45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul

Don · Sep 18, 2009

According to a survey by Investor's Business Daily.

Also noteworthy, these folks on the front lines have serious doubts about the possibility of a positive outcome from the proposed legislation.

It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration's claim that the government can cover 47 million more people with better-quality care at lower cost.

But what do they know? They're only doctors, not politicians, after all.

But here's the capper:

Four of nine doctors, or 45%, said they "would consider leaving their practice or taking an early retirement" if Congress passes the plan the Democratic majority and White House have in mind.

How dare they? Isn't that blackmail? There oughta be a law...

CACTUSWENDY · Sep 18, 2009

Not to worry. They can always 'out source' and bring the new doctors over here. Oh wait....they already do that. Never mind, carry on.

Robert Toy · Sep 18, 2009

nurse practitioners will fill in for the doctors...it's going to happen anyway

Albedo · Sep 18, 2009

Isn't this the same rag that said, rather hilariously, that Stephen Hawking would have been euthanised if he was born a Brit? Stats jockey Nate Silver says this study has about as much credibility as their basic fact-checking competence would suggest:

I'm flying 35,000 feet somewhere over Eastern Ohio now -- isn't technology wonderful? -- so I can only comment on this briefly, but the Investors' Business Daily poll purporting to show widespread opposition to health care reform among doctors is simply not credible. There are five reasons why:

1. The survey was conducted by mail, which is unusual. The only other mail-based poll that I'm aware of is that conducted by the Columbus Dispatch, which was associated with an average error of about 7 percentage points -- the highest of any pollster that we tested.

2. At least one of the questions is blatantly biased: "Do you believe the government can cover 47 million more people and it will cost less money and th quality of care will be better?". Holy run-on-sentence, Batman? A pollster who asks a question like this one is not intending to be objective.

3. As we learned during the Presidntial campaign -- when, among other things, they had John McCain winning the youth vote 74-22 -- the IBD/TIPP polling operation has literally no idea what they're doing. I mean, literally none. For example, I don't trust IBD/TIPP to have competently selected anything resembling a random panel, which is harder to do than you'd think.

4. They say, somewhat ambiguously: "Responses are still coming in." This is also highly unorthodox. Professional pollsters generally do not report results before the survey period is compete.

5. There is virtually no disclosure about methodology. For example, IBD doesn't bother to define the term "practicing physician", which could mean almost anything. Nor do they explain how their randomization procedure worked, provide the entire question battery, or anything like that.

My advice would be to completely ignore this poll. There are pollsters out there that have an agenda but are highly competent, and there are pollsters that are nonpartisan but not particularly skilled. Rarely, however, do you find the whole package: that special pollster which is both biased and inept. IBD/TIPP is one of the few exceptions.

Here's an interesting alternative study from a periodical with slightly more cred:

New England Journal of Medicine said:
Physicians’ Support of Options for Expanding Insurance Coverage and Medicare.

Panel A shows the proportion of survey respondents who favored public options only, those who favored both public and private options, and those who favored private options only. Panel B shows the proportions of respondents (according to their medical specialty) who supported, opposed, or were undecided about the expansion of Medicare to include adults between the ages of 55 and 64 years. The proportion of support was consistent across all four specialty groups (P=0.08).

link

But from what little I understand, Obama's plan doesn't include a "public option" anyway? Maybe all those doctors want to leave because the reforms aren't socimalistic enough.

Perks · Sep 18, 2009

Yeah, I'm taking issue with the first pie chart result they offer -

"Do you support or oppose proposed health care plan?"

Um, which health care plan is that? There is no plan yet. Just a lot of ideas, suggestions, rhetoric, and the seemingly unavoidable lumps of bullshit rolling around.

And sure, nearly half the doctors will go away. And do what, exactly? There are only so many golf courses in America and greens fees ain't cheap. But yeah, they'll all go into pottery and construction instead.

whistlelock · Sep 18, 2009

Albedo said:
Isn't this the same rag that said, rather hilariously, that Stephen Hawking would have been euthanised if he was born a Brit? http://www.fivethirtyeight.com/2009/09/ibdtipp-doctors-poll-is-not-trustworthy.html

I think Albedo is forgetting to follow up and say that Hawking is a Brit, and was born in London. Where he was not euthanized.

http://en.wikipedia.org/wiki/Stephen_hawking

Though Hawking's parents were living in North London, they moved to Oxford while Isobel was pregnant with Stephen, desiring a safer location for the birth of their first child (London was under attack at the time by the Luftwaffe).<sup id="cite_ref-8" class="reference">[9]</sup>

Williebee · Sep 18, 2009

I just read somewhere... (Reader's Digest? yeah, I'm that old.) I'll try to find the story again.

Anyway, they were talking about the numbers of physicians who are quitting private practice because they can't make a living at it anymore, irrespective of the whatever "health insurance" reform that may come down the pike.

veinglory · Sep 18, 2009

So what is IBD/TIPP? Because it doesn't sound like any of the neutral polling companies the media usually uses. I have had enough to do with polling by biassed entities to know it usually isn't worth a thing unless the actual directly-quoted question asked is disclosed along with sampling method and the use of "blind" staff.

MacAllister · Sep 18, 2009

More information about the study reported in the NEJM

A survey of more than 2,100 U.S. doctors shows that the majority favor having both public and private health insurance options as part of the healthcare reform package currently being debated by lawmakers. The results of the survey were published in the online version of the New England Journal of Medicine on September 14, 2009.

To conduct the current survey, the authors obtained data on a random sample of 6,000 physicians from the American Medical Association (AMA). After excluding physicians from US territories and those in training, 4,936 remained. A total of 2,130, or 43.2 percent, returned the survey. The participants were questioned about which of three options for expanding health insurance coverage they would most strongly support.

The three choices were: (1) public and private options, which would provide people younger than 65 years of age the choice of enrolling in a new public health insurance plan or in private plans of their choosing; (2) private option only (no public option), which provides people with subsidies or tax credits if they are low income, to purchase private health insurance; or (3) a public option only, which means private health insurance would be eliminated and everyone would be covered through a single public plan like Medicare.

The results showed that 62.9 percent of physicians supported having both public and private options, while 27.3 percent said they wanted to see private options only. The survey’s authors had divided the physicians into four broad categories - primary care, medical subspecialties, surgery, and other - and respondents were similar in their support of both public and private options. Contrary to the original position of the AMA, there was majority (62.2%) support for a public health insurance option among AMA members.

Expansion of Medicare to Americans between the ages of 55 and 64 years was also supported by a majority (58.3%) of respondents. This support was similar across all four specialty groups.

Williebee · Sep 18, 2009

I would think that doctors WOULD want both, if only because it would seem to increase their opportunities for getting paid.

Perks · Sep 18, 2009

Williebee said:
I would think that doctors WOULD want both, if only because it would seem to increase their opportunities for getting paid.

My thoughts exactly.

Cranky · Sep 18, 2009

I know I'd want to have as many options as possible, given that you have to do, what? Thirteen years of training (some of it low or unpaid) to become a board certified specialist? If I had six figures worth of debt, I'm pretty sure I'd want to get paid, too.

The 2008 AAMC Graduate Questionnaire indicates 17.7% of the 13,400 respondents have loans totaling $200,000 or more. The survey shows the average debt for medical graduates is $141,751, which is $10,000 more than in 2007.

Link

That's just from people who've finished med school. Doesn't include board certification, or the extra five figures it costs for various specialty training (surgical, orthapaedic, oncology, etc.) It's pretty damn pricey to get board certified in your specialty, plus time invested. Pay rates for primary care are much lower than doctors with most other subspecialties, too.

Money aside, I think having a (good) public option as well as a private option is the best way to go. And I don't think that half of all docs are going to quit if healthcare reform in any form is passed. That just seems stupid to me, especially when I consider how much debt many docs are carrying. Might it discourage people from becoming doctors in the first place? I don't know. I would think so, if the costs of becoming a doc aren't going to go down but the compensation doesn't keep up.

Sheryl Nantus · Sep 18, 2009

just a quick note - when I was in Canada and receiving medical care, my doctor and I chatted a bit about the system.

one problem that existed then, and probably does still now, is that the amount paid by the government to the doctors for each procedure, each visit, etc. is obviously determined by someone, somewhere.

but it's NOT automatically adjusted yearly for inflation.

so my doctor was being paid $300 for doing a hysterectomy and then having to pay his staff out of that amount... but it hadn't been adjusted for years, the system being slow to do anything. Like any government system. And, as you can guess, he was falling behind in the amounts being paid by the government and then to his staff and the hospital.

so, if you're going to have a public option, you better make sure that the amounts paid to the doctors for their treatments, etc. should be adjusted yearly. Otherwise you'll end up with the same problems as Canada does - doctors leaving because they can't afford to be doctors, at least not in Canada...

just an observation.

Celia Cyanide · Sep 18, 2009

Williebee said:
I would think that doctors WOULD want both, if only because it would seem to increase their opportunities for getting paid.

Um, yes, it would. I work in health care, which is said to be recession proof. But now things have gotten so bad that clinics are laying people off. The thing is, the recession doesn't make people less likely to need to go to the doctor. It makes them less likely to be able to pay for it. Luckily our clinic has not laid anyone off. I feel bad for clinic workers who have faced layoffs. What it means for them is--fewer people doing the same job, but the ammount of work doesn't go away.

veinglory · Sep 18, 2009

The irregularity of pay rises is a common civil servant thing. It does tend to correct but not annually.

veinglory · Sep 18, 2009

p.s. Like any good union member I have heard the "I'll quit" thing a lot, but never seen it happen. I have even seen people say they were willing to *die* to keep their current deal without federal interference--but they are all still alive today.

Bird of Prey · Sep 18, 2009

I remember all kinds of folks declaring they'd leave the US if Bush were reelected. They're still around, too. . . .

Williebee · Sep 18, 2009

one problem that existed then, and probably does still now, is that the amount paid by the government to the doctors for each procedure, each visit, etc. is obviously determined by someone, somewhere.

but it's NOT automatically adjusted yearly for inflation

.

This would seem likely to me, and/or that the adjustments might not keep up with actual inflation. Same has been true in the US for military service members and employees and COLA (Cost of Living Allowances) for as long as I can remember.

dclary · Sep 18, 2009

So in other words, about 55% of doctors wouldn't consider quitting.

Or, spoken plainly, doctors are about as split on this plan as the rest of the nation.

This is not news, nor even newsworthy. What's that doctor who quits going to do? The manager at Wal-Mart won't let him be a pompous asshole to customers as he greets them at the door, and Taco Bell doesn't pay 120K a year to stuff tortillas.

They'll keep working, and they'll hate their jobs, just like the rest of us.

robeiae · Sep 18, 2009

Quit yer bitchin'.

Romantic Heretic · Sep 18, 2009

I don't hate my job, or any job I've had.

It's the BS around the job that raises my ire.

Alpha Echo · Sep 18, 2009

Williebee said:
.

This would seem likely to me, and/or that the adjustments might not keep up with actual inflation. Same has been true in the US for military service members and employees and COLA (Cost of Living Allowances) for as long as I can remember.

That may be true, but as a gov't worker who gets COLA, and whose COLA raises every year, I am thankful b/c a lot of private industries don't have it, and w/o it, I would be making a good bit of money less. I'm not sure how I'd be paying all my bills w/o it.

DavidZahir · Sep 18, 2009

Albedo--thanks. I actually do market research for a living and what you've posted sounds (to put it very mildly) fishy.

dclary · Sep 18, 2009

veinglory said:
p.s. Like any good union member I have heard the "I'll quit" thing a lot, but never seen it happen. I have even seen people say they were willing to *die* to keep their current deal without federal interference--but they are all still alive today.

And let's not forget all the people who promise to leave America if the guy they like doesn't get elected.

We're still waiting, Baldwins.

adktd2bks · Sep 18, 2009

To those who don't know: IBD stands for Investors Business Daily. They are a marketplace newspaper, and very good for investing purposes. But they are very conservative and highly slanted. I don't put a lot of faith in this poll.

45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul

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