Congress' failure so far to prevent a Medicare physician payment cut has generated a great deal of anger among physicians. The American Medical Association declares that physicians are "outraged." Alicia Ault blogs that "Doctors are Mad as Hell," citing my post from Friday and its reference to Howard Beale's "I'm mad as hell" rant from 1976"s "Network" movie. Ault also links to a post from the Happy Hospitalist who blogs that "It's time to screw granny and let the government find a way to provide their care for them."
How have we come to the point where a physician would advocate that the medical profession turn away from taking care of elderly patients? Even allowing for the hyperbole that is commonly accepted in the blogosphere, is it right for physicians to allow their righteous indignation at the government's failings to stop a Medicare pay cut (well deserved on this score) descend into threats to deny care to Grandma and Grandpa?
It is one thing to say that continued Medicare pay cuts will force many physicians to limit how many Medicare patients they can see (which I believe to be true), but a very different matter for physicians to advocate that physicians deny care to patients to make a political point. Instead of gaining the support of the public, I believe that the medical profession will lose public support if it seems to be elevating economic self-interest above patient care.
This is that point that "Harrison" made in response to my Friday post: He wrote: "We have to continue to be careful about advocacy. The US economy is precarious. Our patients are increasingly unemployed. It is right for us to advocate for our patients. It is right for us to point out that a 21% cut will lead to an impact on thousands of small businesses and to our employees. But if we start to say that we are going to stop seeing Medicare patients because we are going to get paid $80 per 99214 instead of $100 for a 99214 visit, well ... I don't think that is going to go over so well." Others disagreed.
Last week, an ACP member wrote to me and urged that we organize a "strike" against Medicare patients if the 21% cut goes through, saying he would be "very disappointed" if we did not. I'm not a lawyer, but I know that there are legal reasons why a physician membership organization can't advocate for collective actions by individual members to achieve economic gains for them. But there are ethical reasons as well.
ACP's Ethics, Professionalism and Human Rights Committee published a case study that draws the line between acceptable political advocacy and actions with the intent of denying care to patients to achieve a political purpose. The case study notes that ACP's Ethics Manual, which represents approved ACP policy, states that "... physician efforts to advocate for system change should not include participation in joint actions that adversely affect access to health care or that result in anticompetitive behavior. Physicians should not engage in ... organized actions that are designed implicitly or explicitly to limit or deny services to patients that would otherwise be available." Similarly, in addressing collective actions, the AMA specifically states that "physicians should refrain from strikes because they reduce or delay access to necessary care and interfere with continuity of care, all of which are contrary to professionalism and the physician's ethical obligations."
As I wrote last week, physicians should let their legislators know the continued Medicare pay cuts are unacceptable. They can inform them that they may not be able to afford to continue to see Medicare patients if the cuts continue. But the understandable outrage at government inaction should not turn into calls to organize boycotts or strikes against patients. "Organized actions that are designed implicitly or explicitly to limit or deny services to patients" not only would be bad politics, but according to the ACP and AMA, unethical to boot.
Today's question: Do you think physicians should deny care to their own Medicare patients as means to express their anger at the government?