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How are the Doctors affected by Reform

Doctors - where do they stand?

The level of doctor discontent with Obamacare is growing and the doctors are becoming more outspoken.  Given that it is estimated that many doctors would leave medicine and more would not join medicine, with Obamacare, it is of grave concern to the public.  Also it is becoming apparent that the doctors in general would take as much as a 20% pay cut in the government run system. 

It is also becoming apparent that Obama one does not understand the decisions that doctors make with their patients, nor the quality of these decisions.   Looking also more closely at Medicare, it is also clear that Obamacare does not fix anything wrong with Medicare, but rather spreads it over the entire healthcare system.

Doctors need to comprehend what Obama is really saying, and the notion that Doctors somehow are not making good decisions is most apparent in this article.  Obama has criticized insurance and the doctors, leaving Hospitals and Pharma to cut deals that seem quite insecure at the moment, so what is next?  If he really looked at the cause of the problem and looked at healthcare reform was market reform starting with government policy reform, then we could progress on healthcare.

Several outspoken doctor associations continue to drive towards a single-payer system as their first choice for healthcare reform in America.  It is a good indication of the struggle that doctors have in general with the third party payment systems that exist.  The level of doctor dissatisfaction with the healthcare system continues to grow to a high percentage. 

The AMA, which a small percentage of the doctors in America as its members (one estimate has it at 15%), is finding itself more marginalized as a lobby group.  The AMA is a risk to doctors in this country.  It also has been instrumental in keeping the number of doctors per capital at one of the lowest in the OECD group of countries.

The compensation for doctors is something that pay experts can comment on .  An argument can be made that given the system of litigation, regulation, and the length of time a doctor prepares to be practice medicine, that this compensation is within some boundary.  It can also be argued that the pay is inflated due to the low number of doctors practicing medicine, (2.2 per 1000 citizens, versus 3.6 of the highest OECD country).  The nature of the work is quite demanding for most.

Certainly the threat of law suits, the move towards large healthcare companies (who can afford the lobbyists) is a factor in their economics and lack of satisfaction.  Regulations and their effects on doctors are of concern for doctors.

The comparison of Kaiser with the IHS in England finds that Kaiser has roughly the same number of doctors, but a much higher percentage of specialists.  Also the MRI, CAT Scan machines are highly in Kaiser's favor. 

Since most of the healthcare services go a small percentage of the people, it would certainly make good sense to improve and make more wide spread best practices by doctors and hospitals.   To do so would save an estimated $500B in annual healthcare costs

Also the notion of tying healthcare to quality metrics is on the surface not a bad idea, until one realizes that these metrics are policies handed down to doctors to cause decisions to be slanted toward the central ideas.  This can have deleterious effects on quality, as two doctors detail.

It does not seem to have become widely accepted within the doctor community the implications of Obamacare.  The restrictions and social decision making that doctors will be performing will cause wide spread concerns for their role in society.

Financing Residency Programs

The Department of Health and Human Services, primarily Medicare, funds the vast majority of residency training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education or DME payments. Medicare also uses taxes for Indirect Medical Education or IME payments, a subsidy paid to teaching hospitals that is tied to admissions of Medicare patients in exchange for training resident physicians.[1]

Overall funding levels, however, have remained frozen over the last ten years, creating a bottleneck in the training of new physicians in the US, according to the AMA.[2] On the other hand, some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $35,000 per year) that are far below the residents' market value.[3][4].

Nicholson's research suggests, in fact, that residency bottlenecks are not caused by a Medicare funding cap, but rather, by Residency Review Committees (which approve new residencies in each specialty) which seek to limit the number of specialists in their field to maintain high incomes[5].  I

n any case, hospitals trained residents long before Medicare provided additional subsidies for that purpose. A large number of teaching hospitals fund resident training to increase the supply of residency slots, leading to the modest 4% total growth in slots from 1998–2004..[2]

Comments on Above Residency funding: (from Yale)

Non-primary care physicians earn considerably more than primary care physicians in the United States.  I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating a shortage of non- primary care physicians.  Entry barriers exist due to cartel behavior by residency review committees, regulation that until recently required residents in all specialties to receive the same wage, and/or scarcity of teaching material. 

I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents’ salary of $34,000.  In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated $0.6 to $1.0 billion per year in labor costs.