Doctors Have Their Own Problems

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.



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19 Responses to Doctors Have Their Own Problems

  1. CW says:

    GREAT post, Garnet! That last line really says it all.

  2. Mrs AL says:

    It IS a great post and hits close to home. My PCP has hinted that he may not be my Primary Care doctor for long. He hasn’t outright said it, but am going to ask him when I have my next appt.

    I am angry but need to keep BP down so I don’t have to take another communist pill so I will stop now …

    • Garnet92 says:

      It’s already somewhat difficult to find a PCP around here that will take new Medicare patients. When I first went on Medicare, the first three doctors I called would not take a new Medicare patient. While researching this post, I found that only 50% of doctors now are taking new Medicare patients – and that will drop now with the advent of Obammycare. My last PCP moved out of state and I don’t currently have one – I’m going to play hell finding a new one.

      • Mrs AL says:

        Oh my goodness, Garnet. Had no idea! What an awful situation to be in! My PCP’s practice stopped taking Medicade and Medicare patients. It’s a growing trend and it’s going to get worse. You know me, I pray about everything, including this pickle you are in 😉

        • Garnet92 says:

          My only saving grace Mrs., is that the doctor I see the most (Pulmonologist) and a couple of others are specialists with whom I already have a relationship. But, I do need a new PCP and I better get started on finding a new one. Thank God, with the exception of COPD, I have been healthy. Of course, what good is a healthy heart when you can’t breathe?

    • Garnet92 says:

      Thanks for commenting upaces, but I don’t believe that the technique noted in your link will work for long:

      1) most of us don’t want to go without any insurance – unless you’ve got a cash-discount policy worked out with a PCP such that you can do without insurance and pay cash when you need treatment, and heaven help you if you have a really serious problem and have no insurance

      2) that loophole won’t last long since Omammy will open up methods available to the IRS to collect the penalties. You’re not really avoiding the penalty, only putting up a (temporary) roadblock to the IRS collection of that penalty.

      It sounds good and might work for the first year, but that “loophole” won’t be allowed to stay. The IRS will need their usual Nazi methods to collect penalties.

      • upaces88 says:

        It probably won’t…..this is what I have been doing.
        I have been copying and pasting the REALLY important parts…then: “Continue Reading.give url just it case it is still there.
        I had too many articles AND video(s) just disappear.

        But the original? I try to copy and paste the entire article JUST FOR ME so I won’t get into Copyright Trouble. Then I can take just an “excerpt’ out of it IF someone needs it.

        • Garnet92 says:

          I can dig it – I do something similar to capture links and sometimes whole articles – ’cause you’re right, if they’re too controversial, someone ends up deleting them – gotta get’em while they’re hot!

          • upaces88 says:

            IF an article hits me really hard….I am thinking of a specific one:
            “Crucify Political Correctness at the Altar of Freedom of Speech.”
            That article hit me so hard that I wrote to the author to ask copyright permission to copy and paste ALL of it.

            She said yes, as long as I keep her name and url on it. LOL

      • upaces88 says:

        We have to be careful and respectful due to copyright laws.
        This is how I do it.
        I copy and paste the “entire article FOR MYSELF…leaving the URL at the bottom.
        then when I email it out, of course, I just email an excerpt. BUT, if anyone has questions, and they ask me about it…..IF it has disappeared, I have the entire article and can email just the “excerpt” that covers their question.

  3. Kathy says:

    Good stuff, Garnet, and no I’m not surprised. Many doctors have already stopped taking new Medicare patients because of the burdens imposed by the paperwork and the low pay. My dad’s PA said that sometimes they have to run the paperwork through the process three or four times to finally get paid.

    As usual, Congress doesn’t address the real problem and fix it, they just keep putting another band-aid on it. They’re much too occupied with the next election to actually do meaningful work.

    • Garnet92 says:

      You got it, Kathy. According to a survey I read, only 50% of PCPs are taking new Medicare patients now – and that’s forecast to drop even lower because of Ofugyoucare.

      We all know that Congress will never allow that 25% reduction in doctor’s payments to happen, they’d be crucified – so they will, as you say, put another Band-Aid on it. Sooner or later, they’ll have to kill the SGR formula altogether. The troubling thing is that savings anticipated by those reductions were included in the CBO forecast of the ACA’s impact on the deficit – and they’ve never happened – and won’t.

  4. Clyde says:

    Damn good post on an IMPORTANT subject that the lamestick media refuses to cover. Take ANY profession, kick it’s teeth in, and make it damn near impossible to achieve a return on the investment MOST medical professionals have in TIME, as well as TREASURE, and they WILL find a way to make that return. I, also, foresee a HUGE medical “black market” sprout up.

  5. Garnet92 says:

    You got it right, Clyde. Who is the MOST IMPORTANT professional that most of us will ever deal with? Our doctors. And frankly I don’t begrudge them making their bucks – they keep us healthy, and in some cases, ALIVE! If anyone in this country deserves BIG bucks, it’s doctors – not actors, musicians, sports figures, etc. They should be making more than Beiber, Kardashian, Baldwin, Gaga, etc. What do THEY do to advance our civilization and make our lives better? A little short-term enjoyment for some (not me) and they’re zillionaires – it just ain’t fair.

    Almost forgot to add that a “medical black market” is not only a possibility – I’ll bet it’s a certainty. The concierge practices are a step in that direction and seem like a good idea to me. Better to return to the days when no one was between a doctor and the patient – removing the insurance company from that position would be good – except possibly for catastrophic care policies.

  6. Hardnox says:

    Excellent post Garnet. Every doc that I know professionally or personally is bailing out or planning to.