Dr. Robert Pearl: 5 fears physicians have

In an op-ed for Forbes, Robert Pearl, MD, former CEO of Oakland, Calif.-based Permanente Medical Group, spoke with a number of physicians during his various conference appearances about the fears they have regarding their profession and the industry, and why they only share those concerns with other physicians.

"The industry's pulse is racing with fear. I've observed that in just the past 12 months, the once-mild anxieties of American doctors have transformed into clear and present phobias," Dr. Pearl writes.

Here are the five fears physicians expressed to him, according to Dr. Pearl:

1. The fear of being poor. While most physicians Dr. Pearl surveyed said they supported the industry's change to a value-based care payment model in theory, they are concerned about the real-life implications of such a change. One physician told him that initially, CMS' pay-for-performance reimbursement criteria sounded like a good idea. However, the initiative has resulted in finite funding, and the program is becoming cost-neutral instead of rewarding all physicians who improve.

"No matter how well we practice, 50 percent of us will be in the lower half," another physician told Dr. Pearl. "I figured that if we all improved, we'd all be rewarded. But by raising the bar every year, CMS guarantees there will always be losers. It's just another way to pay doctors less."

2. The fear of change. Providers who spoke with Dr. Pearl reportedly said the industry is not, and has never been, known for cost efficiency. However, many expressed concern that the new operating models being touted at national conferences may force physicians to work even longer hours, further straining their personal lives and families. While technology like EHRs were designed to aid physicians, one physician told Dr. Pearl all the EHR does is "slow [him] down," the report states.

3. The fear of politics. Healthcare may be one of the top issues for voters during the 2018 midterm elections, but some physicians expressed concern that policies from both parties may not be in Americans' best interest — Republicans' mission to lower healthcare costs by stripping back insurance coverage would impede many patients' access to care, while the most vocal proponents of "Medicare for all" would reduce physician payments by at least 10 percent, according to Dr. Pearl. Since physicians typically spend at least half their reimbursement on office overhead, they would see a roughly 20 percent cut to their take-home pay.

4. The fear of being blamed. According to Dr. Pearl, many physicians he spoke with discussed the tendency to be inappropriately scapegoated for healthcare's skyrocketing costs. One surgeon reiterated that physicians have no control over pharmaceutical industry pricing or hospital billing procedures.

"Pharma companies raise their prices 1,000 percent for brand-name drugs and Congress does nothing. Hospitals can bill patients $1,000 or more for a CT scan that takes two minutes. If I say no to either, my patient will find another doctor," the surgeon said. "I'm not the reason healthcare costs are out of control, but I get all the blame."

5. The fear of failure. Failure is the No. 1 fear physicians have, according to Dr. Pearl, and the burden of avoiding failure hits before they even begin practicing medicine.

"As the pace and pressures of being a doctor increase each year, so do the fears of making a mistake. Doctors fret over errors all the time and worry their patients will be hurt by something they failed to do," Dr. Pearl writes, adding that those pressures result in growing rates of depression, burnout and suicide among physicians.

To access the full report, click here.

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