(NY Times) U.S. Plans Stealth Survey on Access to Doctors

Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.

The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.

Read it all.


Posted in * Culture-Watch, * Economics, Politics, --The 2009 American Health Care Reform Debate, Consumer/consumer spending, Corporations/Corporate Life, Economy, Health & Medicine, House of Representatives, Office of the President, Politics in General, President Barack Obama, Senate, The U.S. Government

26 comments on “(NY Times) U.S. Plans Stealth Survey on Access to Doctors

  1. IchabodKunkleberry says:

    Just an anecdote, but maybe things are headed in this direction …

    My wife’s primary care physician – let’s call her Maxine (not her
    real name) announced recently that she is setting up a new practice
    and that we can obtain access to her medical care by paying an
    annual fee of $1500, which is not reimbursed by our medical
    insurance. I told me wife we’re not paying $1500 a year just to be
    a “Friend of Maxine”.

  2. Katherine says:

    #1, smaller practices may be moving in that direction. They can’t afford not to. Other doctors are going to work for hospitals and large clinics instead of having their own practices. My own internist is with a large practice having its own lab, X-ray, and other diagnostic facilities. They make up some of the difference in reimbursements on fees for those tests. They also file with Medicare but require payment up front from the patient, so they don’t lose money on the Medicare reimbursement time delay. So far they are still taking new Medicare patients.

  3. Jim K says:

    This Orwellian assault on freedom should terrify you all! In essence, the government lies to the physician, finds out if he/she makes rational economic decisions (i.e., showing a preference for accepting patients whose insurance coverage pays better), and amasses a secret data base that will be available to the higher ups at Health and Human Services who get to decide which physicians can practice.
    Oh, and of course it’s being done by Michelle’s old outfit, the U of Chicago.
    Where is the ACLU?

    [Slightly edited by Elf]

  4. Dan Crawford says:

    #3, I guess when I stumble on MDs struggling with the kind of hardscrabble life so many of their patients have to contend with, I might share your hysteria. Until then, I will unrealistically wait for the day when Americans don’t have to pass up needed health care because they can’t contribute to their physician’s life style.

  5. AnglicanFirst says:

    Pretext phone calls are used by investigators in order to extract information from a person that otherwise would not be provided by that person.

    The whole concept behind such pretext phone calls is the use of a “lie” of some form or shape that misleads the person being interviewed in order for the interviewer to obtain the desired information.

    It is a dishonest technique at best and its use can be rationalized when used against criminals or persons who are a threat to national security or society in general by citing the need for the “lie” in order to protect other people against an imminent or insidious danger to the country or to the safety or property of persons.

    However, it is definitely an ethically dishonest technique when used against persons engaged in the traditional practice of their professions or businesses.

    The fact that officials of the Government are willing to commit such acts in their pursuit of the implementation of a widely unpopular law is a cause for real concern.

    It begs the question of what other unsavory tactics might be practiced by an incumbent Administration in pursuit of its political goals.

    But, in the end, a “lie” is still a “lie” and those who promote or participate in such lies are in fact by their actions ‘liars’ and as such risk losing the trust and repect of other persons.

  6. AnglicanFirst says:

    Reply to Dan Crawford’s comment (#4),
    “Until then, I will unrealistically wait for the day when Americans don’t have to pass up needed health care because they can’t contribute to Until then, I will unrealistically wait for the day when Americans don’t have to pass up needed health care because they can’t contribute to their physician’s life style.”

    Dan talks about
    “…their physician’s life style.”

    Let’s see. That physician studied hard in high school and displayed the self-discipline and academic performance necessary to qualify for entering an undergraduate pre-med program in college and then being accepted into medical school. That same person spent long years as an undergraduate and in medical school, not earning money, but borrowing money that had to be paid back.

    So that person took a double financial hit. Lost income while being educated as a doctor and the accumulation of a humongous debt that he/she then had to repay. Further, for 8 to 9 years of study, he/she was intensely absorebed in the business of becoming a medical doctor. Little or any free time for fun and play and developing close personal relationships.

    Then, having completed intersnship, he/she after paying off college bills begins to start earn some money. And yes, its more money than the average person earns, but this medical doctor has made an incredible personal and financial sacrifice to become a doctor.

    And you seem to covet the financial reward that finally, finally, starts to be paid to this doctor.

  7. Capn Jack Sparrow says:

    Dan #4, sounds like you’re a betting man and you figure the docs are just bluffing. Who knows, maybe the statistics are wrong and access to care really is just fine.

    I’ll tell you that my hourly income is less than that of bankers, insurance salesmen and certainly lawyers as I’m caring for patients in my clinic. I get so much more consulting for lawyers and signing papers at my state side job instead of seeing patients.

    You can bet I think about that as I miss time with my kids and wife. Every primary doc I know is thinking the same thing. I notice that my cars are older and my house is smaller than others who don’t have to worry about lawsuits. They don’t get condemned by people like you either.

    But you know that we are bluffing as we look, very carefully and persistently, for a way out. The docs I know have found ways out.

    But maybe we are not bluffing and are just evil people in medicine. If only we would just accept our fate and smile, it would be so much more convenient for folks like you.

  8. Teatime2 says:

    I’ve noticed a lot of movement in my area among the docs. They’re forming networks and, as someone else pointed out, they’re working for the hospital system in setting up their practices as part of a hospital network.

    My internist, who is wonderful, and I were discussing it. She said that she sees it as a win-win. The doctors don’t have to shoulder all of the huge expenses involved with opening and staffing an office and the hospital wins by being able to attract good doctors. The hospital provides the office space, the staffing, and even health insurance and other benefits for the doctors.

    She said it takes a whole lot of pressure off to build up the practice and see a ton of patients to pay the bills. She is able to the number of patients she can handle well and she’s able to spend more time with her patients. She does an excellent job — she even calls patients herself to give test results, discuss issues and see how you’re doing!

    Before the hospital set up this internal medicine practice, I was having a devil of a time finding an internist who was taking new patients and would accept Medicare.

  9. Sarah says:

    Thankfully my long-time family practice doc finally left his hospital. He started out on his own — then got driven out into a hospital owned practice, then ended up in another hospital owned practice, and now has finally come full circle into a simple partnership. He is ecstatic.

    And so is this patient. The level of bureaucracy was unbelievable — the price inflation gigantic.

    I definitely agree that it’s easier to have a huge corporation do all the ridiculous quantities of paperwork and carry the escalating administration costs required by the State. But I’d rather see a doctor who has his own practice. I suspect that those are going the way of the dodo bird — but I can at least revel in what I have for now.

    At some point, thanks to the State-owned system, we’ll have a cash-only medical system, and then the State-run system. If I’m allowed, I’m picking the cash-only system, using an HSA — if, that is, they’re still allowed by then.

    We’ll see. There are trade-offs either way — some folks prefer the corporate system and others the solo/duo practice system.

  10. Jim K says:

    #4 Mr. Crawford, I utterly reject your mischaracterization of my concerns as “hysteria.” When my government engages in deliberate deception and amasses information intended to coerce me into giving my services away at whatever price the government feels like paying me, I–and you–have every reason to fear. To do this while funneling my tax money to a corrupt institution (Why did the University of Chicago continue to pay Michelle’s salary for most of 2008 when she was campaigning full time? Why have they not bothered to hire anyone in her former position?) in order to produce these very clear threats to my livelihood is one more example of the cronyism within the Dim establishment and one more confirmation that your liberties are up for grabs. To quote from a source that I doubt you’ll recognize: “…they came for the Jews, but I was not a Jew so I did not speak out. And when they came for me, there was no one left to speak out for me.” Wake up, sir.

  11. Country Doc says:

    Well, this whole survey is bogus. The government knows already Medicare/Medicaid patients are finding it difficult to find a doctor. There have been many surveys already made. Less than 2% of medical graduates are going into primary care. With close to $300,000 owed on finishing they must go to specialities that pay well. Primary care is dead and the students know it . Of course that won’t keep the government funneling millions into fat cat surveyers and government friends to set up this bureacrachy to “study to see if there is a problems.” Well, I have board certifiation in family practice, geriatrics and sleep medicine. I take no new Medicare patients unless they are going into the one nursing home I still go to or are consults for sleep studies. And I am on Medicare! But the government is always saying that 80+% of doctors will take new patients. They just don’t say it may be for reading an EKG at the hospital or like me.
    Oh and Dan, go for it. Don’t put up with it. Obama will care for you for free. However it is his goal to do away with the need for doctors. You can just go on down to the city hospital and after six hours see the Chinese nurse practitioner who will order some x-rays and lab which you can get in a couple of months and come back for followup in six months. Enjoy. Or you can go to a cash only clinic and be seen instantly and for about 40% less since there is no foolish government overhead. I’ll bet they then soon outlaw that. In which case you can come by night to my kitchen and I’ll see you and you can pay me with a chicken or ham. Then again maybe the present statistics are lying and things will get better. As they said in Russia, “They pretended to pay us and we pretended to work.” Yes I am angry to see them destroy the best medical care in history and now they are set to destroy the rest of the economy. But the new world govenment will be so much better. Enjoy, that is what folks voted for.

  12. robroy says:

    We have this from the article: 1) The Obama administration is concerned about the shortage of primary care physicians, 2) The Obama administration is embarking on a campaign to spy on primary care physicians. They can’t see any problems with that? Really?

    Why go to medical school and residency (a total of seven years post-baccalaureate) if you are going to get paid exactly the same as a PA or NP who have significantly less debt and training? The only way to make it as a PCP is too be a manager of several physician extenders.

    Someone said if you do something in your business at a loss, you can’t overcome that with increasing your volume. If you are Sarah’s family physician in a small group of primary care docs, every medicaid patient costs you money. You necessarily have to limit your medicaid patients or you go broke, (or you have mid-levels to see the Medicaid).

    The article gives an example of the lie they will telling the physicians, a a scenario where the patient has a cough for two weeks, a fever, and some blood now being coughed up – at best pneumonia, at worst lung cancer. I can tell you the outcome without the government spending millions: if the “patient” has real insurance, they might squeeze him in or they might refer him to the ER, if the patient has Medicaid, he will be told to go to the ER.

    Wasn’t that easy? Instead of spending millions, how about the government simply give me a couple of thousand for my answer and and I will take my kids and wife to Yellowstone and Mt Rushmore?

  13. Capn Jack Sparrow says:

    Well, the other angle they may be setting the people up for is based on the misunderstanding that HIPPA applies to private offices (or that it should). That way, when the study “discovers” what we know it will, the dems can trumpet about how evil it is that doctors are discriminating by payer (or non payer) status.

    Remember HIPPA is the law responsible for 6 hour ER waits as it requires hospitals to treat everyone for free. If that is applied to offices the dems can claim to provide universal care without having to pay for it. This would simply accelerate the current process of destruction of small intimate medical practices into large government controlled structures, only now with no competition from well run private offices.

    Yes, I know the ER sends huge bills to its insured and supposedly self pay clients to offset its losses on Medicare/Medicaid/no pay patients. But after you loose your house and quit your job, you are judgement proof so the bill can be ignored, thus producing free health care.

  14. Capn Jack Sparrow says:

    Rob, its interesting you bring up the PA/NP angle. You abt right that PA and NP salaries are coming very close to what your hard working FP makes in his own office. I’m a believer in such physician extenders, but they do miss things that a more experienced doc would catch just because their training is by definition a lot less.

    This is why I do believe private practice is doomed. One commenter pointed out that a doc she knows is happy at her hospital job. Sure, because she is heavily subsidized by the hospital, which has access to all sorts of during streams that your small town doc doesn’t. She is also (for now!) probably seeing a lot fewer patients so she has more time. Sooner or later the hospital will squeeze her harder until she quits, once they get sufficient market share. I hope she has the guts to quit when that happens. It’s the only way that conditions might improve, although most docs will be replaced with PAs and NPs because they are cheaper to deploy.

    I’m always bemused when my leftist patients talk about how they like seeing a “real doctor” instead of a NP. I just tell them to enjoy it while they still can and I can afford to keep working.

  15. Cennydd13 says:

    Speaking of ‘state owned systems,’ the Veterans’ Administration Healthcare System is recruiting doctors and other medical professionals. I use the system, and wouldn’t go anywhere else.

  16. Joshua 24:15 says:

    What my medical colleagues and AnglicanFirst (#6) said.

    Of course, the REAL laugh is the plan under ObamaCare to find tens of billions in Medicare cost savings largely through–you guessed it–decreased payment to providers!!

    I’m just waiting for the administration and Dems to find ways to compel physicians to work, as in linking licensure to a requirement to take all comers, or through “provider taxes.” But, after all, we docs are all just greedy and only interested in our inflated life styles, right, Dan?

  17. Capn Jack Sparrow says:

    I’m going to put in a recommendation for Dan to medical school. We need more compassionate people like him in the profession. 🙂

  18. Capn Jack Sparrow says:

    I also propose that the govt run a fake attorney client study to see if there is any difference in service between plaintiffs with potentially lucrative cases and those who been genuinely wronged but have no money or deep pockets to get into.

    Equal justice under the law is a basic American right, after all.

  19. Mitchell says:

    #10 I seriously doubt there are many on this blog who do not recognize the quote from Martin Niemoller. But if you seriously want to go that route, you need to use the entire quote, and when you do ask your self which political groups in America have traditionally attacked the same groups as the the Nazis did. I believe the order was Communists first, Labor Unions second and Jews third.

    I don’t like the process employed by the survey, but I don’t think the question is bogus. My experience is that Medicare recipients have no more difficulty finding doctors they like and who will take them as new patients, than private insurance patients have in finding doctors in their PPO they like and who will take them as new patients. That may differ by state, and that would be useful information to have.

    I like my doctor, and he is in a small private practice. But I left the last doctor I had because I changed insurance companies, and the doctor I had before was not in my new PPO. If he had been I would have stayed with him. Consequently, while I am now happy with the doctor I have he was not my choice, and I was unhappy about being required to give up my former doctor.

    #15 most of my clients who have VA coverage seem to be happy with the coverage. In the past they complained about the VA hospitals, but that seems to have stopped in recent years. Additionally in every poll taken, Medicare recipients are happier with their health care than people on private insurance. Just as Canadians and Europeans consistently poll more satisfied with their health care than Americans do.

    #13 is correct however, if our choice is to do away with Government health insurance we must allow hospitals and doctors to turn away sick people without treatment. If we decide to eliminate Medicare suffering the consequences of growing old uninsured and poor is part of the deal.

  20. Formerly Marion R. says:

    Dan Crawford-
    I don’t know about hardscrabble, but in my neck of the woods, over the course of their careers general practitioners make less than public school teachers.

    on the other hand, AnglicanFirst’s argument centers on the reasoning that the more time, money, and energy someone puts into their education, the more they should be paid. My brother-in-law has a PhD in medieval literature and more years than I can count of post-doc work. I can’t really see him being paid more than a good RN in any reasonable system.

    For my part, I think this latest government project is like the drunk looking for his car kesy under the streetlamp because the light is better there. Shouldn’t they instead be counting the number of physicians who don’t practice at all anymore? I know five just off the top of my head.

  21. Capn Jack Sparrow says:

    Marion makes a great point. It may be that our society no longer values expert medical training sufficient to pay docs enough to keep them in practice. That’s perfectly fine.

    It’s the same with your relative. Some may choose to go into such fields in spite of the poor pay, but most people will choose jobs that pay better because society values them more, such as rock stars, politicians, lawyers, etc. Physicians will simply continue to factor this in as they decide whether to stay in practice and move to “hobby mode”, practicing at a loss just for the fun of it. Personally I can’t afford a hobby job and intend to continue working in a different capacity from family medicine.

  22. Mitchell says:

    I have no objection to physicians making a lot of money, but your assertions that physicians are not paid as much as school teachers is simply not true. Physicians are paid more than any other professional in the country, including lawyers and engineers.

    Last year the median salary for a primary care physician was $165,000.

    That beats the average income of lawyers by $50,000+, and the average income for engineers is in only around $85,000.

    And this all excludes specialty practices which pay even more. Once you get into the speciality practice the income of doctors vastly exceeds the income of any other profession.

    I understand doctors believe they should be paid more money, but to assert they don’t make enough to make practicing medicine profitable, is a stretch to say the least. In fact if you want to get rich in America today, your odds of doing so are greater in the practice of Medicine than any other profession you could choose.


  23. Capn Jack Sparrow says:

    Funny, none of the family docs I know make that kind of money? I don’t know about the lifetime incomes of teachers, but I would assume that their hourly incomes are improved by pensions, insurance benefits, summer break, etc. My brother in law is a teacher and often takes work in the summer to take advantage of the free time. He struggles financially but I don’t know what his lifetime benefits are. One benefit of govt work is the insurance and retirement.

  24. robroy says:

    Mitchell writes, “Medicare recipients are happier with their health care than people on private insurance.”

    Of course. I would be happy if I health insurance that I could pass off a significant amount of the costs onto other people. Unfortunately, the “other people” are mine and other kids.

    Right now, Medicare is break even for most physicians, private insurance, you make a profit, and Medicaid you lose your shirt. Now, physicians need to make some profit (yes, that icky “p” word). Obama is planning to raid Medicare of funds from “cost saving measures” – as Joshua 24:15 said, i.e., decreased payments to physicians. They are predicting that Medicare will be paying Medicaid rates within a decade. Good luck, finding a physician.

    I was wondering if I applied to the IRB (the board that decides on the ethics of medical studies), and I said that I was going to pose as a patient and lie to physicians asking them if they would take me as a patient if I had private or public insurance whether this study would pass ethical muster. I don’t think so.

  25. Clueless says:

    “Good luck, finding a physician”.

    Oh you’ll find a physician all right. Or at least a “provider”. They will follow “evidence based guidelines” to carefully and responsibly bring you “appropriate” medical care free of fraud and abuse.

    They will definately pay for your bottle of lisinopril to treat your hypertension. They will also pay for the annual homily from your “provider” regarding the evils of your obesity, “tobacco abuse disorder” and sedentary lifestyle.

    What Medicare will not pay for is access to specialists (Who will be strangely unavailable. Ask folks with Medicaid how easy it is to find a specialist). As Medicare starts paying Medicaid rates, specialists will first drop back to easier aspects of care (check out how many neurosurgeons outside of very large cities operate on head cases rather than back cases). When this becomes fiscal insanity, they will drop back to being “providers” or working urgent care. (I know several specialists who do just that. They make more money and have saner hours). Those who trained in foreign medical schools (some 30% of physicians) will go home where they will make the medical schools and hospitals of India the envy of the West. Those who are over 55 will retire.

    Thus, when you need your hip replacement, your shoulder arthroscopy, your stent or pacemaker, there will be a shortage of specialists to assist you with these needs. Then, your “provider” will carefully consult the “evidence based guidelines”. You will be informed that you are:
    1. too old
    2. too fat
    3. too irresponsible (still smoke have not lost weight down to your ideal BMI, misses appointments)
    4. too sick
    5. too stupid/noncompliant (fails to follow your “providers” kindly homily on the importance of losing weight – see above)
    6.too drug dependent (that would be the opiates you are taking for your hip pain)
    7. Etc.

    This is, of course part of the reason for having more nurses as “providers”. They have been trying to coerce physicians to practice like that for years. We stuck up for our patients, and refused to do so. Too bad for us that our patients did not stick up for us. (Too bad for them also).

    But this is the “care” you wanted, America. Hope and Change. I hope this is the change you wanted. You asked for it, and you deserve it!

  26. Clueless says:

    #15 most of my clients who have VA coverage seem to be happy with the coverage. In the past they complained about the VA hospitals, but that seems to have stopped in recent years. ”

    Unfortunately, VA care, while it is indeed less expensive than private practice care is ONLY less expensive because it is permitted to ship emergencies, homeless persons, children, and all non-vets (especially those without insurance) to the local private sector hospital. If the VA was required to “see all comers” like a regular ER it would be very much more expensive. The VA does have some cost savers, including using evidence based guidelines (see post above) to eliminate and delay some care that is thought to be “medically inappropriate”. It also gets a volume discount on most pharmaceuticals that is by law required to be better than any volume discount provided by the private sector. It does have an outstanding electronic medical record. And finally, it has significant constraints on malpractice costs.