Will physicians ever support the Affordable Care Act?

A recent survey by Deloitte of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators.

The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether the Affordable Care Act was “A good start” or “A step in the wrong direction.” The question was split 44% to 44%. All respect for Mr. Pollack and Dr. Murthy writing for The New Republic who find the sum of survey data to date equivocal, including the recent small Deloitte survey, but, it seems to me, despite that single question, that physicians, at least as much as the general public, have a distaste for the ACA which is not improving.

In that same Deloitte report 69% of physicians responded “Yes: I think the best and the brightest who might have considered medicine as a career will think otherwise” when posed to rate the “Impact of health reform on the future of the medical profession.” Previous surveys as the debate over health care reform raged last year found similar dissatisfaction amongst physicians with the Affordable Care Act. The act remains very unpopular, with a plurality of Americans opposing it and a large majority continuing to oppose an individual mandate. Despite implementation of more than a few parts of the law, that opposition amongst the public has barely budged. And neither, seemingly, has the opinion of physicians moved.

Attempts to paint widespread support for the act amongst physicians is misplaced.

A better way to gauge these issues is to examine how physicians and the organizations which represent them actually behaved during last year’s health reform. One wouldn’t know from Pipes’ article that the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, the American College of Surgeons, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American Osteopathic Association, the American Psychiatric Association, and the American College of Cardiology all endorsed last year’s health reform. These groups represent hundreds of thousands of physicians across a wide range of medical sub-specialties.

Its true that, like physicians as individuals, organized medicine’s reasons for supporting the Affordable Care Act were disparate, but at the highest levels of the largest organizations I promise you, pledges by the Obama administration to work towards a full Sustained Growth Rate formula fix and a feeling that physicians would be left out of the table served as the reasons to support reform far more than any true love for the provisions of the Affordable Care Act.

It’s wishful thinking that the public at large or physicians will come around to the Affordable Care Act, even once the most powerful provisions come online in 2014.

We believe that physicians will embrace the Affordable Care Act because the new law helps to address many critical issues that have long concerned physicians and patients—abuses and market failures in the provisions of health coverage, rising numbers of uninsured patients, variable quality, poor coordination of care, the erosion of primary care, and the lack of focus on prevention and public health. As the law’s main provisions kick in, physicians will see that it is, indeed, a big step in the right direction. We are sure that the new law will attract serious criticism. Real on-the-ground progress will provide the best rebuttal.

Here is how I imagine the next few years as it comes to physician and public opinion on the Affordable Care Act. The Supreme Court hears and decides the challenges to the individual mandate this term and strikes it down but allows the rest of the act to stand. Now you’re left, for the physician, with the bureaucracy of ACOs, CMS pushing pay for performance and best practice trials and independent of the ACA, but tainting the opinion of government’s role in health care in general, no SGR fix.

I can’t imagine a majority of physicians having a truly positive opinion of the ACA anytime soon.

Colin Son is a neurosurgical resident who blogs at Residency Notes.

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  • http://pulse.yahoo.com/_6C65YWGCC7P5C6CGMMBK7VMFXE JenniferL

    “Will physicians ever support the Affordable Care Act?”

    Answer: absolutely no.

    Will physicians ever support a non-totalitarian, non-corrupt, transparent, simple, bureaucracy/hyper-regulation reducing, bipartisan, civil liberty respecting, Constitutional, freedom of choice legislation, no longer that 100 pages in length and voted on in the light of day?

    Answer: absolutely yes.

  • RickRM

    The facts do not support some of the assertions in this opinion piece.  For example, Dr. Son states “The act remains very unpopular, with a plurality of Americans opposing it” and this statement links to the Nov 2011 Kaiser Health Tracking Poll.  The more recent tracking poll (March 2012) states:

    As the two-year anniversary of the law approaches, the public remains chronically divided.  The public is almost perfectly split: 41 percent of Americans hold a favorable view of the law this month, while 40 percent hold an unfavorable one — not terribly different from the 46 percent who favored it and 40 percent who did not in April 2010. Opinions divide sharply along partisan lines, with Republicans disliking the law (75% have an unfavorable view of it this month), Democrats favoring it (66% favorable) and independents more divided (40% favorable vs. 42% unfavorable). There have been other polls that show support for the specific provisions in this act when people asked about them in a blinded fashion, and a rejection of these same provisions when they are discussed as components of “Obamacare”.  This reveals what is really going on – support for the act has become politicized, and many people state their opinion on the act based on whether they’re Republicans or Democrats, and not based on whether or not they agree with what’s actually in the legislation. 

  • katerinahurd

    In order to support the Health Reform law, the physicians must be convinced of either more gain in status or income or at least maintain their current status.  Do you think that they will choose between these options as individual physicians or would they follow the choiced made by their professional organizations.  It is ironic that professional organizations such as AMA ahs already endorsed the Affordable Care Act.

  • Bradley Evans

    I don’t think there’s data to support the main initiatives of the ACA. What data I can find from CBO and Health Affairs is negative or equivocal. Not only is ACA not tested, it will layer bureaucracy on top of the bureaucracy we already deal with. In other words, when doctors get a new surgery, medicine, or test, the old one goes away. Government programs just layer on. 

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