Investors Business Daily Puts Its Thumb On The (Medical) Scale – Again

Investors’ Business Daily is out with a new editorial, crowing that their much-maligned 2009 survey of doctors (which trumpeted the alarming headline that 45% of doctors would consider quitting practice if health care reform passed) has now been vindicated by a new survey showing very similar results to IBD’s conveniently-timed 2009 poll.

During the white-hot war in the fall of 2009 over health care reform, truth was indeed the first casualty. The IBD/TIPP poll made quite a splash indeed when it was released to much fanfare on the right. Upon closer examination, however, the unanimous conclusion among those who took the time to fact-check the survey was that the poll was unscientific and therefore not particularly credible. You’ll be unsurprised to learn that didn’t stop FOX News and other conservative outlets from “running with” the poll as proof that Obamacare was bad, as everyone from Media Matters to PolitiFact to NY Times poll-analysis guru Nate Silver noted at the time. Silver went so far as to suggest that his readers “completely ignore” the poll, its methodology was so sloppy.

This clearly stung IBD, enough so that they’ve been stewing on it for almost eighteen months now. How else to explain the “TOLD-you-so” tone of today’s editorial?

The critics said our poll was not credible, was “shabby” and “garbage.” They accused IBD of being partisan, pursuing an agenda, trying to sway gullible readers with shameless journalism.

Useful rhetoric for keeping the left stirred up, but it was nothing more than an attempt to poison findings the critics didn’t like.

Now a Merritt Hawkins survey of 2,379 doctors for the Physicians Foundation completed in August has vindicated our poll.

Has it really?

Remember, in the first two weeks of September, 2009, which is when IBD conducted its survey, “Obamacare” was still very much in flux. No one could predict with certainty what form the final legislation would take. Arguments were still raging not just over the advisability of issues like the public option, but whether it would even be included in the final legislation. That ought to have been the first clue that the IBD poll was iffy. Yes, the public had been given a chance by then to see the Obama team’s (actually, the Baucus Finance Committee’s) proposed legislation by that time. But – as the conservatives never missed an opportunity in those days to remind us – it was quite a large bill indeed, and most people simply hadn’t taken the time to read it all. It was certainly doubtful that many ordinary physicians would have taken the time to slog through the entire thing, which meant they were likely relying upon news reports, summaries from interested groups, and the like

In any event, the recent survey which IBD claims is “vindication” of their ‘09 survey of how physicians hate and fear “Obamacare” was commissioned by the Physicians Foundation and carried out by Merritt Hawkins. The latter is significant because although this particular study was commissioned by an outside foundation, Merritt Hawkins themselves have been around for nearly 20 years, and have been conducting their own, similar surveys of the medical profession on a variety of topics for much of that time.

So what does the current, Physicians Foundation-commissioned survey actually say? The relevant key findings (pdf) upon which IBD rests their “vindication” argument are:

In response to reform, 40% of physicians said they would drop out of patient care in the next one to three years, either by retiring, seeking a non‐clinical job within healthcare, or by seeking a non‐healthcare related job.

That does seem serious and troubling. And, on its face, a vindication of IBD’s 2009 poll. Unfortunately, as was determined by many groups who reviewed their claims in 2009, IBD continues to present only those facts which support its own arguments. Should you or I be concerned at the number of doctors who are apparently preparing to stop practicing medicine (or at least stop seeing patients), supposedly due to “Obamacare?”

To answer that question, it helps to see whether there’s any historical data available. And that’s where the fact that Merritt Hawkins has conducted their own surveys in the past becomes tremendously useful. Additionally, it’s interesting to note that in today’s IBD editorial, they take pains to point out that “of those who said they planned to retire, 28% are 55 or younger and nearly half (49%) are 60 or younger.” As long as the reader doesn’t think about that statistic too hard, it sounds bad: large percentages are younger than a certain age. However, the lowest age IBD mentions is fifty-five. According to IBD’s editorial, only 28% are younger than 55. Considering the retirement age is usually considered to be 65, that’s a sampling of the nation’s doctors which skews fairly heavily toward the older members of the profession. Also, considering that IBD doesn’t give percentages for doctors under 50 who are planning on retiring, or under 45, we’re left, in the end, knowing only that nearly three-quarters of these 40% of the nation’s doctors who are supposedly quitting practicing medicine with patients in the next 1-3 years are between the age of 55 and 65. I’d love to know what percentage of the other 28% who are under 55 fall between 50 and 55.

My guess would be that it would be quite a few of them. Why? Because, as it happens, Merritt Hawkins conducted a similar survey in 2007 (pdf) of doctors aged 50-65. Unless there was an inexplicable gap between ages 50-55 in respondents to the 2010 survey, it means that likely a very small percentage of them were under the age of 50. And the smaller that percentage of under-50 respondents is, the better a comparison the 2007 survey of doctors ages 50-65 is. Somehow, I’m betting that if a significant percentage of doctors in this 2010 survey IBD is touting as “vindication” had been younger than 50, they would have shouted it from the rooftops. Instead, they carefully “forgot” to mention what that percentage actually was.

So…what light can that survey shed on the one IBD is touting as its “vindication” of its own 2009 poll? Here is the comparable key finding from the 2007 survey of doctors aged 50-65:

49% of physicians responding indicated that they plan to make a change in their practices in the next one to three years…In short, about half of physicians responding plan to take steps that would either take them out of patient care settings or reduce the number of patients they see. (emphasis mine)

In other words, in 2007 – well before anyone had even heard of “Obamacare” (and many hadn’t even heard of Obama himself yet) – the same firm asked virtually the same question to a virtually identical sampling of doctors, and the result was that nearly half (49%) said they were planning to either retire or otherwise transition into not seeing patients over the next one to three years. Yet in 2010, only 40% answered similarly – though by now, many did indeed blame “Obamacare.”

What can we learn from this? First, it’s probably the case that dissatisfied professionals will give a variety of answers for their dissatisfaction which can tend to vary with the prevailing trends and developments within their profession – but given the consistency of the dissatisfaction over time as the developments themselves change, it’s likely that the stated reasons may or may not reflect the genuine source of the discontent. Second – should you or I be worried about a severe shortage of doctors in the USA in the future? I don’t know. both 40 and 49 percent seem like an awfully high figure to me: it may very well be that a critical doctor shortage looms. However, third: given that the figure of doctors planning to stop seeing patients declined nearly 20% between 2007 and 2010, either the reality of health care reform has actually improved the country’s chances of avoiding a doctor shortage, or – as I suspect – the figure has remained fairly constant.

The fourth and final conclusion we can draw from the comparison of Merritt Hawkins surveys in 2007 and 2010, however, is that IBD continues to attempt to bend data to fit a narrative they are trying to push to the public.

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