn perhaps $100,000 a year. No wonder so many qualified individuals these days are choosing careers on Wall Street or in Silicon Valley instead of medicine.
The forecast shortage of doctors is about to become a real problem. The predicted shortage of 42,000 primary-care physicians and specialists (such as heart surgeons) has been underestimated. It doesn’t take into account the ACA’s effect on doctors retiring early, refusing new patients, going into concierge medicine or leaving the profession entirely.
According to a 2012 Physicians Foundation survey, nearly half of the 830,000 doctors in the U.S. are over 50 and approaching retirement. American doctors are increasingly concerned about changes already implemented or coming to the healthcare system, and many are opting to retire sooner than planned.
A Deloitte 2013 survey of U.S. Physicians found 57% of doctors view changes in the industry under the ACA as a threat, and six in 10 physicians report it’s likely that many will retire earlier than planned in the next two to three years. This trend could cause more widespread issues in the health-care system that is already struggling with doctor and nurse shortages. The survey found these numbers to be fairly uniform among all doctors regardless of age, gender or medical specialty.
Fifty-seven percent also say the practice of medicine is in jeopardy, because the “best and brightest” may not consider a career in medicine under new requirements of the reform.
According to the Association of American Medical Colleges estimates, the United States faces a shortage of more than 91,500 physicians by 2020, a number that is expected to grow to more than 130,600 by 2025.
We already had a shortage of doctors, what else could be expected when an additional 30 million individuals are added to the mix?
So, as a result of Presidential and Congressional meddling in our healthcare matters, just finding a doctor will become more difficult and, when one is found who is “in plan,” we can expect wait times between scheduling and actually having a face-to-face session to grow longer. We can also expect to find that much more of that “face time” will be spent with a Nurse Practitioner or Medical Assistant than with an actual MD.
But don’t worry, if you like your cancer or coronary disease, you can keep it.