The Healthcare Tsunami: Physician Backlash and Mass Exodus

In the Fit Family series we've talked primarily about 2 major waves that have "slammed" the healthcare system: The greatly out-of-control increased cost of healthcare and the rapidly rising rate of chronic and acute disease due to lifestyles brought on by the epidemic of obesity. But, now the realization by well read and frustrated physicians brings the possibility of practitioners leaving their medical practices en masse. This is the third tsunami wave that will potentially break the full spectrum of any functioning healthcare system. No matter how much technology, hospitals , clinics or expensive health plans exists; if physicians do not agree with it or refuse to go along with it there is safe or effective system. Several studies support the possibility that 46% to 50 % of medical doctors will leave medical practice beginning in 2013. The AMA(American Medical Association) Masterfile Practice Self Reporting by physicians from 1998 to 2001 measuring physician intent to leave practice resulted in a predictive value of 52.9 % with a self reporting index sensitivity of 73.3 %. But other reporting has been just as revealing. The NEJM(New England Journal of Medicine) reported in 2009 that 45-46 % of doctors were predicted to leave medical practice. The study was conducted by the Medicus Firm. One thousand physicians were queried in the study. The BLS(Bureau of Labor and Stastistics) ironically states that there remains still a 22 % rise in physician vacancies up to 2018. What does this mean if an additional 50% of practioners leave by then? It potentially means that the 22 % we see can be unimaginably increased. Jackson and Coke a noted physician placement company revealed in its study of 500 MDs,also found that 50 % of doctors intended on leaving practice in the near future. The AMA has already begun to ask physicians "please, if you do leave the practice ; do not leave the profession". In an attempt to retain doctors in some aspect of their profession. However, many physicians do not feel that the AMA( the largest lobbying group that represents physicians) has equitable concerns for all medical doctors. Medical doctors are the first line of defense against disease and are the healthcare system's primary foot soldiers when it comes to improving outcomes of patient care and decision making. What are the reasons for doctors potentially leaving practice en masse? Many report several issues that the current healthcare system hasn't addressed adequately enough for them to remain in practice. These include: rising rates of medical liability($5000 -$200,000), the cost of converting medical records to a digital system($5000 - $20,000), cost of medical education(avg $250,000), cost of running a medical practice (immeasurable based on practice specialty), time out and costs of medical updates and CME, cost and time out for pharmaceutical updates, the time in clinic reading charts and lab(not billable), the time making rounds in hospital(not billable),the drive time to offices, medical recording, on call status(may not be be billable), reduced or delayed compensation by Medicare and Medicaid. New changes in healthcare coming in 2014 and a study by Funk and Wagnalls showing risk of medical liability are perhaps the two concerns on the list that will cause physicians to reconsider medical practice as a viable future. New legislation demands digital health records in all practices eventually. Physician decisions will be "aided" by a large database in which their diagnostic and clinical decisions will be "reviewed" as being either cost effective and meeting the new health reform guidelines. If they are not , the physician will encur a costly penalty or fine(see Accountabilty Cost Organizations). The "art of medicine and healing" has been one of the primary reasons doctors heeded the call into their profession. This formulaic approach risks to rip apart this single privlege and pleasure. To some this is the final nail in the coffin to continue practice. Some physician-owned groups have acquired physician owned clinics and hospitals , but again new reform will not really allow them to compete with multi-billion dollar health programs such as HMOs who stand to benefit from a new system. Larger medical establishments that have promised to keep costs down will be rewarded further in the new paradigm of healthcare.Again, this is a feat that is difficult to do by smaller physician owned facilities. What this means is even if qualified physicians "wanted" to stay in their own practice, they couldn't afford to do it. Those physicians who wish to stay within their field will be foreced to join a larger medical facility such as a corporate based run medical group(HMO). The "vacancy" that the BLS states in physician positions was already predicted to happen as early as the late 60s in a report known as the GMNAC Report. The report stated that there was a critical need of more trained physicians to be in practice. But, this hasn't happened. Physicians will be forced to leave. Who will fill those positions that will become vacant-physicians assistants, clinical nurse practitioners, LPNs, RNs? These professions are not trained to the same extent . Physicians are professionals who not only do their 4 years of college , but 4 years of medical school and at least 3 more years of residency. Many specialist and sub-specialist have had another 2 to 3 yeas additional training. The growing dissatisfaction in medical practice and problem of physician retention threatens the viability if not "health" of the healthcare system.The days of Dr. Welby, Dr.Ben Casey and Kildare are over, but, physicians have not been given a model to operate in the new coming system. If becoming government functionaries that work by a formula is their only choice and if improving the healthcare system is purely viewed as one that only requires spending in one area while cutting in another ; the MBAs, CPAs and other actuarial professionals will have start donning white lab jackets and make hospital and clinic rounds as well as enjoy those long nights oncall. How would you feel if an accountant started making all your healthcare decisions. This is what many physicians see what is becoming of their profession. This is the 3rd wave of the healthcare tsunami and it is about to hit the healthcare system in the "soft underbelly" that has been greatly under estimated and underrated, physicians. It is most likely to happen gradually, but nothing has been said how to prevent this or is it too late? The 3rd wave may prove to be the worst. Are we prepared?