November 20, 2003
Summary of Survey Results: Situation critical, "reforms" expected to worsen condition as doctors bail out, refuse patients; doctors wouldn't take part in Medicare if starting over, and predict severe rationing.
While the future looks bleak, the present isn't much better, according to 344 physicians responding to the respondents, who are involved in patient care at least 20 hours and an average of 23 years in practice.
"This study is concrete documentation of the atmosphere of fear and frustration in which doctors practice today," said Kathryn Serkes, co-author of the survey and public affairs counsel for the Association of American Physicians and Surgeons (AAPS). "Money is not the issue - control is. More doctors would rather treat uninsured patients, possibly for free, than jump through Medicare hoops."
The results show that increased government involvement in Medicare is actually responsible for increasing physician demoralization and practice changes that are making it tougher for patients to find doctors who are willing to treat them. And the impact is being felt by all patients, not just seniors, and will get worse if an open-ended, costly drug benefit is added.
"Tacking on some cosmetic changes as Congress is now considering in the conference report will only make things worse," said Serkes. "It's like the sick patient who was in deep denial. He delayed treatment for so long that he became terminally ill, and then ran out to have expensive plastic surgery - that bankrupted him. But his friends say he was a good-looking corpse."
The survey supports 6 conclusions:
1. Increasing fear of prosecution or government retaliation has had a negative impact on Medicare patients' access to physicians, and their ability to receive referrals and certain services such as surgery.
2. Compliance with Medicare regulations is costly, takes significant time away from patient care, and is an increasing cause of reluctance to treat Medicare-eligible patients.
3. Unrestricted private contracting under Medicare would greatly increase willingness to treat Medicare-eligible patients.
4. Increased fear of retaliation and regulatory burden are causing physicians to make changes in practices that adversely affect patient access and quality.
5. The increasing role of government in medicine results in more difficulty for all patients to access care, not just those who are Medicare-eligible.
6. Physicians are becoming increasingly disheartened and negative about the future of the practice of medicine.
The survey examines five areas: Access by established Medicare patients, acceptance of new Medicare patients, costs and changes to practices, opting out and private contracts, and assessment of the future of the practice. Further, the survey looks at trends of the past three surveys.
Some of the findings:
Physicians have made great changes to their practices to comply with Medicare regulations, most involving less time for patient care or additional cost, including spending more time on documentation, restricting services, hiring more compliance and billing staff, or just quitting Medicare.
Of particular note is that physicians prefer uninsured to Medicare patients, turning them away 50 percent less frequently than Medicare patients (17 percent and 33 percent respectively).
"This regulatory roulette is affecting every patient in the country. Doctors have less time to spend with patients, and are retiring earlier than ever," said Serkes. "Medicare expansion will only bring more of the same."
Serkes says one respondent's comment sums it up: "Unless things change soon, the best and the brightest will leave Medicare. It's simply not worth it."
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