Career and Life Planning Guidebook for Medical Residents

SECTION I: T MINUS THREE YEARS Affordable Care Act (ACA), Medicaid Expansion, and Economic Factors More patients have insurance now that the ACA has been fully implemented, but many states have not expanded Medicaid; many of those that have are imposing work requirements, so the number of uninsured, while stable, may go up rather than down. For people who do have insurance, high- deductible plans are becoming more popular because premiums are more affordable. However, this often results in patients delaying necessary care because they don’t want to or can’t pay deductibles and/or copays. Thus, when they do present for care, they are often sicker, require more (and more expensive) care, and hospitals have a harder time collecting reimbursement for care provided. More private insurance companies are paying closer to Medicare rates, so less cost-shifting is possible, pressuring hospitals to be able to “break even” at Medicare rates in order to stay open. Hospital closures and bankruptcies are adding to the mix as many struggle to maintain operating margins. Physicians are struggling to maintain revenue and working more in order to do so; more are seeking employment to gain more job security and better work/life balance. Physician Impact Organization Impact Patient Impact Increasing pressure and burnout. Physicians moving into employee role versus owner role. Less connection with patients from spending less time with them. Increasing pressure to cut costs as much as possible. Instability in longevity. Losing top-line revenue. Decreasing staff retention. Patient satisfaction could be lower. Increasing out-of-pocket costs despite industry and ACA attempts to reduce them. Often avoid seeking care to avoid any out-of-pocket costs. Potential increased emotional stress due to avoiding/ delaying care. Impaired effectiveness/ productivity at work while sick. Table: Impact of ACA, Medicaid Expansion, and Economic Factors Use this for citation on impaired effectiveness/productivity at work while sick: http://md.careers/Managedhealthcare CAREER AND LIFE PLANNING GUIDEBOOK FOR MEDICAL RESIDENTS 96