Physicians Practice - July/August 2008 - (Page 37)

WHAT PHYSICIANS SAY But what do doctors think of all this reform talk? Not the policy-wonk MDs who work for universities and think tanks but physicians who make their living in private ofﬁces diagnosing tennis elbow and getting people to say “aaah”? Doctors like you. One survey found, to the surprise of some, that physicians view a lack of access to healthcare as the system’s biggest problem, and they’re mostly in favor of some kind of universal healthcare. But precious little data exist on the subject of physicians’ views of healthcare reform; the anecdotal evidence suggests that there’s not much more consensus among physicians than there is among the general population or on Capitol Hill. To wit: “The only thing that will save medicine is a good dose of free enterprise. Government regulations, entitlement programs, and HMOs are leading us down the road to socialized medicine.” So argues Steven F. Hotze, a family physician and founder of the Hotze Health & Wellness Center in Katy, Texas. “The solution is to return to a free enterprise system for medicine with doctors charging a fee for service, just like any other business. Beware of politicians who promise to lead us into the Promised Land by giving us universal health coverage, which really means socialized medicine.” But wait. “Since we’re humane enough to … not let people die on the streets, people are going to get some level of care. … We might as well just pay for everyone and get a better bang for our buck, no?” Such is the thinking of Graham Walker, who at this writing was about to head off to residency in New York after graduating from Stanford Medical School. Hotze is emblematic of the conservative-minded physician who yearns for the day when doctors and patients had a relationship based on trust, unencumbered by third parties. Walker, writing in his blog, is the young idealist whose focus is on getting more people covered. Yet this goal is counterproductive if you believe, like Hotze, that the health consumers get better access to generic drugs in the form of the patient’s “bill of rights,” legislation that was largely touted by the Democratic side back in 2001. He also favors pay-forperformance models for physicians. Obama is pushing for high portability, so that if a person changes jobs, her health benefits follow her. So what’s in any of this for you, the physician? “To the extent that [one of these] proposals becomes reality, and coverage is improved, doctors can beneﬁt from a larger part of the population having coverage,” suggests Leo Brideau, who is president and CEO of Columbia-St. Mary’s hospitals in Milwaukee. That certainly could be good, he says, because “there’s enough research on the uninsured to know that they put off care.” Indeed, nearly six in 10 physicians now say they favor universal coverage, according to a survey published in Health Affairs in March, up from 49 percent only ﬁve years ago. But no one seems to have any ideas on how to solve the primary-care physician shortage — one that would become more pronounced if healthcare were more available. On this subject, the presidential candidates have said almost nothing. “I don’t see anything that will solve the primary care shortage,” says Kevin Pho, a board-certiﬁed internist based in Nashua, N.H., who also maintains a widely read blog, www.kevinmd.com/blog/. Pho notes that there are merits on both sides. “I laud the Democrats trying to cover the uninsured. But doing so without controlling costs or ensuring access will make it difﬁcult,” he says. “And patients should have more say in spending healthcare dollars, but for patients to ﬁnd the appropriate info is difﬁcult. What’s out there is not quite good enough for the general public.” It all “looks good on paper,” notes Pho, “but difﬁcult to pull off.” I Shirley Grace, associate editor for Physicians Practice, holds an MA in nonﬁction writing from The Johns Hopkins University. She can be reached at sgrace@physicianspractice.com. WWW.PHYSICIANSPRACTICE.COM JULY/AUGUST 2008 | PHYSICIANS PRACTICE | 37 http://www.kevinmd.com/blog/ http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - July/August 2008

Physicians Practice - July/August 2008 Contents The Bigger Picture: Battle Royale in the EMR Market Letters Physicians Practice Pearls: Hire Right Noteworthy Cover Story: Healthcare Reform: Voting for Change Patient Relations: Dealing with Problem Patients The tech Doctor: Is Self-Service Medicine Inevitable? Technology: Do EMRs Make You a Better Doctor? The Guide Idealab: Cash-Only Care Still Works The Administrators Desk: Who’s in Charge? Ask The Experts What Went Wrong: ‘Why Our Great Idea Didn’t Work’ Coding Start It Up: How to Launch a Practice: Operations Partnership: Don't Let Partner Conflict Destroy Your Practice Appraisals: What’s Your Practice Worth? Getting Advice: How to Hire a Consultant Classifieds Advertiser Index

Physicians Practice - July/August 2008

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