Physicians still are at the center of the American health system, even though they feel beleaguered. Their opinions and perceptions about the health system substantially influence the opinions of patients, consumers and regulators. Deloitte’s Center for Health Solutions surveyed about 500 doctors (a low number for statistical reliability) to learn their views of health reform and other health system issues. (Deloitte Survey) About a third of doctors think the US system gets an A or B; primary care physicians give it the worst grades and surgeons the best. Most physicians think they are fairly well informed about the “reform” act. Physicians are equally split on whether the reform law was a good or bad step to take. Over 90% think that unhealthy lifestyles and defensive medicine contribute to high health spending growth; about 90% blame insurers, hospitals and drug makers. Only about half seem to think physicians might be contributors.
The respondents felt reform would lead to more managed care in Medicare and Medicaid, greater wait times and decreased quality. Particular concern was expressed for ER wait time growth. Most believe the law will lead to more use of evidence-based medicine, but also think it will lead to less efficient care because the new emphasis on HIT. Few think reform will make it easier to practice medicine or lead to lower costs. Over half favor either repealing the bill altogether (41%) or everything but the insurance reforms (26%). Ninety percent think reform will lead to higher insurance premiums and lower payments to providers, which seems wildly inconsistent since provider payments are the biggest cost category and admin costs are capped, but maybe they expect a surge in per member utilization.
Most doctors felt left out of the reform process and that their voice was not heard. They obviously would like to see substantial malpractice reforms. Specialists think they should be paid 30% more than PCPs, who don’t agree with that spread. Most physicians anticipate flat or lower income as a result of reform, consistent with their views on reimbursement. A large majority of doctors are very pessimistic about the future of medicine. Their ideal role would be in a concierge practice or as an administrator in a delivery system, but most would like to practice independently. New payment mechanisms, including value-based purchasing, are feared for their effect on income and administrative expenses. They support evidence-based medicine, but think achieving consensus on what the evidence supports will not be easy. And consistent with their whole history, they don’t think other provider types can do their work.