Doctor obligations

The New England Journal of Medicine recently reported survey results show that 78% of active physicians believe they have a professional obligation to address societal health issues.

The results are from a May 2009 survey of 2,000 doctors nationwide.

“Previous research suggests that physicians endorse a public role for the profession and believe they have an obligation to care for people with limited resources. But it remains unclear whether physicians in 2009 see participation in the formation of health policy as part of their professional responsibility or accept the potential consequences of reform,” noted the NEJM statement.

Findings and statements of the report included:
• “Individual physicians may have strong financial incentives to downplay their responsibility for caring for the uninsured and underinsured. Although physicians tend to agree in the abstract that health care resources should be distributed fairly, they may be unwilling to endorse concrete policies that expand coverage for basic health care by limiting reimbursement for costly interventions. And despite widespread discussions about using cost-effectiveness data or comparative-effectiveness research to guide clinical decisions, physicians may remain skeptical about such practices.”

• A large majority of respondents (78%) agreed that physicians have a professional obligation to address societal health policy issues.

• Majorities also agreed that every physician is professionally obligated to care for the uninsured or underinsured (73%), and most were willing to accept limits on reimbursement for expensive drugs and procedures for the sake of expanding access to basic health care (67%).

• Physicians were divided almost equally about cost-effectiveness analysis; just over half (54%) reported having a moral objection to using such data “to determine which treatments will be offered to patients.”

• “Since surgeons and procedural specialists were less willing than other physicians to accept policies that would limit reimbursement for expensive medications and procedures, reformers can expect opposition to reimbursement reform from such groups unless proposed reforms create incentives that benefit those who currently get paid for providing these goods and services.”

• The 28% of physicians who consider themselves conservative were consistently less enthusiastic about professional responsibilities pertaining to health care reform. These physicians must be engaged if reform is to be successful.

• “Our data suggest that efforts to mobilize physicians can build on their sense of professional responsibility — but also that such efforts may encounter considerable opposition from some quarters of the profession, particularly to elements of reform that impinge on physicians’ decision-making autonomy or threaten to reduce reimbursement for the costly interventions they provide.”