A physician friend asked me today if I had seen the survey in the New England Journal of Medicine that says nearly half of us will quit medicine if health care reform passes. My fried, a life-long Republican, found the numbers difficult to believe. So did I.
The New England Journal of Medicine (NEJM), one of medicine's most respected journals, did not publish such a poll. Apparently, in an earlier version of a web-based story posted on their jobs page, they reported the results of a poll conducted by a physician recruitment firm. Partisan bloggers and networks jumped on the story as an argument against health care reform.
The Journal changed it's website to reflect explicitly the fact that the survey was industry-produced content in an advertising newsletter, not actual journal content. I find the behavior of the Journal a bit problematic. It looks bad when you have to clarify the origin and purpose of your content. But this was clearly never a peer-reviewed journal article.
In other words, when asked about HCR without a public option (there is no public option in the current legislation), a plurality felt that their own quality of practice and career satisfaction would be unchanged; many thought that their income would drop; many thought medical care would decline, and many thought that physician supply would decline. Many physicians can form reasonable opinions about most of those measures---but not physician supply. Nothing I do in my daily practice give me data on physician supply.
When asked, "How do you think the passage of health reform WITHOUT a public option would affect your professional/practice plans, if at all?" 70% of respondents said, "no change." It is not reported in this data, but apparently primary care physicians, who made up about a third of respondents, were more likely to say that they would leave medical practice.
I have no doubt that there are unsatisfied physicians out there. This data, gathered unscientifically, hyped by the survey company, and widely picked up by partisan media, is not a reliable measure of doctors' responses to health care reform.
Thinking about it from a purely practical standpoint, how many primary care physicians can financially afford to retire? How many can simply pick up and change careers?