Sunday, April 4, 2010

In rural areas of the country, obtaining a doctor’s appointment is practically mission impossible. Even in cities such as Boston and Manhattan, it can be very difficult for patients to attain the medical care they badly need, particularly for Medicare and Medicaid patients. From New York’s Upper East Side to the heartland to San Francisco’s Haight Ashbury, a striking physician shortage exists in this country. The reasons for the dearth of doctors are complex, but one thing is certain: The “health care reform” that President Obama ardently pushed down the public’s throat and recently signed into law will not increase the scant supply of doctors. In fact, it will make the problem worse.

There is a huge investment in both time and money before one is qualified to practice medicine. Medical school, which future doctors complete after four years of undergraduate studies, is another four years of expensive schooling. Then, to be able actually to practice and make a living, doctors must complete a rigorous residency program ranging from an additional three to six years of training, depending on the specialty. The majority of physicians do a fellowship on top of that, which is another two to three years. By the time most doctors start their careers, they are in their 30s and have accrued more than $150,000 in education-related debt.

It is true that in every profession one must pay one’s dues, so to speak. Yet, the “dues” in medicine considerably trump those of any other field. Medicine is not only mentally challenging, but incredibly physically and psychologically demanding as well. The training is brutal - 30-hour shifts, 80-hour-plus weeks, four days off per month, lunch breaks nonexistent. The salary, which hovers just above minimum wage on an hourly basis throughout the training marathon, bears no relationship to the responsibility, education and skill set. While contemporaries move on with their lives, buy homes and take vacations, a vacation for a young doctor often is merely the opportunity to sleep in his or her own bed and not at the hospital. A break on a 30-hour shift can be little more than five minutes to scarf down dinner, praying you are not interrupted by a page. You usually are.

It takes tremendous sacrifice to become a physician. If anything, doctors should be rewarded to give up so much to pursue this noble calling. They certainly should not be disincentivized, which is precisely what the newly passed law will do.

Obamacare is brutal for physicians, and the detriment transcends dollars and cents. The law establishes approximately 159 new committees, agencies and bureaucracies, each with incredible power and flexibility to dictate physician decisions and burden an industry already regulated to death with even more red tape. This will further strip doctors of their autonomy and drown them in ever more bureaucracy and paperwork. It will make doctors even more beholden to the whims of unaccountable bureaucrats and lawyers than they already are, at the expense of the patients’ best interest. Doctors will have to waste valuable time complying with inane regulations that are superfluous and sometimes harmful to patient care. This will result in physicians having even less time to administer to patients. The problem will be magnified as declining reimbursements compel doctors to see more patients to maintain the same income. It will hamstring a physician’s ability to practice good medicine and will drain job satisfaction.

Obamacare will dissuade bright young minds from entering medicine in the first place, while many doctors already practicing will either retire or switch careers. New patients will be unable to find doctors, and many patients content with their health care will eventually encounter similar difficulty. Obamacare is certainly bad for doctors. Ultimately, however, it is the patient - haplessly facing restricted access, long waits and rationed care - who suffers the most.

Mr. Obama has correctly noted the shortage of primary care physicians, but his prescription to resolve the problem will only exacerbate it. Furthermore, there are shortages in many specialties and subspecialties as well. A policy of “Regulate more, pay less” will prove a very difficult recruiting motto.

Dr. Jason D. Fodeman is an internal medicine resident at the University of Connecticut and a former health-policy fellow at the Heritage Foundation. He is the author of “How to Destroy a Village: What the Clintons Taught a Seventeen Year Old.” (Publish America, 2003)

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