Doctors, An Endangered Species Thanks To The Republicans

doctor photo


After your next checkup, if you know your doc pretty well, take a little time and ask him/her how the insurance companies are treating him/her under the new government health care plan. If said doc is honest, he or she will admit to being extremely frustrated over developments that could cost their practice some really serious money.

Doctors’ fees under the marketplace segment of the Patient Protection and Affordable Care Act (ACA) are, in many areas, nose-diving. Kaiser Health News points out that many state medical associations are getting physician complaints that lowering the rates could lead to a two-tiered system with doctors bailing left and right and leaving sick patients without a road map to care. With the current shortage of family doctors, the problem can only get worse.

Many market exchange insurance companies refuse to pay nearly as much for an office visit as the higher premium commercial plans. That either leaves more money for the patient to pay or refusal of the doctor to accept the patient at all. The insurance companies are not going down without a fight. Doctors’ fees are just the latest strategy to sabotage the ACA. Kaiser quotes a Senior Executive at Blue Cross Blue Shield Association as admitting that “some” of its 37 member organizations are, indeed, offering lower doctor rates, in smaller marketplace venues, but the Association insists that plans know that without a good network of providers, customers will “Go somewhere else.”

What a crock. Many marketplaces have a minimal number of options and a great many states have few options (some only one) outside the marketplace. As I’ve said many times before, no medical legislation in my state of South Carolina ever gets passed without the direct permission from Blue Cross Blue Shield. NONE, EVER!!!

I’m on the side of the docs. And it’s not only because they’ve kept me on this earth on at least three different occasions when I should have been fitted for heavenly wings. The most recent close call was nearly five years ago, when quick work by physicians kept me afloat for the hours it took for lifesaving surgery. Yes, they’re paid a pretty penny and are likely to live in swell houses, but what kind of living is it? It must not be great for some because the profession with the highest rate of suicides is the medical profession. And female physicians kill themselves at a rate of four times the general population of women. Dentists, by the way, rank number two in suicides.

Taking a closer look at the doctor business, let’s start with education. Years and years and years of it. It’s not unusual for a psychiatrist (must be an MD, plus a four-year residency) to have celebrated his or her 30th birthday by the time they open their practice. Then throw in continuing education for good measure. For any and all physicians, there’s undergrad, med school, specialties, internships and residencies, all before the major bucks start flowing in the opposite direction. Bloomberg’s Internet site reports medical school debts as high as $400,000 at interest rates of anywhere from 7-13 percent. The median tab for a private medical school, start-to-finish, is pushing the $300,000 mark.

Finally, after years of sleepless nights, memorization of a virtual foreign language, verbally abusive mentors and repeated conversations with self about why in God’s name did I want to become a doctor, the nightmare ends. You drag your newly reconfigured brain, what’s left of your idealism and open up your own place. And you thought med school was a slog? It’s at this point you realize you’re equal parts doc and small businessperson. Offices don’t run themselves. At the very least, you’ll need three more bodies in place every day the office is open. A receptionist (probably two, for in and out), a billing clerk, maybe a medical assistant or two, an office manager and, unless you outsource your tests, a lab tech. These are mostly modestly paid positions, but pay the practitioner must do; like clockwork.

Then there are insurance companies to deal with. Most of them will argue over use of a Q-tip. Throw 25-30 patients in the mix and you’ve pretty much got the majority of a doctor’s typical daily working life. Yeah, a family doc will pull in a couple of hundred grand; some cardiologist and other pricey specialists nudge a million per annum, but for the most part, your physician is paid what he or she is worth.

And like the disappearing rain forests, doctors are becoming a rare species. Over 30% of doctors have passed their 60th birthday and not enough fresh faces are coming up to replace them. California is estimating a near-term shortage of 17,000 doctors and that’s just one state. And the moronic 2010 National Commission on Fiscal Responsibility (also called Bowles/Simpson or simply shortened to the ‘deficit commission’) proposed cutting $60 billion in Medicare support for physician Graduate Medical Education (GME) funds, or post-med school clinical training, over a ten-year period. In money terms, according to the Association of American Medical Colleges (AAMC) that total would represent a $254 million dollar loss for the state of Illinois alone, plus an estimated 3,500 jobs. The proposal collapsed under its own political weight and was never adopted, but you can bet the farm, it will reappear annually under the auspices of Paul Ryan and company. Incredibly, Ryan was one of the Obama appointees to the commission.

GME funding has politically ping-ponged between the parties in the last few years. The White House fiscal year 2015 budget requests (pandering to the right) read like a kaleidoscope of jumbled numbers that say one thing and eventually do another. The positives include just over $800 million for the National Health Service Corps (NHSC). This specific money enables under-served communities to gain 15,000 primary care providers. But, upon further examination, these “providers” are not all docs. In fact, I doubt a majority of them will be med school grads. Most of the doctors are likely to be very young and just coming out of residency. I suspect patients already in the program are serviced, first and foremost, by nurse practitioners (the future of medicine) and physician’s assistants who are certainly educated and hardworking, but fall far short of the medical knowledge of the average doctor. And looking at the Health and Human Services website, there may even be a problem in getting enough of them for this idealistic venture. It must be pointed out that Nurse Corps Rural Recruitment has been at their job for years in supplementing the NHSC, but the need remains great.

A new GME program would get a $5.23 billion bump over the next 10 years. HOWEVER, the George Washington School of Public Health and Health Services ferreted out the small print of the budget that unearthed the fact that two existing programs are included in the calculation. Both are gone after FY 2015. And, in even smaller print, Medicare’s ‘indirect’ GME payments will actually be reduced by $14.6 billion over the next 10 years. Not $60 billion to be sure, but that cut will be devastating to both doctors and patients.

With this continued political shortsightedness, American medicine will be in critical condition any day now.

There’s a solution. It’s at your nearest polling place.

15 Replies to “Doctors, An Endangered Species Thanks To The Republicans”

  1. This is literally schizophrenic. So the Republicans are to blame for the effects of an act they have voted to repeal 50 times. Wow, just wow.

  2. I dont know of any doctors around here that dont work for clinics. Just hired hands.

    We need free school for these people

  3. I fail to see why you are linking the shortage of physicians to the Republican party in this article. It is very incoherent, so I had to read it twice to figure out your angle. The shortage of physicians is due to Obamacare, which was passed by the DEMOCRATS alone. They are leaving because their reimbursements are dropping drastically , their costs are increasing due to electronic record requirements and most just want to take care of their patients and not deal with all the extra paperwork/regulations. Denis are placing blame where blame is not due! As Kevin before me said…WOW

  4. Perhaps you could have someone read the article to you and understand WHY the reimbursements are going down. There is nothing in the ACA that forces the rates down

  5. “Doctors’ fees under the marketplace segment of the Patient Protection and Affordable Care Act (ACA) are, in many areas, nose-diving.”
    Those fees are their rates. Shortly after it blames republicans for proposing laws they claim will damage the system being at fault, but they weren’t passed. Let me reiterate.
    They associate blame with a law proposed by republicans THAT NEVER PASSED and PROBABLY NEVER WILL.

  6. From medicarenewsdigest:
    Q: What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act?
    A: Business income has increased for doctors because many people on Medicare are now using free screenings and an annual “wellness visit” provided through the Affordable Care Act.

    Through Oct. 6, 2011, the government said, 20.5 million people enrolled in Medicare had received the free screenings or the annual visit, which is also free. Medicare is now offering a 10 percent bonus payment on the fees charged for primary care services, and a 10 percent bonus payment to surgeons who work in areas where there are shortages of doctors.

    For 2013 and 2014, Medicaid payments for primary care services — which are now less than amounts paid by Medicare for the same care — will be increased to match the full Medicaid rate. This will increase availability of care for people enrolled in Medicaid (the federal-state program for the poor), since many doctors have refused to accept t…

  7. With more and more folks able to be treated, their practices are GROWING, not shrinking. I see far younger doctors out there than when I was a kid, mostly females by the way.
    And as far as doctors being miracle workers, three out of four of my daughter’s grandparents were KILLED by them due to misdiagnosis or wrongly prescribed medications. I have little faith in any doctor and fully investigate any and all treatments before I call them. I am armed with more knowledge than they are most of the time. As a mom, I had to argue with a pediatrician who wanted to give my daughter antibiotics for a fucking cold.

  8. Physicians who participate in Medicare are currently paid under a formula known as RBRVS. They were formerly paid on a “fee for service” formula whaich was based on the insurance industry system of “UCR”. The ACA will hasten conversion to PPP (Pay per performance) which has been coming for a long time. Medicaid payments depend upon the State in which the patient resides, and the coverage guidelines thereof. Saying that Medicare/Medicaid patients will “lose their Doctor” is a lie. Physicians who participate in these programs are precluded from denying services to these patients by the “paticipating” agreements they sign with these entities.

  9. Sorry for being dumb, but surely the doctors fee is what it is, the rates that go down will be the insurance companies rates/profits which were capped at 20% under the ACA and used to be something like 35%.

  10. “Obamacare” in case you didn’t know is only a Republican plan formerly known as “Romneycare” as he supported as governor of Massachusetts. Then, the Republicans thought it was a great idea. As soon as the Democrats agreed with them and renamed it the ACA, it became a horrible plan designed to take the country into ruin.

    It seems that hypocrisy and ignorance has never been a problem for Republicans.

  11. Hi Folks:

    I knew the right-wing would jump in on this one. The insurance companies are responsible for virtually every negative associated with ACA, including lower marketplace fees for docs.

    Yep, the truth (rarely heard in radical Republican circles) hurts.

  12. The ACA doesn’t cap profits of health insurance companies at 20%. It states that insurance companies must spend 80% of the premium they take in on providing health care to their policy holders. Nothing in the ACA puts a cap on insurance company profits. Which is too bad because the for-profit health care system in the US is backward and barbaric. It does nothing to lower costs. The US is the only nation in the world with a for-profit heath care system and our costs are more than double of every other nation. We need to end this failed experiment and go to a single payer system like every other industrialized nation in the world and put the parasite insurance cartel out of business.

  13. Providers around the country are either specializing or retiring to get out from under the crushing wait of Obamacare. Who wants to work their A!! off to provide free healthcare to people who are not even legal to be in the states. More importantly, Hussein is intentionally destroying America from within.

  14. Well thanks for proving you know nothing about the ACA. And of course the last obligatory sentence that makes sense only to a WND or breitbart robot.

    Do you ever feel ashamed of yourself? Totally lacking in logical or comprehensive thought?

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