According to her bio, Caroline Poplin is a physician, a health care policy expert, and a visiting fellow at the liberal Center for American Progress. In the journal Health Affairs, she argues that the end result of Obamacare is likely to be an increase in the amount of medical care done by hospital-affiliated medical groups, and reduced access to a personal doctor. This is a result of a greater focus on the bottom line, and greater effort to cut costs:
In the future envisioned by the health policy community, including the leadership of the Amercian College of Physicians and the American Medical Association, patients who want a personal physician, someone they know and trust, who understands and cares about them as individuals will have to pay extra for “concierge” care. Everyone else will migrate to team care from large “Accountable Care Oranizations” (accountable to whom, one may ask—certainly not the patients). These teams may well improve patients’ blood pressures, glucose control, lipid panels, maybe even weight, and indeed improve the outcomes of patients whose outcomes can be improved. Their care will be efficient: providers (yes, providers) who do not see enough patients, whose patients do not improve adequately, who order too many tests, do not meet the fifteen criteria for meaningful use of EHRs, or do not continuously pursue quality improvement projects, will see their incomes fall…
I am a Board-certified general internist. I worked for many years for just such an Accountable Care Organization. It was factory work: we were interchangeable cogs in a vast machine. The people who saw patients, especially “primary care providers” like me, were at the base of the pyramid and the bottom of the pecking order.
The future is clear. The management of the ACO — professional administrators, and physicians who see few if any patients — will schedule every moment of every primary provider’s day, critique every decision, continually scrutinize and evaluate every aspect of one’s practice. At my ACO, yes, we were on teams, but given no time to communicate with one another. We were forced to complete clunky electronic records we had no time to read. Despite years of training and experience, we had no input to the system that controlled our lives. We were not respected as professionals. It was demoralizing.
If one is concerned about a “shift work” mentality in medicine, surely it develops not in residents who get more sleep, but in physicians who can only survive by meeting ever-higher “performance goals” set by others.
When Congress passed Obamacare, they didn’t advertise that this would be a likely outcome. If you oppose this change, tell your Representative to vote for repeal of the health care law when it comes before the House next week.