How doctor's life is affected after ACA is passed?

Pre-Med & Medical School Pre-Med Topics
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<p>Now that the Affordable Care Act has been passed, do you think the life of a typical doctor will be affected in any way in the long run? For example, is it possible more doctors will be hired by hospitals instead of running his/her own private business? I am interested in the change of doctor's life in practical terms (e.g., life style change, lower income, need to see more patients everyday, some specialty may have more demand, more MediCare/MediCaid patients, the financial aspect of hospitals may be improved with fewer unpaid patients, etc.), rather than whether this is right, wrong, good or bad polity.</p>

<p>BTW, it appears to me that Roberts, the chief justice, just does not want to throw out ACA, and then this divided country will likely need to wait another several decades in the "inaction" state -- I firmly believe that if ACA were thrown out, we would most likely stay in that limbo state for a long long time without any agreed-upon next step, considering how divided we are as a country currently.</p>

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<p>Thanks for including this.</p>

<p>This is a very pertinent subject and I am interested in comments. However, if this thread strays too much into right/wrong, good/bad, it will be closed per CCs Terms of Agreement about debates on political and other controversial subjects.</p>

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<p>Simple economics dictate that you will wait longer for doctor’s visits. You can’t add 40 million people to the rolls of those covered with the same number of providers and not expect longer wait times.
Former Surgeon General C. Everett Koop stated that there were three parts to the health care system, high tech, immediate access and universal coverage. He theorized that you could have 2 out of the three but not all three. Canada doesn’t have immediate access, while Cuba doesn’t have high tech and until recently USA didn’t have universal coverage. Unless you plan on bankrupting the country, one will have to suffer and it will be immediate access. Be prepared to wait, in ERs, for appointments and for surgery. It is the price you will have to pay, in addition to other costs for universal coverage. How will it impact physicians? It’s too early to tell but I believe health care in 10 years will look far, far different than it does today. I’m not sure if it will be a positive or a negative but one problem with the ACA is that it doesn’t address runaway costs which are eating up more and more of Federal budget and entitlements… rant over…back to work.</p>

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<p>Thanks for the reminder. Sometimes CCers, including me, may be carried away to talk about something that should be kept out of the public forum.</p>

<p>Maybe in the long run, the size and the number of medical schools and the number of residency slots may be increased as well (especially when we as a country have more money after the economy is improved.) Who knows!</p>

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<p>As a pediatrician, even though I’m not going into general pediatrics/private practice, the ACA really did very little. Most states already cover children up to 400% of the poverty line through SCHIP programs and because of that most of the stats I’ve seen have had shown most states have >90% coverage of children through a combination of Medicaid/SCHIP and private insurance. So for the average general pediatrician, I really don’t think this changes much. </p>

<p>But this brings adult care much more in line with what pediatrics has already experienced. I agree that there will be some strain on the system, particularly in the places that are already underserved (which tend to be economically depressed and likely don’t have as many people with some sort of coverage). In theory, ER’s could actually see less volume as people now have Primary providers to see for the run of the mill chaff (fevers/coughs/stupid stuff) that ends up in the ED now, plus people will seek care earlier and so not show up needing such extensive workups. </p>

<p>The alarmists will say that waits for things like CT scans will grow exponentially, but that’s hogwash - the medical infrastructure in this country is orders of magnitude greater than anywhere else. Just from my experience in Australia, I can tell you that true rationing will never occur in the US. I did a clinical month in a 300+ bed hospital that had a single CT scanner. Exams were done at their scheduled times only - Wednesday afternoons were when you got scans for kidney stones. You showed up Thursday morning with a presumed stone, you would have to wait until Wednesday for your scan. Contrast this to nearly any hospital in a town of more than 1000 people in the US and there’s a high likelihood that even that small town will have a CT scanner available. </p>

<p>Will this affect doctor’s salaries? Yeah, I think that can be said with a high level of certainty, especially for those fields that are probably overcompensated at the moment. However, there were already movements like diagnosis bundling that were going to move those down anyway. I think the pediatric specialties will likely see very little change, but we’re not paid very much as it is. </p>

<p>I think some hospitals will see an improvement in the bottom line as their revenue streams will increase. I know that for children’s hospitals, the influx of state and federal funds from things like SCHIP had a major, major impact on their financial stability. Of course, there’s not a children’s hospital I know of that will not treat a child who is unable to pay…that charitable care is a central tenet of every children’s hospital I know.</p>

<p>There are still a lot of issues though that need to be addressed, and if I had a major objection to the ACA it would be that it’s only one component of the greater issue of actually reforming the health care system in this country - other aspects like tort reform, financing of medical education/student loan debt, funding of graduate medical education (this is a BIG one that most people don’t know about), and things like pay-for-performance reforms are all out there and need to be figured out as well.</p>

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<p>I can definitely vouch for this - the peds residency program at my school is by far the best funded haha :slight_smile:
However, at a recent discussion on the ACA at my school, an administrator for the children’s hospital said they stood to lose on the order of $40 million a year because of how they were classified and how funds would be redistributed under the ACA. I can’t remember the specifics, but it seems to affect Children’s hospitals exclusively for some reason. Do you know anything about this, BRM?</p>

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<p>I heard comments that very many currently practicing physicians will leave (some are saying it could be up to 50%) as paperwork will increase tremendously and all kind of regulations will make practice very restricting. It is the same idea as many employers do not hire because of current and unknown (but predictable) government regulations increase cost of each hire tremendously. Businesses cannot take such a risk. Docs will not tolerate all piled up restrictions and paperwork either. I also heard long time ago about docs in Europe being very unsatisfied with their situation, we are getting there, following in footsteps, not only in health care, in all other aspects. The footsteps to the edge…
From my personal experience with “national” health care, the quality of care will go down a lot, the most at risk are very young and old (I have personal family experiences), the groups that need care the most.</p>

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<p>Moderator Note:</p>

<p>A final reminder that this discussion must stay on the topic of the OP: how a doctor’s life is affected.</p>

<p>OT comments, generalized comments about government, etc. will be deleted/edited and may result in the closure of this thread.</p>

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<p>Unfortunately, there is no way to discuss a doctor’s life without bringing in the government. Directly and indirectly, the feds pay 2/3rds of all health care dollars today. And where I grew up, ‘he who controls the purse strings, makes da’ rules…’ </p>

<p>My crystal ball foresees a Canadian-like system evolving in the US over the next generation. High income docs will be severely curtailed over time. But in the near term, general practitioners should see more $. But that money too, will decline over time. Docs will have to become more formulary-like in their practices. The advisory body established by the ACA will set practice standards.</p>

<p>And I strongly disagree with BRM. The fact that a gazillion CT scanners exist today is meaningless. Over time, protocols will indicate when and where a CT is justified. Other than that, it won’t get paid.</p>

<p>As an example, is MRI screening for breast cancer survivors. Insurers (following Medicare’s lead?) will no longer pay for a preventive MRI screening, when they did in the past. That means that docs will have to fight for the screening, or just say it ain’t offered bcos the protocal won’t allow it… The same fate will happen to a lot of screenings; again, over time.</p>

<p>Just my $0.02, based on 20+ years in health care finance/economics.</p>

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<p>Thanks for sharing your experiences.</p>

<p>CNN has an article today with the tile “Your health care is covered, but who’s going to treat you?” I read some of the facts with a keen interest, and I include a few tidbits below (Maybe some of you know this very well already. But some of these are new to me as a newbie about this topic.)</p>

<p>A physician shortage in the U.S. was expected …there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025.</p>

<p>The shortage is a result of several factors. A large number of medical professionals are reaching retirement age, as is a large group of patients: Nearly 15 million will become eligible for Medicare in the coming years.</p>

<p>On top of that, there is a lack of residency spots available for students graduating from medical school. In 2011, more than 7,000 were left with degrees that said “M.D.” but no place to continue their education.</p>

<p>Many residency spots are funded by Medicare, and there’s a cap on the number a hospital can claim each year. That number, about 100,000, has remained steady since 1997. …the Affordable Care Act will redistribute some unused residency slots and increase funding for the National Health Service Corps. (I do not quite get it when it is written that the ACT will redistribute some unused residency slots. Does it mean some residency slots go unfilled as of today even when more than 7,000 were left with degrees that said “M.D.” but no place to continue their education? Also, is it likely the case that those from foreign medical schools would be willing to take any residency slot no matter what the specialty is?)</p>

<p>It appears that it will require more internists, ob/gyns and pediatricians to treat patients who have been in emergency rooms in the past due to the lack of insurances but now can see the doctors out of emergency room. It is also speculated that a longer wait for seeing doctors may be needed.</p>

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<p>I think we’ll probably see a rise in urgent care centers and NPs/PAs. Unless the med school tuition/resident payment scheme is fixed, MDs will continue to avoid primary care (something like 2/3 of graduates currently do).</p>

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<p>Exactly. And it is the limit of residency spots which has held down the number of med schools over the past few decades. Again, he who has the money (feds) makes da’ rules.</p>

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<p>Many of the unmatched residencies were caused by people not heeding their schools’ advice and over reaching the specialties to which they applied.</p>

<p>S had a friend who ONLY wanted Ortho despite the fact that he was borderline at best in qualifications. He thought that his URM (Hispanic) status would provide the necessary bump. It didn’t. He applied very widely and to over 60 programs, got 3 interviews and no match.</p>

<p>Very sad situation. His home program offered him a preliminary IM match and he is going to reapply for another specialty next year.</p>

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<p>Except for that’s not exactly what I said:</p>

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<p>But that’s OK, I will not make any further efforts to keep this discussion within the TOS.</p>

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<p>As we have all preached , if money is your goal…there are quicker and easier ways to make money than by becoming a physician.</p>

<p>My kid is money-conscious or maybe money-aware but not money-driven. I doubt seriously she will give more than a cursory glance at the relative differences in pay between the surgical specialities that interest her. That would be akin to chasing the stock market. Never a good idea.</p>

<p>She will pay attention to issues of continued shrinking autonomy . Now that will **** her off. lol ;)</p>

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<p>In light of the GOP’s vow to repeal the act, I’d wait until November to make any plans. If the Congress and White House go to the GOP, the ACA will be nothing but a memory.</p>

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<p>Heck. If I would have seen entomom’s abdication I would never have posted. I don’t do politics.</p>