Congress and the Budget; a newly christened Physician's point of view

I apparently have been in a blogging mood as of late, likely due to the great schedule I have this month with emergency medicine...which has allowed me a little free time.

So I received an email this morning that kinda got me fired up. Here it is:

In the debt compromise just reached in Washington, mandatory cuts of $1.2 trillion are scheduled to take effect if there is no new agreement.

What are the targets for these cuts? You guessed it: “Medicare providers” … physicians.

The group charged with deciding who will receive cuts is a 12 member “supercommittee.” This panel, selected a few weeks ago by House and Senate leadership, consists of Members of Congress with a broad range of experience. Interestingly, the panel, which has the ability to drastically affect physicians and their patients, does not have a single physician. Since there are only twelve slots on the committee, many regions will not have representation.

Physicians are particularly vulnerable to the agenda of the supercommittee. With a 30 percent cut in Medicare payments already looming, Congress is not going to be able to simply patch the broken SGR formula as it has done in the past. Funding for Graduate Medical Education is also an area the supercommittee will look to cut.

The “Supercommittee” has the power to fix one of our most pressing issues – the SGR. Every year that the SGR issue is not addressed the cost to fix the problem increases.

I know the budget is broken. I know the economy is tanking. I know there will be painful steps, cuts, tax hikes, etc to fix the problem. But doesn't 30% slashing of one group's salary seem excessive? From my vantage point, this is HUGE! Before go any further let me say emphatically I did not go to medical school to get rich. I chose medicine because I felt it would offer good job stability and allow me to provide a good income for my family and allow my wife to stay at home and not work if she chose not to, and of course to help people. But talking about a 30% decrease in provider payments makes me shake in my boots. Every year the physicians have to fight with congress to patch up the SGR. What is the SGR? It is the sustainable growth rate formula. Some whiz kid on capitol hill developed it years ago and it schedules cuts every year to medicare to keep it sustainable, and yes it mostly targets the providers(Ben is probably grimacing right now with that crude explanation...oh well). There are a lot of flaws in the formula and fails to take alot of things into account. Every year congress comes through at the last second and patches it up with a 6 month or one year hold for the cuts. But like the email says, every year the formula isn't fixed, it becomes more and more expensive for a permanent fix.

You might be saying whats the big deal? It is only medicare that will be cut, there are alot of insurance companies out there! True, there are alot of insurance companies out there, but unfortunately they all base their reimbursement schedule on what medicare is doing. You might be saying, "well doctors are rich, they can handle a 30% cut in there salary." Hold on there cowboy, todays doctors are not yesterdays doctors. The average salary of a physician has been dropping steadily for years(minus a few select specialties). While most other careers reward an employee with a higher salary with the more experience they accumulate, most physicians I have worked with are telling me their salary has flatlined or decreased over the past 10 years, despite seeing more patients, becoming more efficient and skilled and doing more paperwork! Imagine that in your chosen career, doing more work, with more experience, AND getting paid lees than when you started! If that is not a deterrent for hard work, I'm not sure what is. I look at the hours i'm working and see some of the Real(not resident) doctors working longer hours and think to myself "that is what I have to look forward to, with a 30% decrease in what he/she is making?" I also look at the average debt load of newly graduated physicians, over $180,000 (p.s my debt load is higher) and worry about repaying that, on top of life expenses(i.e.mortgage) with nearly half of what physicians are now making? Scary. I think of the malpractice insurance I will be required to pay, along with the constant looking over my shoulder for the lawyer watching every decision I make, waiting to pounce and sue me for all I'm worth. (p.s. for those of you who think the threat of lawsuits is NOT driving up health care costs, I have news for you...IT IS! I've over ordered tests to protect myself on several occasions even if my suspicion is low, and I've only been doing this for a couple of months!)

Then I think of the ripple effect that a cut like this will have in addition to the new health care law (ie Obamacare) on society (ie: YOU) and it looks frightening. Let me paint the picture for you: Several current practicing doctors have told me they will RETIRE early and do something else if these changes are implemented. That will leave young physicians like myself who have too much debt to switch careers to care for a huge baby boomer population in addition to everyone else. You think you wait a long time to see a physician right now? You think the physician doesn't spend enough time with you right now? I forsee wait times nearly doubling and physician time spent with patients dropping dramatically with these changes. Additionally, a doctor would be required to see 50-60 patients a day(almost double the average patient load right now), and maybe more with a 30% paycut to make what they are currently making. Do ya think that will increase quality of care??? Then there is the viscious cycle that will happen to medical training that i've been saying for years. Who in their right mind would want to become a doctor with everything i've said above? It is true that medical schools right now only accept a mere fraction(most less than 5%) of applicants applying to their school, thus have a Huge pool to choose from. But I forsee the quantity and quality of those applicants diminishing significantly with these cuts as brighter students choose to pursue other fields. Then as income from tuition decreases for medical schools, and salaries decrease for professors, the brightest educators will start leaving medical schools for greener pastures. And thus the spiral will continue downward with less qualified students being taught by less qualified educators, and thus our overall healthcare quality suffers and dwindles.

It is true that by the WHO classification, the USA's current healthcare grades are not very high compared to other places in the world. I believe a part of that is our focus on prolonging life and keeping people alive that other countries simply do not keep alive, which increases our morbidity(sick) rate. The american diet doesn't help our statistics either. But everybody knows there are problems that need to be addressed with healthcare and I agree. (and I don't buy into the scare tactics of death panels etc that republicans use to detract obamacare). That being said, I don't think 30% cuts of physicians salaries and obamacare as presently outlined will bring the change some people think it will. I feel my concerns are valid. Please leave me a comment and tell me what you think. Am I way off base? Am I right on target? Please share your viewpoint.

END OF RANT.