By TERRY JONES
News Analysis by IBD | Posted Tuesday, September 15, 2009 4:30 PM PT
Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found.
The poll contradicts the claims of not only the White House, but also doctors' own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul.
It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration's claim that the government can cover 47 million more people with better-quality care at lower cost.
The IBD/TIPP Poll was conducted by mail the past two weeks, with 1,376 practicing physicians chosen randomly throughout the country taking part. Responses are still coming in, and doctors' positions on related topics — including the impact of an overhaul on senior care, medical school applications and drug development — will be covered later in this series.
Major findings included:
• Two-thirds, or 65%, of doctors say they oppose the proposed government expansion plan. This contradicts the administration's claims that doctors are part of an "unprecedented coalition" supporting a medical overhaul.
It also differs with findings of a poll released Monday by National Public Radio that suggests a "majority of physicians want public and private insurance options," and clashes with media reports such as Tuesday's front-page story in the Los Angeles Times with the headline "Doctors Go For Obama's Reform."
Nowhere in the Times story does it say doctors as a whole back the overhaul. It says only that the AMA — the "association representing the nation's physicians" and what "many still regard as the country's premier lobbying force" — is "lobbying and advertising to win public support for President Obama's sweeping plan."
The AMA, in fact, represents approximately 18% of physicians and has been hit with a number of defections by members opposed to the AMA's support of Democrats' proposed health care overhaul.
• Four of nine doctors, or 45%, said they "would consider leaving their practice or taking an early retirement" if Congress passes the plan the Democratic majority and White House have in mind.
More than 800,000 doctors were practicing in 2006, the government says. Projecting the poll's finding onto that population, 360,000 doctors would consider quitting.
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• More than seven in 10 doctors, or 71% — the most lopsided response in the poll — answered "no" when asked if they believed "the government can cover 47 million more people and that it will cost less money and the quality of care will be better."
This response is consistent with critics who complain that the administration and congressional Democrats have yet to explain how, even with the current number of physicians and nurses, they can cover more people and lower the cost at the same time.
The only way, the critics contend, is by rationing care — giving it to some and denying it to others. That cuts against another claim by plan supporters — that care would be better.
IBD/TIPP's finding that many doctors could leave the business suggests that such rationing could be more severe than even critics believe. Rationing is one of the drawbacks associated with government plans in countries such as Canada and the U.K. Stories about growing waiting lists for badly needed care, horror stories of care gone wrong, babies born on sidewalks, and even people dying as a result of care delayed or denied are rife.
In this country, the number of doctors is already lagging population growth.
From 2003 to 2006, the number of active physicians in the U.S. grew by just 0.8% a year, adding a total of 25,700 doctors.
Recent population growth has been 1% a year. Patients, in short, are already being added faster than physicians, creating a medical bottleneck.
The great concern is that, with increased mandates, lower pay and less freedom to practice, doctors could abandon medicine in droves, as the IBD/TIPP Poll suggests. Under the proposed medical overhaul, an additional 47 million people would have to be cared for — an 18% increase in patient loads, without an equivalent increase in doctors. The actual effect could be somewhat less because a significant share of the uninsured already get care.
Even so, the government vows to cut hundreds of billions of dollars from health care spending to pay for reform, which would encourage a flight from the profession.
The U.S. today has just 2.4 physicians per 1,000 population — below the median of 3.1 for members of the Organization for Economic Cooperation and Development, the official club of wealthy nations.
Adding millions of patients to physicians' caseloads would threaten to overwhelm the system. Medical gatekeepers would have to deny care to large numbers of people. That means care would have to be rationed.
"It's like giving everyone free bus passes, but there are only two buses," Dr. Ted Epperly, president of the American Academy of Family Physicians, told the Associated Press.
Hope for a surge in new doctors may be misplaced. A recent study from the Association of American Medical Colleges found steadily declining enrollment in medical schools since 1980.
The study found that, just with current patient demand, the U.S. will have 159,000 fewer doctors than it needs by 2025. Unless corrected, that would make some sort of medical rationing or long waiting lists almost mandatory.
Experiments at the state level show that an overhaul isn't likely to change much.
On Monday came word from the Massachusetts Medical Society — a group representing physicians in a state that has implemented an overhaul similar to that under consideration in Washington — that doctor shortages remain a growing problem.
Its 2009 Physician Workforce Study found that:
• The primary care specialties of family medicine and internal medicine are in short supply for a fourth straight year.
• The percentage of primary care practices closed to new patients is the highest ever recorded.
• Seven of 18 specialties — dermatology, neurology, urology, vascular surgery and (for the first time) obstetrics-gynecology, in addition to family and internal medicine — are in short supply.
• Recruitment and retention of physicians remains difficult, especially at community hospitals and with primary care.
A key reason for the doctor shortages, according to the study, is a "lingering poor practice environment in the state."
In 2006, Massachusetts passed its medical overhaul — minus a public option — similar to what's being proposed on a national scale now. It hasn't worked as expected. Costs are higher, with insurance premiums rising 22% faster than in the U.S. as a whole.
"Health spending in Massachusetts is higher than the United States on average and is growing at a faster rate," according to a recent report from the Urban Institute.
Other states with government-run or mandated health insurance systems, including Maine, Tennessee and Hawaii, have been forced to cut back services and coverage.
This experience has been repeated in other countries where a form of nationalized care is common. In particular, many nationalized health systems seem to have trouble finding enough doctors to meet demand.
In Britain, a lack of practicing physicians means the country has had to import thousands of foreign doctors to care for patients in the National Health Service.
"A third of (British) primary care trusts are flying in (general practitioners) from as far away as Lithuania, Poland, Germany, Hungary, Italy and Switzerland" because of a doctor shortage, a recent story in the British Daily Mail noted.
British doctors, demoralized by long hours and burdensome rules, simply refuse to see patients at nights and weekends.
Likewise, Canadian physicians who have to deal with the stringent rules and income limits imposed by that country's national health plan have emigrated in droves to other countries, including the U.S.
Tomorrow: Why most doctors oppose the government's plan — in their own words.