Sunday, July 1, 2012

Another Doctor Squeezed by ObamaCare

A physician colleague posted the following on Facebook, as part of a discussion of rethinking his career in the wake of the Supreme Court ObamaCare decision. Basically, the new government controls will drastically limit his autonomy to practice, force him to fire people, and shatter his dreams of owning his own small private practice.

He has given me his permission to repost this lightly-edited excerpt:
We all go into medicine for different reasons. We all believe in 'helping people,' as we all wrote in our admissions essays. But we all also have enlightened self-interests in pursuing a career in medicine.
Some of those are related to money, to scientific inquiry, take part in an endeavor worthy of respect, etc. A big part of my decision to enter the Art was also to be able to take a bigger role in guiding my life's wishes, i.e. autonomy. 
As a lowly lab tech & employee, I was frustrated being at the mercy of others. I saw medicine as a way to take control of my own life. And I love it at present given all of its current faults. I can decide how much to work, what types of patients to see, how much time I spend on certain patients, etc.
But this bill directly attacks that autonomy in ways no individual insurance company could ever. ACOs [Accountable Care Organizations] with their care rationing incentives, bans on physician-owned hospitals (i.e., there will be no new Mayo Clinics or competition to Big Hospitals), meaningful use, gold-silver-bronze plans with dictated coverage, the IPAB [Independent Payment Advisory Board], etc., all centralize decision making authority away from doctors and patients and move that to government bureaucrats whose main concerns may be costs or graft.
While the rest of the world becomes more vibrant and flexible through decentralization, this Administration has 1) identified people like me (us) as the problem and not the solution, and 2) placed itself on the wrong side of history (and freedom) by centralizing perhaps the most important decisions people will be making about their lives and some of the most important recommendations that doctors can provide to them during their time of need.
So while I can morph to make sure I still make a decent wage, how do I maintain my self-respect in a setting that doesn't value my contributions?
Second, I would respectively challenge your notion that I've come a long way in all of this. 13 years ago I was living month-to-month with little savings and feeling trapped. Now, I am up to my ears in debt, essentially living month to month with no savings. I can't afford a home. I am just a couple of paychecks away from being homeless and defaulting on loans. And I don't have any great escapes that wouldn't negative impact my family (i.e., I'm still trapped). I knew that it would be tough before it would get better.
And while I'm now beginning to see the light at the end of the tunnel where I will get ahead of the game, I have an Administration that says I have to spend six figures on electronic medical records (which of my employees do I fire to buy an EHR [Electronic Health Record]?), that will filter some (and eventually all) of my payments through a big hospital system, that says I am the problem with medicine, that taxes me to death, that has frozen with regulations and taxes my small business from hiring above 50 employees so I can compete with larger providers, that outside of medicine claims that I am not paying my fair share, that's made it more difficult for me to get a loan, that will increase the costs of insurance for my patients, that will tax me as a specialist to shuttle more money to PCPs that will take worse care (if you believe the studies) of asthma & allergy patients than I do, etc.
Up to this point in my life, I've been an optimist because I felt that I could overcome any challenge. Now, I don't see how my dream of owning my own small medical practice is possible with what's coming down the pike.
So, do I employ a bunch of NPs [Nurse Practitoners] and essentially become an administrator, do I go off the grid and open a concierge IM [Internal Medicine]/allergy practice, or do I find something else to do?
(Note: The material in square brackets [ ] are my own insertions to clarify some of his abbreviations.)

I really hope my colleague doesn't decide to leave the profession, especially not after all his years of hard work, including college, medical school, residency, and fellowship.

But I wouldn't blame him if he did.