- The Washington Times - Thursday, February 7, 2013

After 25 years of practicing medicine, Dr. Tamzin Rosenwasser packed in her dermatology practice in 2011, barely a year after the passage of President Obama’s health care initiative. The timing wasn’t coincidental.

“I have interrupted practicing medicine because of Obamacare,” said Dr. Rosenwasser. “I’d read the bill. I was conversant with what had already happened with Medicaid, and I didn’t want to go down that road with Obamacare.”

The Affordable Care Act isn’t scheduled to be fully implemented until next year, but some doctors already are viewing it as dead on arrival. The medical rumor mill is abuzz with stories about physicians girding for Mr. Obama’s signature domestic policy achievement by limiting their exposure to Medicare and Medicaid, selling their practices, converting to fee-for-service approaches, or even retiring from medicine altogether.

“Every single day, people are talking about retiring early, getting out of clinical medicine, or going into hospital administration, where you don’t have to think about patient care anymore,” said Dr. Richard Armstrong, a Michigan surgeon and chief operating officer of Docs 4 Patient Care, which opposes the Affordable Care Act.

Not all doctors agree. The American Medical Association endorsed the health care legislation at the time of its passage in 2010, although the group now is pushing for the elimination of the Independent Payment Advisory Board, the cost-control organization at the heart of the president’s plan that became known to critics as the “death panel.”

“Some physicians are all for [Obamacare],” said Dr. Rosenwasser, who had practices in Florida and Indiana and is a past president of the Association of American Physicians and Surgeons, which opposes the program. “They’ve been brought up in the government system. This is what they know.”

Most doctors appear to be waiting to see what happens. “About 90 percent of doctors are completely uninformed about what the government’s doing,” Dr. Armstrong said. “A lot of them are in this free-floating anxiety mode.”

Widespread concern

Even physicians with no plans for career change are worried about the profession for reasons related to Obamacare. A sweeping survey of 13,575 doctors released in September by the Physicians Foundation found that 77 percent were pessimistic about the future of medicine.

The main reason: malpractice lawsuits, which the president’s law did little to address. After that, the top factors cited were “Medicare/Medicaid/government regulations,” “reimbursement issues” and “uncertainty/changes of health reform.”

Craig Garthwaite, professor at the Kellogg School of Management at Northwestern University, said he has concerns about doctor shortages in the coming years even if speculation about an Obamacare-induced physician exodus proves groundless.

“What you’re hearing now is going to be: (a) anticipatory, and (b) purely anecdotal, because we don’t have data yet,” said Mr. Garthwaite, author of a 2012 research study on projected physician shortages. “You definitely hear doctors saying they’re going to work fewer hours, but I don’t know how much stock you can put in that.”

He said the problem is that as many as 32 million people are expected to be added to the health care system as a result of Obamacare, half of those as a result of the expansion of Medicaid. Many doctors already refuse to accept Medicaid patients because the government reimbursements for services rendered are well below the market rates.

“What’s concerning is the economic incentives,” Mr. Garthwaite said. “A lot of people are going to leave private insurance and go on Medicaid because it’s cheaper, and that means lower reimbursements for doctors because Medicaid is such a poor reimburser. At the same time that we’re increasing the need for more doctors, we’re decreasing the incentives that would normally attract people to the medical profession.”

Opponents of the president’s health care law in Washington, led by the Republican majority in the House of Representatives, concede that November’s elections have largely taken the question of outright repeal off the table. But Republican leaders such as House Budget Committee Chairman Paul Ryan of Wisconsin say resistance from doctors in the field is growing and will help fuel the movement to make the law “collapse under its own weight.”

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