Galen Institute President Grace-Marie Turner says the exodus is alarming, as evidenced by a Physicians Foundation report showing the number of doctors who say they run an independent practice has dropped from 62 percent in 2008 to 35 percent in 2014. The survey of 20,000 physicians also shows only 17 percent in solo practice. Eighty-one percent of doctors are at full capacity or even overextended. Forty-six percent grade Obamacare as a D or an F. Just 25 percent give the law an A or a B.
For those greatly frustrated by the system, Turner said the government is making their lives miserable.
“The doctors cannot navigate this incredible bureaucracy,” she said. “They may see 40 patients during a day, and then they have mountains of paperwork to fill out. If they slip up and say something in carelessness or not understanding the rules and make a mistake, they could be subject to tens of thousands of dollars in fines. They just cannot expose themselves to that kind of jeopardy.”
Turner said there are two groups involved in shrinking the supply of doctors. First, she said experienced doctors are simply retiring rather than jumping through Obamacare’s bureaucratic hoops.
“Some of the more seasoned, experienced, established physicians are just taking down their shingle and saying, ‘We have had it. We cannot deal with this cookbook medicine. We cannot fight the rules and regulations and legal jeopardy we’re in.’”
She said the toll on health-care quality is sobering.
“They’re leaving practice early,” Turner said. “We’re losing decades of experience and medical expertise when doctors would otherwise be at the prime of their practice, leaving because they cannot deal with the bureaucracy or afford it.”
The other trend is doctors merging with hospitals and leaving independent practice.
“A number of physicians who are younger and still have bills to pay and families to support are selling their practices to hospitals, which mean that they basically become employees and have to do what the hospitals say,” Turner said.
The Physicians Foundation report finds that 53 percent of physicians describe themselves as hospital or medical group employees, up from 38 percent in 2008.
Turner said their logic makes sense.
“They really are buying the protection of these big hospital chains, which can hire an army of doctors and bureaucrats to try to help them navigate the bureaucracy,” she said. “The bureaucratization of American medicine is well underway and that does not bode well for patients.”
She says it’s bad for patients in two ways, first because of the realities of being a doctor employed by a hospital.
“Now they have to follow these very strict rules and regulations of these big hospital systems in order to treat a patient. If they don’t, they may either not be paid but they also could be penalized,” said Turner, who is also very worried that the notion of playing it safe is stifling innovation and preventing the development of better treatments.
“Both the doctors who stay in practice, and even more the medical students who apply and are accepted, are people who want to work a 40-hour week,” Turner said. “They’re perfectly happy to follow this cookbook medicine standardization and to not rock the boat by trying to do something innovative that might actually teach us something.”
Turner said increased government control of health care in other countries has consistently meant longer waiting times for treatment. She said cancer patients in Canada can wait up to 16 weeks or more for care after receiving a diagnosis, a span she acknowledges can be a “death sentence.”
In addition to losing good doctors, Turner said doctors are often brought in from other countries, and that can prove very challenging for patients as well.
“When you drive out the established physicians who are saying they are not willing to practice under these kinds of conditions, you still have to have physicians,” Turner said. “We do have many foreign medical graduates in this country, and patients complain that they have a physician who they really can’t communicate with.”
But while excoriating the mountain of rules and regulations Washington is piling onto physicians and others in the medical community, Turner said Americans should never doubt how much doctors and nurses want to help people.
“When you look at the nurses and the doctors that are still taking care of patients, it is so inspiring to see how much they continue to want to practice good medicine,” she said. “They are devoted to their patients. But they are so stressed in many cases and so frustrated, saying, ‘I got into this business to take care of patients, not to fill out all this paperwork and bureaucracy.’”