A just-completed survey of MD's found that 45% would consider quitting or retiringearly if the current health care proposal becomes law. The expected consequencesof such a filght from medical practice would include lowered quality of care dueto rationing, delegation of responsibility from MDs to nurse-practitioners andphysician-assistants, less face time with your physicians, and less time forphysicians to think about your medical issues. (See below and atached) Also, the Massachusettes Medical Society said that doctor shortages are a growingproblem in their state since the 2006-passage of their less ambitious overhaul ofhealth care. CD------------------------- 45% Of Doctors Would Consider Quitting If Congress Passes Health Care OverhaulBy TERRY JONES, News Analysis by IBD (Investors Business Daily), September 15,2009 4:30 PM PThttp://www.ibdeditorials.com/IBDArticles.aspx?id=337909690110379IBD Exclusive Series: Condition Critical: What Doctors Think About Health ReformTwo of every three practicing physicians oppose the medical overhaul plan underconsideration in Washington, and hundreds of thousands would think about shuttingdown their practices or retiring early if it were adopted, a new IBD/TIPP Poll hasfoundThe poll contradicts the claims of not only the White House, but also doctors' ownlobby — the powerful American Medical Association — both of which suggest themedical profession is behind the proposed overhaul.It also calls into question whether an overhaul is even doable; 72% of the doctorspolled disagree with the administration's claim that the government can cover 47million more people with better-quality care at lower cost.The IBD/TIPP Poll was conducted by mail the past two weeks, with 1,376 practicingphysicians chosen randomly throughout the country taking part. Responses arestill coming in, and doctors' positions on related topics — including the impactof an overhaul on senior care, medical school applications and drug development —will be covered later in this series.Major findings included:• Two-thirds, or 65%, of doctors say they oppose the proposed government expansionplan. This contradicts the administration's claims that doctors are part of an"unprecedented coalition" supporting a medical overhaul.It also differs with findings of a poll released Monday by National Public Radiothat suggests a "majority of physicians want public and private insuranceoptions," and clashes with media reports such as Tuesday's front-page story in theLos Angeles Times with the headline "Doctors Go For Obama's Reform."Nowhere in the Times story does it say doctors as a whole back the overhaul. Itsays only that the AMA — the "association representing the nation's physicians"and what "many still regard as the country's premier lobbying force" — is"lobbying and advertising to win public support for President Obama's sweepingplan."

The AMA, in fact, represents approximately 18% of physicians and has been hit witha number of defections by members opposed to the AMA's support of Democrats'proposed health care overhaul.• Four of nine doctors, or 45%, said they "would consider leaving their practiceor taking an early retirement" if Congress passes the plan the Democratic majorityand White House have in mind.More than 800,000 doctors were practicing in 2006, the government says.Projecting the poll's finding onto that population, 360,000 doctors would considerquitting.• More than seven in 10 doctors, or 71% — the most lopsided response in the poll —answered "no" when asked if they believed "the government can cover 47 millionmore people and that it will cost less money and the quality of care will bebetter."This response is consistent with critics who complain that the administration andcongressional Democrats have yet to explain how, even with the current number ofphysicians and nurses, they can cover more people and lower the cost at the sametime.The only way, the critics contend, is by rationing care — giving it to some anddenying it to others. That cuts against another claim by plan supporters — thatcare would be better.IBD/TIPP's finding that many doctors could leave the business suggests that suchrationing could be more severe than even critics believe. Rationing is one of thedrawbacks associated with government plans in countries such as Canada and theU.K. Stories about growing waiting lists for badly needed care, horror stories ofcare gone wrong, babies born on sidewalks, and even people dying as a result ofcare delayed or denied are rife.In this country, the number of doctors is already lagging population growth.From 2003 to 2006, the number of active physicians in the U.S. grew by just 0.8%a year, adding a total of 25,700 doctors.Recent population growth has been 1% a year. Patients, in short, are alreadybeing added faster than physicians, creating a medical bottleneck.The great concern is that, with increased mandates, lower pay and less freedom topractice, doctors could abandon medicine in droves, as the IBD/TIPP Poll suggests.Under the proposed medical overhaul, an additional 47 million people would have tobe cared for — an 18% increase in patient loads, without an equivalent increase indoctors. The actual effect could be somewhat less because a significant share ofthe uninsured already get care.Even so, the government vows to cut hundreds of billions of dollars from healthcare spending to pay for reform, which would encourage a flight from theprofession.The U.S. today has just 2.4 physicians per 1,000 population — below the median of3.1 for members of the Organization for Economic Cooperation and Development, theofficial club of wealthy nations.Adding millions of patients to physicians' caseloads would threaten to overwhelmthe system. Medical gatekeepers would have to deny care to large numbers of

people. That means care would have to be rationed."It's like giving everyone free bus passes, but there are only two buses," Dr.Ted Epperly, president of the American Academy of Family Physicians, told theAssociated Press.Hope for a surge in new doctors may be misplaced. A recent study from theAssociation of American Medical Colleges found steadily declining enrollment inmedical schools since 1980.The study found that, just with current patient demand, the U.S. will have159,000 fewer doctors than it needs by 2025. Unless corrected, that would makesome sort of medical rationing or long waiting lists almost mandatory.Experiments at the state level show that an overhaul isn't likely to change much.On Monday came word from the Massachusetts Medical Society — a group representingphysicians in a state that has implemented an overhaul similar to that underconsideration in Washington — that doctor shortages remain a growing problem.Its 2009 Physician Workforce Study found that:• The primary care specialties of family medicine and internal medicine are inshort supply for a fourth straight year.• The percentage of primary care practices closed to new patients is the highestever recorded.• Seven of 18 specialties — dermatology, neurology, urology, vascular surgery and(for the first time) obstetrics-gynecology, in addition to family and internalmedicine — are in short supply.• Recruitment and retention of physicians remains difficult, especially atcommunity hospitals and with primary care.A key reason for the doctor shortages, according to the study, is a "lingeringpoor practice environment in the state."In 2006, Massachusetts passed its medical overhaul — minus a public option —similar to what's being proposed on a national scale now. It hasn't worked asexpected. Costs are higher, with insurance premiums rising 22% faster than in theU.S. as a whole."Health spending in Massachusetts is higher than the United States on average andis growing at a faster rate," according to a recent report from the UrbanInstitute.Other states with government-run or mandated health insurance systems, includingMaine, Tennessee and Hawaii, have been forced to cut back services and coverage.This experience has been repeated in other countries where a form of nationalizedcare is common. In particular, many nationalized health systems seem to havetrouble finding enough doctors to meet demand.In Britain, a lack of practicing physicians means the country has had to importthousands of foreign doctors to care for patients in the National Health Service."A third of (British) primary care trusts are flying in (general practitioners)