One thing I have often pointed out about the Affordable Care Act (ACA alias Obamacare) is that very few doctors participated in the conceptualization of the legislation. The final bill focuses on expanding Americans' access to health insurance with a total disregard for increasing the supply of medical professionals or facilities for treatment. Some doctors are directing their efforts to educating their patients and the voting public of what they believe the bill is doing to harm patient care.
To better learn the effects upon doctors and thus their patients of this new law, I had a conference call with a group of them who have formed Our Patients First Pac. Dr. Joel Strom, a dentist from Los Angeles and the principal organizer of the group, arranged for the call with himself and five other doctors from across the country. Strom has been working and organizing in the political arena for over three decades and is the author of Learn to Lead: Finding Success as a Grassroots Political Leader.
The group was formed initially to help a fellow physician, Bill Cassidy, in his successful U.S. Senate election in Louisiana. They expanded their efforts to produce 10 radio spots and a video which were aired in Iowa and New Hampshire. They are now looking forward to further expanding their membership and fundraising toward educating the public about the shortcomings of the ACA.
In a conference call with a group of doctors, we went back to the period prior to the ACA's passing and the fact that the American Medical Association (AMA) had endorsed the bill. None of the doctors are members of the AMA except for Nikan Khatabi, who practices family medicine in Laguna, CA. Khatabi stated "I am a member of the AMA because advocating for the health of my patients and rights for my colleagues doesn't take a back seat. Either you're at the dinner table or you're on the menu - period." All of the doctors were strongly against the actions of the AMA regarding Obamacare. They all questioned why if the AMA was at the table they did not abandon the bill when they found out what was in it before it was approved.
Though the AMA guards its membership information, Jane Hughes, an ophthalmologist from San Antonio, TX, stated their inside sources tell them the AMA had just 17 percent of doctors as members prior to the ACA and has now crashed to 11%. John Ammon, an anesthesiologist from Scottsdale, AZ, stated that Docs were not at the table on the plan and that that "the AMA misled the public regarding doctor support for the plan."
We focused most of our discussion on what the future is bringing to the practice of medicine in the United States. All the doctors agreed that many of their peers are retiring from the profession. That means first of all that Obamacare has had the opposite effect when it comes to the supply of practitioners, causing a shrinking of the pool.
Gerry Gianoli, a neuro-otologist from Covington, LA, has already embraced one direction for doctors. He has been in private practice without accepting any forms of insurance for more than a decade. To make an effective living and not be restrained by the current complications of accepting insurance, many specialists are going this route or providing what is referred to as "concierge services." Gianoli spoke of how the "mass media has derided doctors and medicine in the United States for the past 20 years." Instead of celebrating the accomplishments and advancements brought to us by doctors, pharmaceutical companies, and device manufacturers, there has been a concerted effort to deride all for the purpose of creating a single-payer national system.
The rest of the doctors talked about how they are being forced to change their operations. Jeffrey Singer, a general surgeon from Phoenix, Arizona, stated the law is "causing consolidation and impacting patient care." If doctors are not consolidating their practices with others they are becoming employees of hospitals. Singer stated "Doctors have to become employees to protect themselves because of regulatory requirements." All the docs agreed with that.
They also are concerned about new Medicare codes coming out that will complicate matters and make doctors subject to Medicare fraud simply because they provide a service to their patients and don't properly code the procedure. Because of the paperwork requirements they all felt that they are now at the whim of bureaucrats or hospital administrators as opposed to the needs of their patients.
Jane Hughes is the only doctor in the group that has not complied with the medical record computerization and is now subject to fines for any Medicare or Medicaid patient she takes care of in her practice. All the doctors agreed that they are spending so much time completing paperwork instead of tending to patient needs that it is harming their practices.
The big picture of the conversation starts with the fact that although the doctors are desirous of making a good living (they should so that we can attract the top-quality candidates we need to become physicians), these experienced doctors are still focused on why they entered the profession in the first place - patient care. They are being hampered by regulatory requirements causing them to sacrifice their businesses to become part of groups or hospital employees. They are fed up and they are banding together to do something about it.
Our Patients First PAC wants to further enlist their fellow doctors to help alter the political process that has so driven the health care debate. They want to make sure the focus of the system is on patient needs that will be driven by health care professionals and not bureaucrats or Harvard professors with imaginary models.