How Obamacare undermines the doctor-patient relationship

America recently marked the first anniversary of the passage of Obamacare. It wasn’t a happy birthday for American patients.

Obamacare is already exacerbating some of the current trends in American medicine that work against the interests of patients. Paramount among them is an erosion in the quality of the nation’s doctors. If unaddressed, America’s heyday as the world leader in the practice of medicine could draw to a close.

Physicians are extraordinary people. Typically, they are smart, skilled, committed, and confident. That last quality is especially important. Patients want their doctors to be sure about what is wrong with them — and to believe that no one else is better suited to fix what needs repair.

Unfortunately, these “givens” regarding doctors may soon be the exception. Why? For starters, politics have invaded the curricula of America’s medical schools. Few professors champion market-based approaches to improving health care.

Instead, most faculty members seek to indoctrinate future doctors with appreciation for a statist approach to health care. As older, more market-friendly doctors retire, they’re being replaced by fans of socialized medicine.

Doctors’ training programs after medical school have also withered. Newly minted M.D.s immediately begin three to 10 years of residency training after leaving school. This process is like medical boot camp. Long hours, intense study, physical and emotional pain, and sacrifice are the norm.

Doctors, like soldiers, often need to make split-second, life-and-death decisions. This is not a job for the faint of heart, and residency is a process for weeding out those who can’t cut it.

Unfortunately, this process has been subverted by the Accreditation Council for Graduate Medical Education, a powerful organization created as an oversight body in 1981.

In response to a highly publicized case in New York in which a fatigued — and poorly supervised — resident made a significant medical error, the accreditation council forbade residents from working more than 80 hours per week or more than 16 consecutive hours. The body also mandated that residents receive a minimum of 10 hours off.

Sadly, these restrictions result in a “shift system” of medical training. Patients are passed off from one doctor to the next as they punch the clock. And in this scheme, the risk of catastrophic errors multiplies, as doctors may inadequately brief their replacements on the nuances of their patients’ conditions.

The process also produces new doctors who are not trained as well as their predecessors, including some who find out too late that they are not cut out for the demands of the specialties they are studying.

Finally, patient-doctor relationships are slowly deteriorating as physicians leave private practice for salaried employment at hospitals. Last year, for the first time ever, more doctors worked for hospitals than for themselves.

Physicians increasingly worry that a combination of government regulations and plummeting reimbursements for their services will force them out of business. Hospitals have seized upon this widespread fear and are buying up physician practices, placing the practice of medicine nationwide under their institutional control.

As a result, private practice as we know it could be extinct within a decade.

Obamacare is hastening these transactions by pushing for the creation of “accountable care organizations” whereby doctors and hospitals are paid not according to how much care they deliver but in bundles according to nebulous government “quality” standards.

ACOs are simply the 21st century version of HMOs. This time, though, doctors will be forced to serve their hospital paymasters — not their patients.

None of these trends is new; all of them predate Obamacare. But like Obamacare, they are undermining what has always been and should continue to be the heart of American medicine: patients’ confidence in their doctors and doctors who have the necessary tools to provide excellent health care that Americans have come to expect.

Dr. Hal Scherz is assistant clinical professor of urology at Emory University, an attending surgeon at Children’s Healthcare of Atlanta, and president of Docs 4 Patient Care, a national physician advocacy group. Sally C. Pipes is president, CEO and Taube Fellow in health care studies at the Pacific Research Institute.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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