I am sitting here in my white lab coat with dirty sleeves (from use), thinking that there is no reason for a practicing physician to support the current health reforms before Congress.  Patients are going to have a rude awakening when their new insurance cards don’t give them the kind of access to doctors they are expecting. Doctors are too frustrated and marginalized to play ball with the president. Here are the reasons that every doctor I know is vehemently against Obamacare:

*  No comprehensive tort reform. Most surgeons I know are struggling with a constant fear of malpractice claims. Most have had at least two or three frivolous lawsuits in their careers to contend with. Most have spent hundreds of hours with lawyers going over the fine print of their records only to have the case settled. Most surgeons are now opting out of accepting insurances in order to afford their malpractice premiums which are often close to $100,000 yearly. Caps on pain and suffering are only one part of the problem.  32 states have some kind of tort reform already, but there needs to be a consistant federal mandate or doctors will hop from state to state.  In California, when caps of $250,000 were instituted, doctors’ premiums did not decrease until a second law compelled insurers to transfer savings to physicians. Nuisance suits can be blocked by creating boards of doctors and lawyers to review cases before they are brought (these boards already exist in Tennessee and Michigan). “Loser pays” statutes can be added (doctors win the vast majority of suits) so that liability insurance companies won’t force doctors to prematurely settle claims to avoid large legal fees.
*  The bills before Congress all include large Medicare cuts. The Baucus bill would cut Medicare by $500 billion over a decade. This will lead to cuts to hospitals who will then be compelled to cut patient services and doctor salaries. The moratorium for not cutting doctor reimbursements across the board by 21% as Congress is supposed to do is not likely to last. Medicare cuts to doctors will cause more to quit or game the system. A changeover from fee-for-service to bundled payments, as the Baucus bill envisions, will leave many doctors out in the cold when they are denied payment for a service that is considered unnecessary or redundant.
*  The growing doctor shortage – the Association of American Medical Colleges calculates we will be 125,000 doctors short by 2025 – does not leave us with the manpower to take care of an additional 30 to 40 million patients. Doctors will be more rushed than ever.          
*  The extension of Medicaid to 10 million more people as the Baucus bill proposes will be a disaster for doctors. Consider that Medicaid often pays doctors less than $10 per office visit. 50% of doctors don’t take Medicaid, and states have already been cutting Medicaid payments to hospitals because most states are having trouble funding Medicaid. Medicaid networks of services and service providers within hospitals are being cut, making it impossible for doctors like me to take care of these patients (we have nowhere to send them for services or procedures).

We doctors are being squeezed, marginalized, ignored, and criticized. Of course we aren’t happy. Of course we feel that it will impact our patients’ care.      

If there is a hardworking doctor out there who thinks the current health reforms are good for doctors or America, I don’t know her.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

While the Obama administration pushes for national health insurance, expensive overuse of technology based on the defensive practice of medicine by doctors is not being considered at all. Doctors over order tests and treatments for fear of missing a remote diagnosis. Doctors are afraid of being sued by aggressive trial lawyers who lobby Congress against real reform.

Though 98,000 people die in U.S. hospitals every year from medical mistakes, at the same time according to a recent Harvard study, 40 percent of malpractice lawsuits are not legitimate, though they lead to 15 percent of the money paid out. Often times the doctors who are sued did nothing wrong, while those who make mistakes too often escape retribution.

Most malpractice cases are won by doctors, but they suffer a long-extended process first where they must meet with lawyers. I know many doctors who have quit medicine or become even more defensive and ordered more unnecessary tests as a result. I remember when the best urologist and one of the top cardiologists at my hospital quit practice abruptly because of extended lawsuits where they weren’t at fault.

On the defense side, lawyers milk doctors for billable time, and on the plaintiff side, ambulance chasers thrive, creating and exploiting frivolous cases for profit.

Many patients get unnecessary operations because of defensive medicine. C-section is on the rise and is vastly overdone because of doctors fearing lawsuits. There is a culture of fear that motivates doctors to practice defensively, which causes costs to skyrocket.

With rationing of care that is inevitable under the Obama health care reform, especially with a public option, malpractice will skyrocket because tests and procedures will be denied and doctors will be blamed. Yet we doctors are too busy and too scared of being singled out to band together to resist.

What is the solution? One solution is to create state review boards like Michigan has to limit frivolous lawsuits. Doctors and lawyers can serve on these boards together and provide a barrier to nuisance suits. More peer review in the hospitals is also a good idea, regular mortality and morbidity conferences where doctors behavior is examined without the fear of lawsuits.

Capping pain and suffering awards would seem like a simple enough solution, but some patients truly deserve a high reward if they’ve been badly mistreated by a physician (as when the wrong organ is removed or a diagnosis is blatantly missed). A better approach is to target nuisance suits for destruction.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

President Obama has mentioned many times that the health reforms he is proposing will not alter the health care of those who already have health insurance and want to keep what they have. But this is NOT the view of most practicing physicians — myself included. I may be one of the most vocal, but I am not alone.

1.  First of all, there is a critical and growing shortage of primary care physicians. Only about 2 percent of the current medical school graduating class is going into primary care. Those of us who already practice primary care are overwhelmed and many are quitting. The public insurances have the most trouble. Surveys show that 50 percent of doctors don’t take Medicaid, and in 2008, the Medicare Payment Advisory Commission found that 28 percent of Medicare patients looking for a primary care physician couldn’t find one. This problem will only get worse under any Obama plan. You may have new government-provided insurance, but you may not be able to find the doctors who take it. And if you do, they may be buried under a pile of paperwork, or be too busy changing over to the new Electronic Medical Records system to spend time with you.

2.  More than 150 million Americans have employer-provided health insurance. But if there is a public option, your employer may stop providing you with insurance. You may be compelled to take the public option, which will probably provide you with less real health care choices.

3.  If the public option grows bigger, because private insurers find they can’t compete, expect care to be rationed, as the government makes choices to try to contain costs. Reimbursements to doctors will be cut, as they have been under Medicare and Medicaid, but also, you may not be able to get dialysis if you are over a certain age, or you may have to wait on long lines for procedures, as they do in Canada.

4.  Bottom line — extending a system that already has too few primary care doctors who are overworked to the entire population does not bode well for prevention or quality of medical care. The costs will continue to spiral upward, and access will decrease rather than increase. A better approach would be to work on re-organizing the health care system towards prevention rather than intervention BEFORE expanding it. One way would be to pay for the education of primary care doctors and create a task force to treat the uninsured.

For more on my take on public health insurance and how doctors view it, check out my oped in Monday’s NY Post.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

I am very disappointed with Saturday Night Live’s depiction of governor Paterson.

For years I have watched the show admiring its originality and satire. SNL is a strange animal — it can make us laugh or even cry, but it should not hurt. Making fun of someone’s disability is not creative, it’s downright hurtful.

I think that even Howard Stern — who is known for pushing the limits of comedy, and many times makes my friends and me laugh — would not consider this skit on Governor Patterson humorous. Of course, I could be wrong.

It has taken many years for society to become cognizant of the fact that people with disabilities deserve respect and support. We’re living in difficult times. Because of the current economic strain, budget cuts will be made that will affect healthcare and programs that many disabled citizens so desperately need.

Being in the media, I know that television production is in dire need of good content, however, we must keep in mind that respect for others is of utmost importance.

Governor Paterson is a decent man trying to do his best during some of the most difficult times this generation will see; a generation that includes many of the writers and actors on SNL. Therefore mocking those with disabilities is neither appropriate nor funny.

Let’s face it; that is not creative comedy.

A recent survey of 12,000 general practice physicians found that 60 percent of them feel they’re overworked, are planning on quitting or cutting back their hours, and that they would not recommend medicine as a career.

I get it — I too feel tired and overworked — but I would not go as far as to say that I don’t recommend medicine as a career. Medicine, to me, is an art. I just wish I could practice it with less bureaucracy. One of the most common complaints I get from physicians, nurses and general medical personnel, is the tremendous amount of paperwork that is required in today’s heavily regulated industry. Many people would argue that physicians brought this upon themselves, that all this regulation was necessary to make sure safety standards grew and that patients’ bill of rights were protected.

So I asked some of my friends in the healthcare field: “Would President-elect Obama bring good news for our healthcare system?” And the most frequent answer I got was, “We don’t know.”

I believe some of my peers feel that there are so many priorities for our new government, healthcare may take a backseat.

So then I asked them, “How would you advise our new president-elect with regard to some of the doctor dissatisfaction survey results?”

Here’s a compilation of their wish list:

1. Malpractice reform

2. Significantly reduce the cost of medical education

3. Educate the consumer to create realistic expectations on what the healthcare system can provide

4. Decrease bureaucracy

Let’s face it, there are many choices President-elect Obama can make. But unfortunately, with the state of the economy being a top priority, his resources are limited and his agenda is yet to be seen. So I guess as physicians, we just have to continue to create innovative ways to save the American healthcare system. But one thing is for sure — I still dream of my little girl being a doctor one day.

The other day I was asked if I expected an increase in the number of babies that I will be delivering in 2009 and I said “Absolutely, I expect an Obama baby boom.”

Now this is a topic that I know a lot about. Pregnancies come in cycles. I mean let’s face it, some pregnancies are accidental, some pregnancies are planned. But the trend has always been that life-changing events tend to bring people together. And you know what happens when we bring people together―nine months later, we have a blessed child.

I don’t know what it is about these life-changing events―maybe fear or euphoria is the most attractive indicator―but nonetheless, as someone who runs a hospital that delivers more than 6,000 babies a year, I have a pretty good idea when we can expect our birth rates to go up.

Now let’s talk about those life-changing events. Politics in and of itself does not make a very sexy scenario to plan a pregnancy. But I can go as far back as 1961 with the election of John F. Kennedy to tell you that following his election cycle, we saw an increase in births. The last four Republican presidents have also seen a spike in the birth rate during their presidencies. So if the trend continues, I do expect president-elect Obama to give us a significant increase in the national birth rate.

However, I think that this Obama baby boom might be more significant than others. The reason? There are two key factors president-elect Obama is bringing to the table that we have not seen on a national level in many years. Number one: Obama has such a positive optimism in some of the changes he has offered, which have resonated in the psyche of many Americans. And two: One of the top priorities on president-elect Obama’s agenda that he would like to try to accomplish in the early phases of his presidency is healthcare reform.

So I hope that president-elect Obama sets his sights on women’s healthcare with a focus on giving women the access to prenatal care that they truly deserve. Yes, this is going to be “change that you can believe in.”

No matter who wins Tuesday, both candidates have reminded us that one of their first priorities when they take office in January will be the economy, and a close second: healthcare… No! Wait, it will be alternative energy and healthcare―or better yet, I think it was foreign policy and healthcare.

Well any way you look at it, healthcare reform is always one of the Top 5 items politicians would like to tackle after winning the election. But somehow, it always seems to end up taking a backseat to what they perceive as “more immediate” popular needs.

As a practicing physician, I always feel like a bridesmaid, but never a bride. Yet in this election, I truly feel a marriage is in my cards. Now maybe I sound like a hopeless romantic, but if you think that Wall Street has problems, our healthcare system is worse off.

Every time we mention the issues with healthcare in this country, many ill-informed individuals  immediately begin to critique our nurses, doctors and researchers, making idiotic claims that Cuba or Venezuela have it better than we do in the U.S. And trust me―I have visited many hospitals and talked to the leading physicians from all around the globe―we are still the envy of the world. 

So when healthcare is put on the political agenda, we do not need to reinvent the wheel. We just need our government to give us the same attention that they have been giving to the crisis on Wall Street―and understand that our future is at stake as well.

So just like our economic and political pundits hoping for their perfect gift―I too have made my list―and I hope that the politicians are not stingy, and give me the “wedding” of my dreams.
 
1. Create affordable healthcare insurance for all families with CHOICE.

2. Make hospitals and physicians accountable for quality and create incentive for success. The incentives should be fiscally responsible, yet REAL.

3. Create the “Pregnant Women’s Security Act.” We need to decrease premature labor in the U.S. and give financial protection to women with high-risk pregnancies that cannot work.
 
4. Invest in healthcare infrastructure.  We need to built more hospitals and give access to these hospitals to secure federal loans with favorable terms.

5. We need more nurses. Help nursing students get educational aid and foster the nursing science.

So all I can hope for on our “big day” is that this election brings a union between two American institutions―politics and healthcare―and a president who is really committed to the best interests of the American people.

After reading the story about the couple in Arkansas that is suing the doctor and hospital because the wife became pregnant and miscarried after her husband had undergone a vasectomy, I understand how a patient could get upset and disappointed about having had that outcome happen to them.

But I’m also disappointed by the fact they’re rushing to sue the healthcare establishment for negligence and defamation and are seeking unspecified monetary damages.

Now, I don’t know of any procedure that is risk-free. If you go up and down the medical literature, you will always find that there is certain percentage of patients that will experience complications and/or contribute to failure rates. Therefore it seems that we must always sue any doctor who has a complication or a failure in the procedure.

My friends, if this trend continues, we will further weaken our healthcare system.

If you read medical articles written on failure rates of vasectomies, you will find that each and every one of them quotes a small but real risk of a subsequent pregnancy. I think that many folks hear “small risk” and somehow translate it into “no risk.” Failure to communicate this type of information to patients does represent a negligent act on the part of the physician, but if the information is given, then there is a mutual responsibility among doctor and patient of understanding the reality of medicine. A vasectomy can fail within the first 3 months after surgery, and even though the chances are much less, it can also fail one year after surgery.

Yes, I know I don’t have all the facts in this case, but let’s be fair about what medical science is: not always perfect.