Dermatologists discuss potential impact of healthcare reform in U.S.

Key Points

On Call wondered where dermatologists find themselves falling in their assessment of the reform legislation, as well as what primary changes they would like to see made before the bill actually takes effect. We found dermatologists who place themselves in each of the camps, along with one more - the group that wishes someone could explain what the legislation actually does.

Not sure what to think

"The bottom line is that nobody really knows what's in the plan. Almost nobody's read it. So I don't really know what I would think of it. People have opinions with no information, or just partial information. Our local medical society president started to read the report and has gotten through about 300 pages out of 2,000. She says the table of contents is 11 pages long.

"Probably one reason we don't know how things will work is that (they) haven't actually figured that out," Dr. Halasz says. "They'll flesh it out as we go along. There will be penalties for not having EMR and others if we don't use e-prescribe. Maintenance of certification (MOC) requirements will be instituted gradually over the next few years, and nobody knows exactly what that entails. It could be burdensome, requiring increased bureaucratic assistance for us to fill in all the forms and surveys, but nobody really knows what's going to happen."

A solo practitioner for 25 years, Dr. Halasz is concerned that the reform will mean the end of his kind of life.

"My fear is that it will become impossible, because of the increased regulatory environment brought about by this, for people to start a private practice, or even to remain in a small practice.

"I think the goal of the government is to have all doctors employed, either directly or indirectly, by the government. It may not be the stated goal, but it will be the effect, because doctors who aren't in a large group like Kaiser won't have the backup staff to handle not just CLIA and OSHA, but MOC and all these other certifications. I doubt it will be easy to do.

"I don't know if they should start over. I'm just rolling with the punches and hoping I can deal with it. I don't feel like I can have any control," Dr. Halasz says.

Starting from scratch

In Ocean, N.J., Paul Klenoff, M.D., doesn't feel he has any answers either, and he doesn't believe the legislation can be salvaged.

"I'm not familiar enough with the actual provisions. I've read a lot of opinions, but they are other peoples' opinions. At this point, my impression is that we would probably be better off starting over again," he says.

"Some of the issues the plan does not address include the question of tort reform. It fails to address the need to increase competition among third-party payers by allowing them to sell across state lines, and I don't know what else," he says.

In practice for 35 years, a solo practitioner and an attending physician at Jersey Shore Medical Center, Dr. Klenoff says he doesn't think these problems can be solved by modifying the existing law. "I think those types of issues need to be included in the basic bill, and we should just start all over again."