Family doctors are mostly very nice people. They also usually render
good medical care. However, they are not accorded high status in the
medical hierarchy and in general have little power in medical schools
or the research establishment. However, they are well organized
politically, and have triumphed in the Obamacare wars. Approaching the
concept of doctor reimbursement as a zero-sum game, their lobby
convinced Pelosi and Reid that favoring family practice over specialty
care would save money. This may well be true, but every time a
pressure group meddles into a complex system, the reallocation of
resources results in unintended consequences. Medical research may be
one of the first casualties of Obamacare.
Family doctors do not do much medical research. General practice, with
the need to be a "jack of all trades" precludes studying one topic at
the depth required to be an original investigator. In addition to the
five or so years required to become a specialist, doing basic medical
inquiry requires additional post-residency training. It is these
highly specialized, non-family doctors, who do the research and teach
in the medical schools and universities.
In the power grab that was Obamacare, the family doctors did not
consider, and the Congress did not understand, that the high fees paid
to medical specialists are a key component to funding medical
research. Although laboratories and lab workers are paid for by
grants, most physician researchers receive a salary based upon their
part time clinical practice and supervision of residents. Seeing
patients, with the help of residents a few days a week, has previously
generated enough income to pay the salaries of these academic
researchers. Although the incomes were not as high as those of private
practice, the system worked well enough to keep medical schools and
research positions filled.
The proposed reimbursement reductions to these "overpaid" specialists
will impact the academic centers the hardest. Academic physicians,
already paid less than their colleagues in private practice, will be
faced with substantial reductions. Rules meant to shorten resident
hours will further increase the demands on these faculty doctors.
Faced with reduced grants, lower medicare reimbursement, and
increasing costs, the possibility of medical schools or hospitals
supplementing physician salaries is not possible.
My guess is there will be an exodus of academic physicians, and a
reluctance of younger doctors to enter in to the research world. After
years of study and huge student loans, the best and the brightest may
no longer be able to afford the academic life.
The American medical research establishment has been the source of
incredible discoveries and advances in medical care and knowledge. It
relies on the dedication and sacrifice of a large number of very
talented individuals, working in hundreds of universities across the
country. However, it is based upon a complex and fragile funding
system. Obamacare, and it's financially motivated, politically driven
backers, are unwittingly dismantling the infrastructure that has been
built over the last 50 years. Like the civilians at ground zero in a
bombing run, medical research may well be one of the first victims of
collateral damage from Obamacare.
Random notes
Some early fallout from the Obamacare rules is starting to fall.
Insurance companies and large corporations are realizing the impact of
the new rules, and starting to react. More to come.
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