Health Overhaul Could Force Doctors to Quit

Published October 13, 2009

A September 15 Investor’s Business Daily editorial revealed stunning poll data showing 45 percent of American physicians “would consider leaving their practice or taking an early retirement” if Congress passes President Barack Obama’s proposed health legislation.

As a practicing physician, I’m not surprised. These numbers mirror the sentiments I’ve heard expressed by my colleagues. I’ve been in practice for more than 15 years, and I’ve never seen physician morale as low as it is today.

Older physicians have told me they’re glad to be “getting out” and retiring soon. Medical students have asked me whether they should switch to engineering or pharmacology before it’s too late. Physicians in the middle of their careers are just hoping to survive any “reform.”

The same IBD poll also showed an overwhelming majority—65 percent—of physicians oppose the proposed expansion of government in medicine. They have every reason to be concerned.

Unwanted Consequences

One reason many physicians are skeptical of the proposed reform is because they already know what government-run health care is like, in the form of Medicare. Many proponents of universal health care want to create “Medicare for all,” claiming it’s a model of efficient, compassionate care.

But as The New York Times reported in April, more doctors are opting out of Medicare for two simple reasons: “reimbursement rates are too low and paperwork too much of a hassle.”

Physicians also have seen the problems in states like Massachusetts that have attempted to implement universal health care, and they worry about its implications for the rest of the country. The plan announced by Sen. Max Baucus (D-MT) is based closely on Massachusetts’ plan, including mandatory insurance, subsidies for low-income residents, and strict new regulations on insurers specifying whom they must cover, what benefits they must provide, and what they can charge.

Skyrocketing Costs

As a result, insurance costs have skyrocketed, raising the costs of the state subsidies. In response, the state has cut back on its payments to physicians and hospitals.

“Every time I have a Medicaid patient, it’s like handing them a $20 bill when they leave,” Dr. Katherine Atkinson, a primary care physician in Amherst, Massachusetts, told the Times for an April 5 story. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”

Because of perverse government incentives punishing physicians for taking patients covered by the state’s “public plan,” many patients face long waits for care—as much as a year for a routine physical exam in western Massachusetts. And this is despite the fact that Massachusetts “has the highest physician-to-population ratio of any state, in primary care as well as overall,” according to the New England Journal of Medicine.

Expanding the Massachusetts plan to the national level would multiply this problem by 50.

Rewarding Doctors

Finally, physicians worry universal health care will compromise their ability to practice according to their own best judgment and conscience.

Obama’s “stimulus package” included $1 billion for “comparative effectiveness research” in health care. Writing in the August 18 edition of The Wall Street Journal, Harvard professor Martin Feldstein noted the government’s eventual goal is to use this research to cut costs and ration medical care by “implementing a set of performance measures that all providers would adopt” and by “directly targeting individual providers … (and other) high-end outliers.”

In other words, your doctor would be rewarded if he practiced according to federal guidelines and punished if he strayed too far from them.

If you have abdominal pain due to gallstones, who should decide whether medication or surgery would be “most effective” for you? The doctor who felt your abdomen, heard your heart murmur, saw your ultrasound, and knows your drug allergies? Or the bureaucrat who got his job by telling the right joke to the right person at the right Washington cocktail party?

Most physicians I know aren’t in the field primarily for the money, although they do expect to be fairly compensated for a job that requires rigorous study and costly training. They do it because they love their work, including the ability to apply those years of training to benefit their patients. They passionately want to use their skills according to their best medical conscience.

To practice good medicine, a doctor must be left free to use his reason, his experience, and his judgment. Obama’s health care plan would destroy your physician’s willingness and ability to use his mind for your benefit.

Some doctors will grit their teeth and still try to do their best for their patients. But they will have to waste hours arguing with bureaucrats, while their less-conscientious colleagues can just punch a clock and go home. How long will the better doctors continue working under a system that constantly punishes them for their virtues? And when the good doctors finally retire or quit in frustration, what kind of doctors will remain?

Will your doctor be one of them?

Paul Hsieh, M.D. ([email protected]) practices in the south Denver metro area. He is cofounder of Freedom and Individual Rights in Medicine. This article originally appeared on and is reprinted with permission.

For more information …

“Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription,” by David C. Goodman, M.D. and Elliott S. Fisher, M.D., M.P.H., New England Journal of Medicine, April 17, 2008: