Interesting article by Gardiner Harris in the New York Times, “As Physicians’ Jobs Change, So Do Their Politics.”
And, although there is a lot of conditional phraseseology (“could mean this,” “could mean that”), it raises some interesting points and is worth some discussion.
Reporters (especially those covering health care issues) are keen to say, “The plural of anecdote is not data.” And they’re right. But after leading off with, well, an anecdote, the story continues:
There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.
No surveys or facts or figures but, nevertheless, some telling anecdotal trends worth reporting. Mr. Harris continues:
that change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.
Please note the word “would.” The new law “would provide,” among other things, improved competition and choice. Well, to put it mildly, that remains to be seen.
With the politics out of the way, the article hits the crux of the matter:
Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.
Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.
But the issue isn’t just money – it’s also physician disempowerment. With insurance companies and now (and increasingly) Uncle Sam telling doctors how to practice medicine (step therapy, restrictive formularies, an increasing reliance of questionable comparative effectiveness research and more strident and cumbersome preauthorization requirements), it’s no wonder that physicians are leaving private practice.
So it’s highly questionable that physicians (their political affiliations notwithstanding) are going to be fans of the Patient Protection and Affordable Care Act. And to that point, the article ends … with an anecdote:
Dr. Kevin S. Flanigan, a former president of the Maine Medical Association, described himself as “very conservative” and said he was fighting to bring the group “back to where I think it belongs.” Dr. Flanigan was recently forced to close his own practice, and he now works for a company with hundreds of urgent-care centers. He said that in his experience, conservatives prefer owning their own businesses.
“People who are conservative by nature are not going to go into the profession,” he said, “because medicine is not about running your own shop anymore.”
So, consider the Irish proverb, “Every disease is a physician” – and then consider what disease we’re addressing.