Physicians Divided on Healthcare Reform

Elyas Bakhtiari, for HealthLeaders Media , August 27, 2009

The report found that when asked simply if they support national health insurance, of the more than 2,000 doctors polled, 59% were in favor of and 32% were opposed, a significant jump from the previous poll in 2002.

But if you break that down by specialty, support ranged from more than 80% of psychiatrists to only 30% of radiologists. In fact, a physician's specialty seemed to be a pretty strong predictor of whether he or she supported national health insurance.

The specialties that most strongly supported it—psychiatry, pediatrics, and primary care—all make less than $200,000 (MGMA median levels) or, in the case of emergency medicine, often have patient panels with a lot of uninsured or Medicaid patients. The specialties most strongly opposed—radiology, anesthesiology, and surgical subspecialties—are some of the highest earners in medicine and the biggest beneficiaries of the fee-for-service model.

Are physicians basing these views entirely on compensation? Of course not. But reforming healthcare will affect physicians to varying degrees, and specialty affiliations can't be discounted.

There's been a lot of talk from the Obama administration about boosting primary care training and reducing ED overcrowding through reform legislation, but there has also been focus on reducing imaging payments and moving away from fee-for-service. There will be winners and losers among physicians.

Unfortunately, the survey that showed the specialty correlations came out a year ago, before tangible reforms had been proposed, and I haven't seen a study since that has broken down support by specialty.

But given physicians' allegiance to their niches and the wide gaps in incomes and practice styles, I'd guess there is a similar specialty divide in support for specific reform proposals today.

Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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