HPC Readers on ObamaCare: So Far, So So

How is the rollout of the Affordable Care Act affecting holistically-minded primary care clinicians?

The impact has been surprisingly minimal so far, according to Holistic Primary Care's recent survey of more than 2,000 physicians and nurses. That said, the changes that respondents did report are largely on the downside.

The survey, fielded during the first quarter of 2014, and completed in mid-March, covered a wide range of topics, among them the effect the newly-implemented reform plan was having on patient care, administrative burden, and practitioner income. A total of 549 physicians (MDs, DOs, NDs and NMDs) and 94 nurses (NPs, RNs, LPNs, and nurse midwives) participated in the survey.

Nineteen percent of respondents reported a rise in the number of patients seeking care at their clinics since ACA took effect, while 7% said their patient loads have decreased; 51% said their patient loads have not changed—an interesting finding given all the handwringing about the shortfall of primary care practitioners to handle the impending deluge of patients.

Surprisingly, 23% said they simply did not know how the ACA rollout is affecting patient enrollment at their clinics. MDs and nurses responded very similarly on this question, with the majority in both groups reporting either no change or stating that they do not know.

Tracking closely with the number of clinicians reporting a rise in patient load, 15% said the amount of time they spend with each patient has decreased since ACA took effect. Yet 65% reported no change in time spent. Again MDs and nurses were very similar in their responses.

A small number—4%--said their visit times have increased—a finding that is hard to understand until we factor in that a growing number (30%) of respondents have shifted into direct pay or concierge practice models.

Minimal Income Impact

Administrative workload definitely seems to be increasing since reform became a reality. Thirty-six percent of respondents said their hassle factor has increased, while only 1% said it decreased. Surprisingly, 43% say they've experienced no change, and 20% do not know. MDs were somewhat more likely than nurses to report a rise in administrative workload (43% vs 36%).

One thing is clear: very few physicians and nurses (3%) are making more money since ObamaCare took effect. One in five think they're making less. However, 45% report no change in income, and 30% say they do not know how ACA is affecting their wallets.

The latter two findings could reflect the fact that 39% of all respondents—39% of the MDs and 67% of the nurses—work as salaried employees rather than practice owners or partners. In a sense, they are shielded from any major economic impacts....at least for now.

Survey respondents are not exactly loving life under reform so far: 24% say their personal satisfaction with their practices has declined since ACA took effect, while only 5% say satisfaction has increased. Yet 54% say their satisfaction has not changed significantly.

MDs were more likely to report a decrease in satisfaction than nurses (28% vs 19%).

The Obama Administration's reform plan is still in its earliest stages, and its full impact in the trenches of clinical practice may not yet be apparent. So far, though, healthcare reform has not been the train wreck its critics predicted, nor has it been the primary care renaissance that its promoters envisioned.

The clinicians responding to HPC's 2014 survey do not appear to be thrilled with the changes so far, but for most the impact has been minimal.

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