Daniel Henninger’s recent Wall Street Journal column, “Obamacare’s Lost Tribe: Doctors,” outlined the deleterious effects of Obamacare on physicians and the implications for patients.
At issue, Henninger writes, is not merely if patients will be able to keep their doctors, as Obama promised, but, rather, if physicians will be able to keep their patients — or even stay in the practice of medicine.
The questions Henninger raises about physicians under the president’s Affordable Care Act are even more applicable to Catholic physicians.
Doctors just want to take care of patients. Catholic doctors, in addition, want to take care of patients in a way that is consistent with their faith. But both of these desires have been increasingly difficult to fulfill in recent years, and the future is looking bleaker than ever.
For years, financial and legal pressures have made the climate for medical practice stressful for physicians. In America, payment for health-care services is made overwhelmingly by third-party payers — government (Medicare, Medicaid, State Children’s Health Insurance Program and Veterans Affairs) and health-insurance companies — rather than by patients and individuals.
To prevent fraud and reduce costs, these third-party payers create increasingly complex regulations and demand discounts wherever possible. Doctors have been forced to hire ever more support staff to deal with the bureaucracies and to work harder, seeing more patients and performing more procedures, to make up for the expenses and reductions in reimbursement.
While American physicians earn more than their counterparts in other countries (and specialists can make from 60% to 90% more than primary-care physicians), they also have unique and expanding expenses to cover, not only support staff and malpractice-insurance premiums, but large loans from medical school.
Even before the passage of Obamacare, many doctors were struggling.
In a 2008 survey by the Physicians Foundation, less than 20% of physicians reported that their practices were healthy and profitable; the remainder had either low profits, were breaking even, or were losing money. That same survey reported that 78% of physicians said medicine is either “no longer rewarding” or “less rewarding”; 76% said they are either at “full capacity” or “overextended and overworked”; and 42% said the morale of their colleagues is either “poor” or “very low.”
Obamacare has made everything much worse.
First, it did nothing to address issues important to physicians — lawsuit reform and the Sustainable Growth Rate (SGR) formula, which ties annual physician payment increases to the performance of the general economy. If Congress fails to forestall SGR cuts, physicians could see an immediate 27% cut in their Medicare reimbursement.
The president’s health-care plan makes physicians even more dependent on government programs for their reimbursement (since out of 30 million people expected to gain health insurance under the new law, 18 million will be put on the notoriously low-paying and bureaucratically complex Medicaid program). Obamacare promises exponentially more red tape and federal demands on physicians.
For example, a Physicians Foundation panel concluded that Obamacare “will drastically increase physician legal compliance obligations and potential liability under federal fraud and abuse statutes.”
All these pressures are driving physicians out of private practice and into employment relationships, where their ability to exercise independent judgment will be reduced.
On top of all this, for Catholic physicians, attacks on conscience rights are increasing dramatically under the Obama administration.
During the passage of Obamacare, conscience protections in existing laws were left uncertain. In February 2011, the Department of Health and Human Services gutted the only federal regulation to provide concrete resources for applying existing federal conscience laws. Attempts by the House of Representatives to amend Obamacare to restore conscience protections have been stonewalled by the Democrat-controlled Senate.
Finally, the HHS mandate shows the extent to which the Obama administration is willing to coerce people to violate their consciences and deepest beliefs.
While the HHS mandate applies first and foremost to Catholic institutions that purchase health-care insurance for their employees and to all citizens who will be subsidizing abortifacients, contraception and sterilization with their health-insurance premiums, the other shoe will drop on many Catholic doctors and health-care professionals soon if nothing is done.
It will take little time or effort for the Obama administration to mandate that every health-care professional must offer or refer for all government “preventive” or mandated health services.
Such a mandate could spell the end for many Catholic doctors, especially those in primary care or specialties such as obstetrics-gynecology. Some will give up their faith; the rest will give up the practice of medicine.
The effects of Obamacare on physician morale promise to be devastating. Polls from the Medicus Firm and Investors Business Daily in 2009 show that anywhere from 30% to 45% of physicians plan to retire early or leave medical practice soon.
The Medicus Firm poll showed that 36% of physicians would not recommend medicine as a career, no matter what, and an additional 27% would not recommend it if Obamacare became law.
Finally, a 2009 poll of Catholic Medical Association members showed that 85% would cut back or cease to practice medicine if the government forced them to violate their consciences. All this comes at a time when a shortage of more than 130,000 physicians is projected by the year 2025.
So is there a future for Catholic doctors? There can be — if Catholics within the Church raise up members who can combine an authentic Catholic faith with the learning, skill and dedication required by physicians.
There can be Catholic physicians in the future if we, as a Church, support these physicians by becoming their patients. There can be Catholic physicians in the future if we refuse to allow our increasingly totalitarian federal government to define our faith and what constitutes health care based on its own secularist worldview.
George Orwell said, “At age 50, everyone has the face he deserves.”
Now, and no doubt in the future, we will have Catholic doctors and health-care professionals if we deserve them. Will we?
John F. Brehany, Ph.D., S.T.L.,
is the executive director
and ethicist with the
Catholic Medical Association.
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I have been in healthcare a long time. While this article has many points which are “true” in a sense. I have to bring up what is most often not discussed… How did this happen??!!
Working with physicians, I have to say too many of them are more concerned with their pocketbooks and NOT patient care. The egos are astounding. Medical schools do their best to weed out ethical students because they want everyone to conform to what their “standard of healthcare” is. Which means we have MDs that blindly advocate abortion and other questionable services—I work in both ED and ICU and I am referring to terminating pregnancy with methotrexate, D&C and the “hospice” just because, no reason, just because.
I am mostly appalled by what I see. I am so disillusioned that I have a hard time feeling for these “poor MD’s”.
Back in the day, MD’s where mistakenly treated like gods and those “independent medical decisions” lead to much patient harm and it still does today.
MD’s need to first of all have real ethics and the need to start behaving like team players. Maybe then, they can win back some respect and working TOGETHER (not the world vs them) we can overhaul healthcare and truly HELP patients.
I appreciate the former comment. While a complete answer to “how this could happen” might take awhile, what I would like to stress is that the laws and trends in government policy I mentioned will have the effect of driving (or keeping) the most faith-centered and pro-life physicians out of medicine. Whatever happened in the past, we have to work hard, and together, to build a better future.
I am saddened that doctormom4 has been exposed to the very worst behavior and has not seen any compassion, sacrifice, or courage among physicians. Equally disturbing is the crux of this column: the obliteration of the medical conscience. In both cases, the development of ethics and conscience has everything to do with how a future physician is trained not in medical school but all along in life. I doubt very much that morality is either the culmination of a stint in medical school or the result of peer pressure. Look to the general culture, because physicians come from the same neighborhoods, the same schools and the same churches you do. As for these “poor MDs”, consider for a moment that persons of equal or similar responsibility, training, education, working hours and indebtedness are in fact salaried as well as or better than most physicians. I find a debate about remuneration ridiculous in this space and it is unfortunate that anyone has brought up my pocketbook.
“Official Samples” is promoting a new line of detergent, tooth paste, lotion etc by giving away free samples. It’s more of the “try it before buy it” marketing model and who can resist a free useful household product like detergent? This free sample is limited to one per household and only available while supplies last.
Well, the American Medical Association,as well as a majority of specialty lobbying groups, along with the “president” of the Catholic Hospital Association were fully on board when ObamaCare was being discussed. Anyone who warned of the downside was dismissed as wanting people to die.
Let’s go ask the Catholic members of these groups where they were when the debate was on.
Never did a piece in NCR come closer to home!I am a family physician and pediatrician who has been refused employment and let go from academic positions not for wrongdoing or lack of competence but because I refused to do abortions, prescribe abotrifacient drugs including lowdose contraceptives, and in one case defended a nurse forced to assist at an abortion. No reply to my letter to the National Council of Catholic Bishops 12 years ago warnings that Catholic physicians following their beliefs were or would be in jeopardy ever even recieved a reply. (I was not the only health care worker to experience the above problems)
WE told our children not to go into medicine, and 6 of them listened to this advice.
Though at age 70 I am still employed more than full time, I fear for the future of patients. I also fear for the resident physicians I teach, many of whom do not want to be caught in the murky waters of causing others’ deaths .
I am just an old lady in the trenches, slugging it out with patients who won’t take their meds, feel entitled to yell at me, and yes, some patients who are inspirations, but who can’t even before the full force of Obamacare hits, get expedient care. Waiting lists are already lengthening exponentially!
But I am just a Cassandra, and life will go on for those who eat right, don’t use drugs or alcohol, and exercise. For the others…
As a Catholic physician who has lost positions or failed to be hired for adhering to Catholic teaching, and who wrote to the National Conference of Catholic Bishops 12 years ago about the situation for medical personnel yet failed even to have the favor of a reply to my letter, I am so gratified that you have published the above. I am not alone as many colleagues, resident physicians, Physician Assistants and nurses have had similar experiences, although our competence was never an issue for any of us. WE warned our children not to go into medicine, and 6 of them listened to us. Most people have disdain for medical providers, thinking them wealthy and heartless, the current class warfare being employed by Washington fueling these perceptions. But soon the day will come when people will not be sure if denial of care is predicated upon their age, when folks will have to wait months or years for needed surgery, radiation or chemotherapy, and when advice given about their choices for health care may be more predicated upon social agendas than the needs of the individual. Everyone should know that in the future, health must be maintained through a healthy lifestyle, as access to care will be severely limited, and consonant with the social policy of those who think in different terms from Catholics.
As a Catholic doctor who is 53 years old practicing geriatrics, I agree that Obamacare has the potential to make it exceedingly more difficult to practice medicine according to the dictates of our conscience. It will also be more difficult to be profitable and stay in business given the cuts in medicare which have already occurred over the past 10 years.
As a geriatrician, 99 percent of my income is derived from medicare payments. Over the past ten years, even before the threat of Obamacare, yearly medicare reductions now have us getting re-imbursed for only 50% of what we bill for. Malpractice rates continue to rise. In one year in my state, they doubled. Also, I am not compensated for the hours on the phone with family and loved ones that are an essential aspect of geriatric care. Fortunately, at this point, I am an “employee physician” and the hospital system that employs me is taking these cuts “on the chin.” However, it’s only a matter of time when my employer realizes they can’t maintain the luxury of paying geriatricians who don’t generate anything close to their salary because of the massive reductions in medicare payments. This is in spite of the fact that geriatricians are a most-needed specialty given the retirement of the baby-boomers and the care they will require.
The other aspect of this “perfect storm” for Catholic physicians is the pressure to cut costs at the end of life and to “end the suffering.” We are practicing in an era when the concept of redemptive suffering has no meaning to most patients and many families think the purpose of hospice and palliative care is to provide a quick and painless end to their loved one’s suffering. As a medical director in a nursing home, I am regularly asked to stop tube feeds by families and push the morphine to lethal doses. Thankfully, in my state, it is still illegal for doctors to kill people and my nursing home, though not Catholic, agrees with the basic Catholic concepts of appropriate end-of-life care and my administration rarely questions my decisions to continue or initiate artificial nutrition and hydration. However, with the advent of Obamacare, institutions will eventually be pressured for financial reasons to withdraw and limit care and we will definitely see more euthanasia being performed than it is even now, in covert and subtle ways. The public’s acceptance of physician assisted suicide and euthanasia will increase as the costs of a fully implemented Obamacare drain the already insolvent coffers of medicare.
As Catholic physicians, we are certainly in a difficult time, but I am thankful to have the wonderful guidance of the magisterium to assist me to make the right decisions in caring for my patients. If I have to quit practicing because I am told to kill my patients, that’s ok. Better to go to heaven without a pension than hell with money in the bank.
I doubt that physician is a proper occupation for someone who does not have the patient’s interests at heart. Perhaps a Wall Street bankster is more appropriate for those who are so self-absorbed and narcissistic.
Wow. Now you have me rethinking becoming a doctor. I guess I’ll aim for med school but if things don’t change I will have to scrap that idea. It’s bad enough that doctors are killing patients in the name of mercy and getting away with it but this will take medicine back to the dark ages when you only went to a hospital to die. You never saw a doctor unless you absolutely had to to and even then you did your best to avoid them. This isn’t health care reform but the destruction of health care.
I wrote all the bishops three years ago and warned them about what Obamacare would do to the moral quality of the medical profession; there would be less pro-life physicians. This, after they came out in support of it. And that was well before Obama pulled the rug out from underneath the bishops with his HHS Mandate. Now it is too late. The only way to make sure Obamacare does not become implemented and turn the medical filled into killers before birth as well as after, is to defeat him and his Democrat klansmen, soundly.
Hi, just checking to see if comments are being accepted.
Catholics will probably not be able to work as Doctors in the future. Young Catholics should be advised to avoid medicine as a profession. Dentistry might be a better choice. Many other professions are being closed to Catholics. It’s time for a heart to heart discussion with young Catholics about career choices. The idea that you can be anything you want to be is over.
How does one get a list of Catholic doctors so that we can support them?
I regret to inform you that the deadline for effective action toward that goal has already passed.
Today we live in that “worse case.”
The opportunity for the easy win passed when Medicare was enacted. Victory was still available and not so costly when Sen. Kennedy was stumping for socialized medicine in the 1970s and ‘80s. Had Hillarycare been opposed by the Church in the 1990s, there would have remained a chance for victory but it would have been a costly one. Another such chance occurred in the early 2000s during the Bush push for Medicare Part D. Yet a final chance occurred in 2008 and that too was left to pass by.
America is far, far down that road paved with good intentions. The final destination has long been in sight and today this nation is on the threshold of that end.
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