• Do you really believe 83% of docs are considering quitting?

    I was going to ignore this, but too many of you are asking me about it:

    Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

    The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

    I don’t even know where to start with this. How about with the DPMA? Here is their “non-partisan” stance on the PPACA:

    The Patient Protection and Affordable Care Act (PPACA) was signed in to law by President Obama on March 23, 2010. Doctor Patient Medical Association believes this law, with over 12,000 pages of new laws and regulations giving sweeping new powers to political appointees like the HHS Secretary and IRS is detrimental to the medical freedom of medical professionals and patients.

    It is DPMA’s position that PPACA is the Destruction Of Our Medicine, attempting to insert the government and bureaucrats between the relationship and decisions of medical professional and their patient.

    By the way, their “position” makes the acronym DOOM. Unbiased!

    Getting past that, their methodology is not very detailed. Their response rate is small. Their questions are oddly phrased and not symmetric.

    Let’s get past even that. Let’s just take the top line result. Does it pass the smell test? Do you really believe that 83% of doctors are considering quitting because of the ACA? Do you really believe that only 17% of docs are NOT considering quitting? Really?

    Anecdotally, I’ve heard of no physicians whatsoever who are quitting; I work with a lot of docs. But let’simagine my experience is abnormal. Remember that about 20% of physicians make an earning placing them in the top 1% of the country. Medicine, above any other profession, is more likely to earn you that much. This survey would have you believe that more than 80% of us are willing to throw all that away, just because of the ACA.

    What will all those doctors do? If you believe what they complain about in the media, they’re just squeaking by. They’re not “wealthy”. The job market is terrible, no? What magic high-paying jobs do you think they will get?

    Or is it more likely this is just posturing from a potentially biased group, and not a real prediction of what will acually occur?

    @aaronecarroll

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    • It is hyperbolic, hysterical, frothing at the mouth nonsense.

      We (doctors) don’t even stay home when we’re sick, let alone quit practice because our marginal income may go down a click or two.

      In fact, the target income hypothesis, in which I am a strong believer, suggests that we will try to work more and harder to counter any loss in income – not that there is any of that in the health care law.

    • You don’t agree with their DOOM science? What’s wrong with DOOM science?

    • Clearly ridiculous and demonstrates nothing more than the capacity to misrepresent the opinions held by a particular group using a terribly flawed survey.

      In my estimation, the only groups of practicing physicians where you might see an effect would be late career physicians who are a) financially set for life and in a financial position to retire comfortably and b) harboring a hostility to the ACA that renders them a few standard deviations beyond the norm on this point.

      (IMO)At this stage, most physicians who dislike the legislation (I’d venture that they are in the minority) will grumble to themselves a bit more and soldier on for now. Having said that – the existence of a useless survey makes me curious if there’s been a well conducted survey that actually comes closer to capturing the actual sentiments of practicing physicians and breaks them into meaningful groups like specialty, institutional affiliation, age, and gender.

    • I reviewed this after someone posted it, as it didn’t pass my smell test either.

      A biased organization, a question phrased very nebulously, citing “changes to the health system,” not PPACA, and having only 3 options, deliberately skewing the result. And then checking the demographics, they skewed towards older, more experienced physicians who may be approaching retirement age anyway, and who could reasonably be “scared off” a little early by a movement to electronic health records and from fee-for-service–there’s no real way of knowing if they are really scared by “Obamacare.”

    • So doctors will quit practicing with the introduction of Obama Care. Well OK, what will they do then? What are their options: Turn to professional golf/tennis? Teach in Medical Schools? Become daytime TV talk show hosts/stars? Start a blog? Seek trophy spouse? Sell pharmaceuticals or medical equipment? Stay home and take care of the kids so the wife can support the family, unless of course she’s a doctor and is quitting too. Go to work for a managed care plan denying care? Run for public office. Actually more career options than I initially thought. Investment banking….that’s it. Better yet go to law school.

      I think what they mean is that they’ll stop practicing independently and become employees of some type of health care system.

      I just know too many physicians who retire and can’t stand it and return to practice at free clinics or overseas missions or part time in urgent care centers. They can’t quit. They don’t know how to do anything else.

    • I sent it to you because it was amusing. Only 4% of doctors responded to that mail in poll. I wrote a post to make a point about survey design. http://push-hc4allpa.blogspot.com/2012/06/healthcare-poll-insanity.html

    • Having read the questions, I think the DOOM survey was designed to get the result that it got so that like a Rorschach test unhappy or baffled physicians can explain it any way they like. I choose to see it as physician’s expressing frustration with the Supreme Court upholding the individual mandate to pay for health care through the profit sucking industry of health insurance companies. There is no public exchange and so patients and providers remain separated by insurance companies who are not motivated by patients’ health care or providers’ ethical responsibilities.
      Who would not think of bailing out of THIS particular “fix” to the healthcare reform? Docs who say they are afraid of government interference should wake up–everything we do is regulated by the government: medical license, DEA #, Federal student loans, CMS funding of your residency program and medical school, hospital where you admit.
      Insurance companies are simply a siphon in the system which will charge premiums so high (because there are no limits on premiums in all of those pages of legislation) the problem of the uninsured will still persist.

    • I dont know anyone quitting out of the many docs I interact with. Certainly none in my group are quitting.

      Steve

      • Did you read the Original survey?

      • As an attorney who represents many doctors, I know many who are “retiring” early due to Obamacare. I know one doctor in particular who says he left Canada because he got tired of the government interfering with his ability to practice medicine. He’s had enough and is quitting practicing in the US. He is in his 50s. I don’t know any fairly new doctors (in their 30s or 40s) who can afford to make such a choice — hardly a ringing endorsement. Indeed, in my anectodal world, I am yet to hear a ringing endorsement from a medical professional. In the end, Obamacare is simply a quasi-fascist takeover of health insurance as a back-handed way to control medical care. Before anyone gets too uptight about using the word fascist, you will see that Obamacare clearly within the fair use of the word in an economic sense. What Obama has done with health insurance “reform” and Wall Street “reform” is institute a government takeover of America’s previously private flow of capital. The government is now on a path to control not only education but also decisions of industrial and health policy at proportions unfamiliar to Americans who do not originally come from more statist societies.

    • One of the Sunday morning news programs ran MB’s tweet of this seemingly outrageous statistic across the bottom of the screen during a discussion of the ACA. Seeing the source of the “information,” I assumed that it was some totally made-up piece of misinformation, as is her usual practice, and thought no more of it. Glad to see that someone has looked into this major study, and surprised to find that there was some actual (if dubious) basis for her claim. Aaron Carroll ROCKS!

    • I am a nurse and the last time doctors really quit anything was the family practice docs who quit delivering babies due to high insurance rates. I haven’t found any docs quitting – they grumble about Medicare and Insurance requirements, this is nothing new. What this law is doing, is increasing the use of Nurse Practitioners (which I soon will be), and giving docs more ability to practice preventative medicine rather than having to “treat and try to cure” as much – there is always more money to be made at the end than the front. The family practices never have been rich, it is the specialists. This is a biased group, I could skew a poll the other way!

    • It does highlight the rarity of surveys among physicians around health policy and health reform- best studies done to date by several ex clinical scholars – here http://www.rwjf.org/files/research/48408physician.pdf- response rate of 43% and clear and rigorous methodology.

    • I was reading your short response regarding the DPMA study claiming that 83% of doctors were considering leaving their practice due to the PPACA. This is one of the co-chairs of this supposed non-partisan group of doctors and patients.

      This group is not only linked to Tea Party leadership, but also the American Legislative Exchange Council, a conservative group who recieves most of it’s funding from corporations.

      http://www.teapartyexpress.org/leadership

    • I closed my independent practice and relocated so that my wife, an ex-Federal Public Defender could attend the newest medical school in our nation.

      After retiring from the military we both choose to reloacte to the two poorest counties in Texas. As the only board certified Intensivist and Cardiologist for a total population of about 100,000 people, we both did not sleep much (she ran my office for 8 years) but we made an enormous impact for the benefit of our patient’s.

      However, by fortunate chance she was accepted to Medical School the same year the US Government drastically cut reimbursement for cardiology services. Because of the poverty of the communities in which I practiced, I estimate 1/3 of my work was not compensated. This was OK with me, as I made a good living, and as a German by birth, going to sleep every night at 1-3AM seemed OK, especially since my wife worked next too me.

      But the loss in revenue made the practice unsustainable. A long discussion, but the ACA if in existence than would have kept the practice viable, since so many of my patients admitted from the ER had no medical insurance, and as we all know critical illness and cardiological diseases are very impatient entities.

      I have no plans to retire, now or until the day I die in place…. what sense is there for any of us who have labored so long in the perfection and pursuit of the glory’s of the art and science of medicine to leave a life time quest for never to be attained perfection.

      Not to seem crass, unfeeling, or unempathetic, but honestly have any of us ever cared for a 80 year who had retired at 55 or 60 and wondered at how that successful person could have richly and completely filled his life with endless days of golf?

    • What a spurious report this is.The Authors condensed many reasons Doctors have mused about leaving the Profession down to one the ACA.
      This is false! Read the original report.
      This response to what could be seen by many as a negative to the ACA is
      spin pure and simple.