There are several reasons why I believe that most doctors are unhappy with the direction that health insurance reform is taking. I address several of these reasons in my oped in today’s NY Post (September 23rd, 2009). I will also outline them here. Suffice it to say that adding more patients to the health care turnstiles and promising them access to quality physicians when there is a growing doctor (and nurses) shortage and a growing doctor (and nurse) discontentment is problematic at best. The blanket of health insurance that Congress and the president envision is not long enough to cover the body of health care. If we pull it down to cover the toes, the head will be exposed. If we stretch it to cover the uninsured without dealing with cost or the doctor shortage, we will end up taking care away from those who currently have it and need it (the elderly and the disabled to name two groups who are endangered). Remember, physicians who aren’t functioning well have a negative impact on health care.

Reasons for doctor discontentment:

• No meaningful tort reform is included in any of the current bills under consideration in Congress. No shared liability with insurances or the government, no caps on pain and suffering, no review boards to limit nuisance suits, no “loser pays” allowance, despite the fact that physicians win the vast majority of suits.
• No significant subsidies to primary care education, despite the fact that there has been a decline in those choosing primary care of over 50% over the past decade.
• Big cuts to Medicare and Medicaid payments to doctors and hospitals of hundreds of billions of dollars in the bills, despite the fact that doctors are already cut to the bone in terms of increasing expenses and decreasing reimbursements.
• Cuts in payments for procedures and mechanical devices will put more pressure on doctors as patients express their (deserved) discontent, and there is nothing a doctor can do.

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

I read an interesting article today reporting the findings from a poll that seriously contradict what the White House and the AMA have been suggesting about the way medical professionals feel about the proposed bill to overhaul the health care system. And while I can’t say I’m surprised at the overwhelming negative response to the plan – the statistics speak volumes.

An IBD/TIPP poll found the following:

– 45% of doctors polled said they would consider leaving their practice or retiring early if the proposed health care bill was to pass

– 65% or 2 out of 3 practicing physicians polled say they oppose the plan

– 72% of doctors polled disagree with the administration’s claim that the government can cover 47 million more Americans with better quality care and at a lower cost

Click here to read the full article

I think there’s some truth to this study – and here’s why…

Right now, doctors are caught between a rock and a hard place and we have very few alternatives – many doctors have already started moving to other parts of the country where there is less government regulation on how they run their practice. What we are finding – and will continue to find with this health care bill looming – is that doctors have already started dropping their private practices and taking hospital jobs. Many are changing specialties or plan on not offering certain procedures because of strict government regulation once we move toward a universalized health care system – and for those doctors to perform procedure using local hospital facilities, well, that costs money, too. We’ve been facing a primary care doctor shortage for years now, and the numbers continue to drop. All of these things have a negative impact on the quality of care patients receive.

So I want to do a little research of my own. I want to hear what YOU think – especially if you’re a doctor or in the medical field. How do you feel about the proposed bill and do you think that it will cause doctors to leave the medical field?

Make your voice heard! I’ll be reading some of your comments on FOX & Friends tomorrow morning at 6:30 a.m. E.T., where we’ll be discussing this report in more depth.

As President Obama tries to remake the American health care system, the gutting of psychiatry by insurance company policies and other administrative forces is a good lesson in what to avoid. 

The endless red tape inherent in dealing with many insurers and the loss of professional autonomy to insurance company “reviewers,” has led many of the best and brightest psychiatrists and psychologists to accept no insurance reimbursement at all.  Psychiatrists have, if you will, acted out Atlas Shrugged, Ayn Rand’s cautionary tale of what can happen when institutions throttle individuals.  They’ve walked away and taken their gifts as healers with them.  In fact, when I refer patients to other mental health care professionals, it’s very challenging for me to find clinicians I consider in the top echelons of my field who will accept third party reimbursement of any kind.  A brain drain has siphoned off access to some of the wisest counsel available in psychiatry, except for those willing to pay cash, and I believe the same could happen (or greatly accelerate where it already is happening) in other medical specialties.

The influence of insurance company policies has also led to the public being served by professionals from allied health fields, such as clinical nurse specialists.  The need or desire for these companies to save money, which will only be accelerated by the current Obama plan, means social workers and nurses are the preferred providers of psychotherapy and medication evaluations to those battling depression and schizophrenia and bipolar disorder.  This phenomenon could find its reflection in the firm ground of internal medicine and endocrinology and obstetrics and other specialties yielding to intellectual quicksand, in which the knowledge and skills of physicians often disappear from the landscape entirely.

There’s nothing inherently wrong with getting your health care from physician assistants and nurses.  But these folks didn’t go to medical school, and didn’t complete residencies, and if I were confronting a serious condition I’d want to be treated by people who had.  I’d pay for it out of my own pocket.  And my guess is that we’ll end up having to.

Oh, one more thing:  Not only did many psychiatrists walk out on the system, lots of the ones who stayed let their practices be shaped by insurance company reimbursement policies that pay them more to prescribe medications than to talk to people.  So there are a whole bevy of shrinks who’ll see you for ten minutes once a month and just write you a prescription.  It actually pays pretty well, even if it leaves them out of seventy percent of what can restore patients—effective, expert psychotherapy.  That medical art is in danger of extinction.

See, Obama’s eight principles for overhauling health care address economics, access, prevention, safety and cost.  They don’t address how to preserve the core of the world’s most successful, powerful, inventive health care system ever:  the contributions and creativity and commitment of America’s physicians.

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

These are interesting times we’re in ― to say the least. Over the past couple of weeks, we have all been concentrating on “Octomom” from California, and with new developments in the story everyday, it’s easy to see why she’s been the topic of conversation. I was following the story too, calling for an ethical investigation of the fertility clinic from day one, but with the state of our economy and the country experiencing what could be one of the most pivotal moments in American history, I want to move past that story.

I think it’s time the media starts concentrating on the changes that the Obama administration will be proposing in the future and some of the ideas that have already been approved.

Now, let’s look at the facts … The American health care system needs help! Why? Well, because it is filled with inefficiencies and overpriced operational costs.

How did it get like that? Well, it’s possible the American health care system has seen a lot of the same issues as our financial sector ― which we all know by now is quite a mess. Our financial experts have given us many explanations for the current economic crisis: Many blame the banks for recklessly handing out loans and credit, some blame the public for borrowing more money than they could ever repay, then there’s all the greedy Wall Street executives making profits off back of funds that don’t even exist, and who can forget those elaborate Ponzi schemes that went unnoticed by federal agencies for years.

Well, believe it or not, we have a lot of the same things happening in health care. We have some patients that demand every test in the book on the basis of what they’ve read or seen on television, hospitals that have been enamored with demands because of technological advances and profit margins, and doctors that have concentrated on sub-specialty service, rather than primary care and prevention.

So now, we are all looking to President Obama’s stimulus bill to see how he will resolve these problems. Some of his proposed ideas are very interesting. Electronic medical records, for instance, provide us with computerized data entry on patients, a way to track symptoms, disease processes, a way to dramatically decrease the overutilization of certain tests, minimize medical mistakes both by physicians and hospitals. And down the road, it might even decrease costs.

But many critics worry about privacy issues. I totally agree that patient confidentiality should always be protected. I remember when the new HIPPA laws came into effect under President Clinton, I could not even discuss a patient’s medical condition or get a second opinion from a colleague without getting a written consent from the patient.

But I think that before we start throwing good money in to solve the problems bad money got us into, the way previous financial stimulus plans have, we need to really understand how our current health care system is working, and address the issues that got us here in the first place.

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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.

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.