There is an almost universal recognition that America cannot afford its health care system. While on the one hand the government seeks to expand the number of people covered by insurance and increase the minimum levels of coverage, it simultaneously seeks to rein in the aggregate cost. Obviously, there must be some “give” somewhere.

Reimbursement for medical treatment (including both the reimbursement obtained by doctors as well as the reimbursement obtained by medical facilities such as clinics, surgical centers and hospitals) seems to be the number one target for cost-containment, with big Pharma a close second (although big Pharma is beyond the scope of this post.)

Curtailing, limiting or otherwise decreasing doctor/treatment reimbursement directly effects the revenue medical practices obtain, and therefore the amount that doctors earn.

I believe that there is an apparent lack of recognition that doctors make a very substantial and significant investment in pursuing a medical career. Ultimately, the sacrifices made by doctors must yield a financial reward commensurate with their sacrifices, and in line with the commitment/benefit ratio of other pursuits,  or the medical profession may be abandoned, at least in part.

 A doctor typically spends 10 years + of higher education in pursuit of his or her medical training, many hundreds of thousands of dollars in tuition, significant sums in associated expenses, and the opportunity costs of money not earned during that decade (or longer.) It seems readily evident that people who are intelligent, hard-working, studious, and are ready to forgo instant gratification for a longer-term payoff, have other career choices where the sacrifice/benefit ratio augurs in favor of the alternative choices. At the end of the day, if we want doctors, there must be a value proposition in relation to the other available alternatives. I am concerned that recent changes are upsetting the career choice equilibrium.

In a recent study sponsored by CareCloud in partnership with Quantia MD with responses from over 5000 physicians certain key findings were set forth.

 1. US physicians are now more than twice as likely to foresee eroding, not increasing, profits in 2014.

2. The issues weighing on finances are led by declining reimbursements (60%), rising costs (50%) requirements of the ACA (49%) and the transition to ICD 10 (43%)

3. Successful patient engagement requires that physicians have adequate time and space to focus on care. But the percentage of doctors spending more than one day a week on paperwork rose sharply between 2013 and 2014 from 58% to 70%. Nearly 1/4 (23%) spend more than 40% oftheir time on administration, up from 15% in 2013.

4. Interest in selling their practices is rising

5.   Almost 1/3 of physicians aim to rip and replace at least one element of the core technology platforms in the next year, citing cost (36%) usability (31%) noncompliance with ICD 10/MU (31%) and a lack of vendor innovation (17%).

It does not take a rocket scientist to figure out that as the reward and satisfaction of a particular career declines, the people seeking to embark on that path will similarly decline.

By analogy, there was a recent article in the New York Law Journal regarding the legal profession and the decline in prospective lawyers. The article reported that fewer people are choosing to enter the legal profession. Law school enrollment for first-year students has declined 30% in the past four years and is at its lowest level since 1973. Enrollment at New York Law School’s has fallen approximately 23% since 2010. People are shying away from the legal profession-despite the desperate need for affordable and accessible legal services by the poor and people of limited means-because they sense it is no longer a reliable source of employment in today’s economy sufficient to justify the significant cost of legal education.

Are we being penny wise and pound foolish with respect to the reimbursement and resultant earnings of doctors. Are we driving future doctors away from medicine, and if so, who will ultimately pay the price. 

What do you think