Deloitte: Physicians skeptical health reform can deliver on its promises

Only 27 percent of physicians believe the Patient Protection and Affordable Care Act will likely reduce healthcare costs by increasing efficiency and half believe access to healthcare will decrease because of hospital closures that will result from the law, according to a new study published yesterday by industry consulting firm Deloitte.

"Physician Perspectives about Health Care Reform and the Future of the Medical Profession," also shows that nearly three-in-four doctors – 73 percent – are not excited about the future of medicine while 69 percent believe the "best and brightest" who might consider a career in medicine will think otherwise.

"The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession," said Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report in a press release announcing the results. "Effective reform has to consider the physician's view as a starting point. We not only have to design the right model, but we have to create the right incentives and processes for implementing that model."

Two important factors playing into this are doctors’ concerns about both their clinical autonomy and the potential threats to their income.

“Most physicians believe payment reforms (e.g., bundled payments, performance-based incentives) will reduce their incomes and increase their administrative costs for needed infrastructure and quality measurement,” the report noted.

The physicians surveyed also indicated they expect increased demand on physician services as a result of the newly insured under health reform and that many physicians will seek other opportunities including administrative roles in health plans, hospitals and other settings, as a result of health reform.

[See also: Physician employment by hospitals expected to accelerate.]

Other findings of the study include:

• Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
• More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers. More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
• Surgical specialists (57 percent) are much more likely to support the law's repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent). They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
• There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Physicians aged 25 to 39 are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.

The survey was commissioned by Deloitte and polled 501 physicians obtained as a random sample from the American Medical Association's master file of physicians. The responses were weighted by years in practice according to gender, region and practice specialty to reflect the national distribution of physicians in the AMA master file.