Nearly One-Third of Doctors Could Leave Medicine if Health-Care Reform Bill Passes, According to Survey Reported in New England Journal of Medicine

By Christopher Neefus | March 15, 2010 | 7:23 PM EDT

Doctors meet with President Obama to discuss Meidcare and health-reform legislation. (AP photo)

( - Nearly one-third of all practicing physicians may leave the medical profession if President Obama signs current versions of health-care reform legislation into law, according to a survey published in the latest issue of the New England Journal of Medicine.
The survey, which was conducted by the Medicus Firm, a leading physician search and consulting firm based in Atlanta and Dallas, found that a majority of physicians said health-care reform would cause the quality of American medical care to “deteriorate” and it could be the “final straw” that sends a sizeable number of doctors out of medicine.
More than 29 percent (29.2) percent of the nearly 1,200 doctors who responded to the survey said they would quit the profession or retire early if health reform legislation becomes law. If a public option were included in the legislation, as several liberal Senators have indicated they would like, the number would jump to 45.7 percent.
The medical journal published the results in its March and April edition, saying: “While a sudden loss of half of the nations physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.”
Kevin Perpetua, managing partner for the Medicus Firm, reported that a reform bill could be “the final straw” in an already financially precarious industry.
“Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases,” Perpetua said in the study. “The overwhelming prediction from physicians is that health reform, if implemented inappropriately, could create a detrimental combination of circumstances, and result in an environment in which it is not possible for most physicians to continue practicing medicine.”
“With an average debt of $140,000, and many graduates approaching a quarter of a million dollars in school loans, being a doctor is becoming less and less feasible,” Perpetua said. “Health-care reform and increasing government control of medicine may be the final straw that causes the physician workforce to break down.”
The survey shows that many doctors already find their situations difficult:
-- 36 percent said that they would not recommend medicine as a profession to others, regardless of whether health-care reform passes;
-- another 27 percent would still recommend medicine as a career, but not if the current reform proposal passes.
In total, 63 percent of doctors would not recommend the profession after health-care reform passes. Just 12 percent do not recommend becoming a physician now but think they would if current reform proposals pass.
Primary-care physicians, those who work in the critical fields of family and internal medicine, not only feel that they would want to quit but that they might be cast out of medicine. 46.3 percent of those physicians said that they would either want to leave medicine or that they would be “forced out” by the changes to the system. 

Despite all the opposition to the bill as it stands, only a little more than 3 percent of respondents said the status quo was best, with the vast majority (62.7 percent) saying they believe changes are needed.
The same 62.7 percent said they wanted reforms made, but that they “should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in (the) legislation.”
Andrea Santiago, a spokeswoman for the Medicus Firm, said those numbers were the most striking.
“Please allow me to emphasize that 96 percent of the physicians surveyed in our report are in favor of health reform, in some form or fashion,” she told in an e-mail. “To me, the fact that so many physicians surveyed want health reform, but relatively few are in favor of the current legislation, was one of the most significant, telling results.”
Congressional Democratic leaders, meanwhile, have said that doctors favor the bill and are part of an “unprecedented coalition” of doctors rooting for its passage. The claim is based on the American Medical Association’s endorsement of the legislation in Congress.

According to the Bureau of Labor Statistics, in 2008 there were 661,400 physicians and surgeons within the United States. Of that number, 250,000 are members of the American Medical Association (AMA) -- and nearly 100,000 of those are medical students.

Santiago explained the AMA could not claim to represent all doctors, nor perhaps could any other group, and said the potentially massive shortage of physicians has stayed largely out of the debate because public figures have been trying to speak for doctors instead of speaking to them.
“I think the reason it hasn’t become a big issue in the political debate is maybe because no one else has really thought about the effects of health reform on the physician workforce. Or, maybe people didn’t want to think about it, but as recruiters we can’t help but think about it and take notice,” she said.
“If you are not talking to physicians every day about their career plans, it may not occur to someone that it would even be an issue.  Plus, many public figures, media, and organizations are speaking for doctors in professional associations and groups, proclaiming ‘doctors want this.’ Without surveying each and every doctor, no one can claim that all doctors want this particular version of health reform, including us.”
Santiago said one problem with a comprehensive bill was all the uncertainty about its effects that comes along with it.
“When you’re on the phone with doctors each and every day, discussing their career plans, like we are as recruiters, you start to notice hot-buttons that are related to their career decisions, and health reform was increasingly and repeatedly coming up as an issue that was causing doctors apprehension when making career plans,” Santiago explained.
“Many seemed frustrated by it.  Part of it, I think, is fear of the unknown -- the current health reform bill is so large and all-encompassing, no one really knows for sure what will happen when/if this bill passes, so how does a physician make major career decisions when so much is hanging in the balance?”
The key findings of the survey can be found here.