A friend of mine recently alerted me to this series of interviews on CNN.com that asked physicians what they thought about health reform. Their answers were interesting. Before I get into what they said, however, I think it's important to acknowledge the strengths and limitations of the approach. The obvious strength is that when you want to know how doctors feel about health reform, you ask doctors, not anyone else. It's also a strength that they conducted interviews rather than a polling survey, because the interviews offer more depth--they have the potential to uncover more than a survey can, especially when the topic under investigation is a new one--and successfully enacted health reform is pretty novel of late.
The limitations are that interviews aren't very representative. They can't be, really, unless you do tons of them. Still, it's useful to try and capture a broad swath with the interviews, so that you can feel good about the likelihood that you've identified the views of a wide range of physicians. The CNN interviews fall short in this regard. They interviewed 6 doctors. That's 1 doctor interviewed for every 120,000 doctors practicing medicine in America. You can see why generalizability is a problem. Moreover, of the 6 doctors interviewed, one is a family physician from New Jersey, one is an emergency physician in the Army, one is an emergency physician from Ohio, one is a medical student in Pennsylvania, one is a family physician from Indiana, and one is a general surgeon from Pennsylvania.
So, there's no representation of physicians from the south, west, or upper midwest parts of the country, and there's no representation of many of the medical specialists who represent the bulk of the physician workforce. Should the folks at CNN have been talking to family physicians and ER docs? Absolutely. But what about dermatologists, urologists, or cardiologists? All of that leads me to conclude that these doctors quotes should be taken with a large grain of salt rather than considered as the gospel. Still, that doesn't mean that what they say is without value. So, let's take a look:
One doc reports feeling like a hamster on a wheel, working for the insurance companies rather than the patients. She says in one breath that "The passage of this bill does not fundamentally change the flaws in this system..." and in the next acknowledges that "the legislation benefits my patients." I've got to say, that's an interesting paradox, because if the legislation benefits patients, that's a pretty instrumental change. Now, I don't think it's a panacea, but I don't think it does nothing, either.
The emergency room physicians are worried about the lack of tort reform in the law, and their belief that the law does nothing to control costs or require payment for services rendered, which will continue to erode the services they provide by law under EMTALA.
The medical student hints strongly that he'll not be entering a primary care field, because he wants to be able to repay his medical school loans, and the new law doesn't provide him with strong enough incentives to do otherwise.
One physician says he "basically works for free" which is hilarious considering the average salaries of physicians ranging from the high five figures into the mid-to-high six figures, depending on specialty. The costs of business may be high, but doctors aren't starving, and if anything, as this physician points out, insurance is the culprit that makes operating margins so slim. He concludes: "What will the new health care law mean for me as a primary care physician? Hopefully it will mean that we will get paid a little more for what we do, which would allow us to actually spend time with our patients and stay in business."
The general surgeon has a pretty reasoned approach to the issue. He acknowledges that "It is unclear to me whether the recent legislation will significantly impact me..." and states clearly that "It will certainly not affect how I deliver patient care." That should be reassuring. After all, isn't that what everyone is so afraid of? Finally, he says "Change in the health care system needs to start somewhere and hopefully this legislation is a step in the right direction." I couldn't agree more. Again, this isn't a panacea, but it is a start on the road to improvement.
But what do other doctors think about health reform? Do all or even most of them agree with the voices of these six physicians? Not really. In fact, as an article from Maggie Mahar highlights, two physician lobbies are in complete disagreement on the issue. I think you'd find her coverage of the Association of American Physicians and Surgeons and the National Physicians Alliance to be quite interesting. You can read it here.
If you read what I write here 3 times a week, you really ought to consider reading my daily blog. That means you should subscribe to Wright on Health and tell your friends and family to do the same. I'm counting on you to spread the word! You can also contact me here.