Friday, June 29, 2012

You Can Keep Your Doctor If You Want To…Unless He Is Run Out Of Business By The ACA

“A physician shortage was already expected before ACA was signed into law in March 2010, and now that gap could worsen. According to projections released last fall by the AAMC Center for Workforce Studies, there will be a shortage of about 63,000 doctors by 2015, with greater shortages on the horizon—91,500 and 130,600 for 2020 and 2025, respectively.” 1.

How will this actually affect the number of practicing Physicians? The outlook is not good. 
Two of every three practicing physicians oppose the medical overhaul plan... and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted…”  2. And, now the ACA is the law of the land. 

A major unintended consequence of the ACA is that many private practice physicians will no longer be able to stay in business for themselves. Or, is this really an unintended consequence? Fees that the Physician will be paid will be cut back significantly as dictated by the ACA. And, many Doctors may no longer be able to remain in business. It will also be difficult for new Doctors to hang up their shingle too.
Who will really want to enter the private practice field if there is not a possibility of making a decent income relative to the cost of doing business?

High costs of doing business are taken right off the Doctor’s bottom line. In addition to fixed costs like rent, office, medical equipment, and other expenses, there’s the Physician’s medical and office staff who must be paid. There are at least three staff in a Physician’s office that are important for the practice to function efficiently. The average salary of Physician Assistants is $79,000 annually. 3.  And, for a medical assistant, its $44,000. 4. Someone must answer the phones, meet the patients, and maintain the patient files. That’s the medical receptionist who make on average $28,000. 5.

Newer Physicians have a lot invested in their educations. There is four years of undergraduate, four years of medical school, three years of internship, one year of residency, and if a specialty is entered into, additional time in a fellowship. “The average medical student graduates with nearly $100,000 in student loan debt...A family practice salary may range from $73,150 on the low end and up to $249,950 on the top end, according to the report. But pay can vary dramatically by geographical region.” 6.

Most Physiciand make a good living. They have earned it. As of 2011, “On average, primary care physicians in the United States received $186,582 in pretax income a year, compared with $95,585 in France and $92,844 in Australia.7. Obama apparently wants not only to make our healthcare comparable to France, he also wants physician pay to be equivalent.  

And, Physician’s educations must be paid for, usually by student loans. And, those loans must be repaid.  Income based monthly payments on a $100,000 student loan with an interest rate of 6.8% with a 15 year repayment term is about $887.00.  8.

Part of the ACA provides 250 million for training for residency, nurse practitioners, and physician assistants. 9.
However, based on the meager payments to providers, who will be interested in a decent paying career in the medical field? A major "unintended" consequence is the loss of operating income for Physicians medical clinics.

The typical Doctor’s office has an overhead of between 40 and 60% of the total operating income for the practice. 10. But, will Doctors be able to meet their overhead, let alone take home a paycheck?

In propagandizing about Obamacare, you will remember him saying this about a diabetic foot amputation on August 11, 2009.
“Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed.” 
However, The American College of Surgeons immediately fired back, “The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight. Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.” 11.
Physicians also narrowly averted a 27% cut in Medicare payments this year through a stopgap measure passed into law that ends 12/31/2012. 12.  And, payment cutbacks in general cannot be avoided by the ACA.
There are payment cutbacks for virtually every physician payment category. But, Obama has promised many good things to healthcare providers. Although portions of the  White House fact sheet shown below promises lowering the burden of uncompensated care on physicians, hospitals, and the rest of the system, none of the promises included a “living wage” for doctors and other healthcare providers.
For health care providers, health reform is designed to make our health care system stronger and make it work better for you and your patients:
…Expanded coverage and consumer protections will offer security…  This will lower the burden of uncompensated care on physicians, hospitals, and the rest of the system.
Reduced paperwork and administrative simplification will bring down the cost of care.
Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. 
Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. 
Tough new consumer protections will hold health insurers more accountable for treating patients and providers fairly. 
Health care providers will help drive improvements to health care delivery.”
Strengthening and growing our health care workforce.
Investing in community health centers and new clinical settings.
Loan forgiveness and scholarships. (for those joining The National Health Service Corps)  9.

In addition to patients being at the mercy of the Affordable Care Act, so will the fates of their Doctors.  

If the above is not infuriating enough, see our other blog:

Eric Holder's Letter To Obama Asking Him To Conceal Documents Related To fast And Furious

10. Arnow FM. Acceptable overhead. Fam Pract Manag. November/Dec 2002:78


Dantes said...

The government has a solution. It is making nurse practitioners and physician assistants physicians by fiat. Although it takes a minimum of 7-8 years of post graduate education to become a family practice physician, and more to become a specialist, the government is pushing to allow people with a fraction of the training to act like doctors.

The other reason the government likes lesser trained individuals providing health care is that they will slavishly practice according to the guidelines established by the government death panels.

Anonymous said...

Of course, under Obamacare, doctors from other countries will be welcome here. But, they must bring their own shrunken heads and potion ingredients.