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Unintended Consequences

The opinions expressed by columnists are their own and do not necessarily represent the views of

Physicians like me, who train young doctors in residency and often hire them to join a private practice, have made two observations over the last several years - they are smarter than ever, but they come out of their training programs less qualified to take care of patients than any group of freshly minted doctors that preceded them.


This is a serious problem because as older doctors retire, the younger ones replacing them cannot simply be plugged in to fill the void. The problem is even graver because as reported by Deloitte in its 2013 survey of doctors, 60% of physicians contemplated early retirement in the next 2-3 years. This can be attributed almost entirely to onerous government regulations resulting from the Affordable Care Act (ACA, Obamacare).

The diminishing abilities of recently trained doctors can be directly correlated with limitations in hours spent doing direct patient care in the hospital. In the most recent edition of the Journal of the American Medical Association, Desai and Associates reported the results of a randomized, prospective study that examined this issue. In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented significant restrictions regarding on duty hours. Interns (first year trainees) could not work more than 16 consecutive hours, and must not have in hospital duty more often than every third night. Additionally, shifts were encouraged to limit the amount of consecutive hours on duty.

Desai took a group of internal medicine residents and subjected them to the new regulations, while another group worked longer hours. The residents who worked less were shown to have fewer educational opportunities, less continuity of patient care and were delivering worse quality of care. The residents who complied with the new workplace regulations had significantly fewer patient encounters and less exposure to their professors and mentors. Although this study examined trainees in internal medicine, it can be theorized that the problem would be even worse in the surgical fields, where repetition is a critical element in training.


This issue is instructive for several reasons. The ACGME had good intentions trying to protect doctors in training from fatigue which they presumed would result in more errors and would potentially harm patients. Of course, this was never proven, and consequently a group of medical bureaucrats who believed that they knew what was best, made changes in a system that worked very well for decades. These individuals decreed that they would not allow doctors in training to decide if they wanted to exceed the proscribed work hours to see an unusual case or attend an interesting conference. They knew what was best for these young people. They failed to appreciate the unintended consequences of their actions- in this case, creating doctors not nearly as well prepared as their predecessors.

The same thing is happening on a much larger scale with Obamacare. A group of bureaucrats in Washington have determined what they believe is best for all Americans when it comes to their healthcare, without any proof that their ideas will work. They have decided what a health insurance policy should look like, who may deliver healthcare, where the care will be delivered and how much it should cost. Very soon, these same bureaucrats will determine the care people are entitled to or worse- what care can be denied to certain individuals. Just as it was with the ACGME, the unintended consequences were not considered.


The 2700 pages of the ACA has spawned 20,000 pages of regulations -so far. The $980 Billion that the ACA was promised to cost has ballooned to $2.7 Trillion and climbing. The “simple” process of signing up for subsidies in the Obamacare exchanges is now a 21 page form with a 61 page appendix, inquiring about every aspect of your life. Instead of insurance premiums decreasing by $2500 per family, they have soared and now on average have increased by $3065. According to Mark Bertolini, CEO of Aetna, these rates will go up 20-50% more in 2014. The ACA may create government jobs thanks to the 159 new agencies created by this massive law, but the private sector stands to lose as many as 800,000 jobs because of the mandate to provide insurance to employees.

When a small group of people decide that they know what is best for the rest of us and are determined to make changes, ignoring the potential unintended consequences, it is time to strip them of this power, replace them , and protect the institutions that are so vital to our well-being.

Hal Scherz is the President & Founder of Docs4PatientCare. He is a full time pediatric urologist at Children’s Hospital of Atlanta and a clinical associate professor of urology at Emory University.


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