Lamenting Obamacare in the docs lounge

HOT SPRINGS, Ark.—Doctors need a place to hide.

Everywhere they go in the hospital someone is tugging at them—patients, families, nurses, drug representatives, and administrators. The hospital’s doctors lounge has always been their sanctum.

The conversations in the Mercy Hospital doctor’s lounge used to be about difficult cases, the latest therapies, great escape vacations, or sports. Now Obamacare is the most common topic.

“My patients are just now seeing what is going on,” dermatologist Dow Stough says. “They ask me why my rates are going up, and the small business owners are telling me that they can’t afford to provide insurance for their employees anymore.”

All the doctors present complain that they are doing as much as three times the work they did 20 years ago and making less money. Obamacare feels like the tipping point. “Any doctors who don’t have their retirement in the bank are hosed,” neurosurgeon Jim Arthur says.

Private practice physicians are worried they can’t stay in business much longer. Ten years ago, that group made up the majority of physicians. Now more than three-fourths of the physicians in the doctor’s lounge are employed by the hospital. Family doctor Shawna Lucas gave up her popular office practice several years ago. She now does shift work taking care of other doctors’ admissions.

“I don’t have to fool with all the administrative stuff,” she says. “I don’t have to deal with the insurance companies. I would never go back.” The hassle and economics aside, doctors feel they are losing something more significant.

“What is best for society replaces what is best for the individual patient,” says pulmonologist Bob Johnson, who treats respiratory problems. “The doctor-patient relationship shifts from the exam room to the board room.”

Doctors who have long prided themselves on providing excellent care aren’t sure they will be allowed to continue. “I can do OK medicine, but not what we used to be able to do … they tell me I meet quality indicators but not cost indicators,” says nephrologist David Desoto, who specializes in kidney care. Good patient care is expensive, and “no one wants to be the one to say we aren't going to take care of your mom,” Desoto says.

Early retirement is a constant topic. Rheumatologist Ross Bandy, who treats patients with arthritis and other rheumatic diseases, sees the light at the end of his tunnel. “I may be older, and closer to death, but at least I won’t have to put up with this crap any longer,” Bandy says.

Obamacare’s expected tidal wave of new patients combined with a surge of early retirements threaten a severe doctor shortage. Half of all doctors are over the age of 50. “There aren’t enough of us to go around,” Bandy says. “Most patients won’t get to see a doctor. Nurse practitioners will be doing that job.”

Who will take care of the doctors when they grow old? “We are going to have to maintain our licenses and take care of each other,” Bandy says.