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ACA: Tune in to all sides of the debate

May 22nd, 2014

by Kent Bottles

"Your doctor's unhappiness is a catastrophic problem that the new law didn't anticipate and is not prepared to address," said Marc Siegel, M.D., associate professor of medicine at NYU Langone Medical Center.

"To us, supporting the [Affordable Care Act] makes moral and medical sense," according to Jeffrey Drazen, M.D., editor-in-chief, and Gregory Curfman, M.D., executive editor of the New England Journal of Medicine.

In the last two months I chatted with physicians in various cities, including Dallas, Philadelphia, Chicago and Minneapolis. I encountered colleagues who are energized and excited about transforming the healthcare delivery system along the lines of the ACA. I also discussed medicine with doctors who are angry and frustrated.

[More:]

Daniel F. Craviotto Jr., M.D., spoke for the latter group in an April 2 Wall Street Journal opinion piece titled, "A Doctor's Declaration of Independence." Craviotto, an orthopedic surgeon in Santa Barbara, California, makes the following points:

  • The doctor patient relationship is key to medicine.
  • Individual physicians in the trenches do not have a voice in the current debate.
  • Doctors should "damn the mandates ... from bureaucrats who are not in the healing profession."
  • Electronic health records waste physician time.
  • Board recertification is time consuming and expensive.
  • Medicare and Medicaid reimbursements have declined.
  • Physicians should as a group not accept any health insurance.

Aaron Carroll, M.D., professor of pediatrics at the Indiana University School of Medicine, writing in The Incidental Economist blog offered the following advice to unhappy doctors like Craviotto:

  • Complaining about not having a voice in the debate in the most read op-ed pages in the country is like crying wolf.
  • "Most people have to choose between doing God's work and being in the 1 percent. Only doctors get to do both."
  • Board recertification is mandated by physicians who run specialty boards, not the government.
  • "It's ... tone deaf in today's economic climate for the people at the top end of the socioeconomic spectrum to complain so publicly about how little they are paid."
  • Medicine is not the only profession with mandates and outside interference.
  • "Less than 1 percent of physicians opt out of Medicare ... Your colleagues aren't joining you."

Dan Munro in a Forbes blog post made the following points in "An ePatient's Reply to 'A Doctor's Declaration of Independence'":

  • "I don't think his criticisms are remotely patient-centered or patient-engaging."
  • We're all trying to deal with statistics like health care expenditures of 18 percent of gross domestic product when we need to deal with the federal budget deficit.
  • Of the 25 medical specialties tracked by Medscape, orthopedics had the highest average annual compensation at $413,000.
  • Eighty-four million nonelderly Americans were uninsured or underinsured during 2012.
  • Nearly 100 million Americans are either in poverty or in the fretful zone just above it.
  • In the Medscape survey, half of all doctors thought they were fairly compensated.

C. Otto Scharmer's "Theory U: Leading from the Future as It Emerges," taught me that society can only create robust solutions to complex problems like healthcare delivery by understanding issues from the perspective of all involved. This blog post highlights the process by listening to an unhappy physician, a happy physician and an ei-patient. We must listen to other voices besides these three to come up with an improved American healthcare delivery system.

I try to read The New York Times and the Wall Street Journal every day; I try to watch both Fox News and MSNBC. I try to be open-minded because I need all the help I can get in understanding our rapidly changing, turbulent healthcare world.

Kent Bottles, M.D, is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.

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