But one thing is clear: There are a lot of unhappy people practicing medicine right now.
A survey of physicians in 119 clinics in New York and the Midwest published in the Annals of Internal Medicine in 2009 found that 48 percent reported working in "chaotic" environments. Thirty percent said they needed at least half again as much time for appointments as they were given. Only a quarter said their practices strongly emphasized quality. Nearly a third said they were likely to leave their jobs in the next two years.
If the new types of practice envisioned by the Patient Protection and Affordable Care Act take hold, much of that could change for the better.
"It appears that when a doctor happens to be in a place that moves to a 'medical home' model, they can turn their frustration into excitement again. That is huge," said J. Fred Ralston Jr., president of the American College of Physicians. "We are getting reports that patients are happy, physicians are happy and that, in at least some cases, [these new sorts of practices] are saving money."
But will doctors truly love the new system? Or will they run away from it? Some doubts might enter in by article's end, where Brown starts whispering about the mandates and the rationing:
Doctors already have incentives to report quality-related measures to Medicare. The new law will penalize doctors who don't make such reports, starting in 2015. In the future, physicians participating in the Physician Quality Reporting Initiative will receive reports about how their performance compares to others'.
There is also money for the creation and dissemination of "patient decision aids" -- handouts, videos, computer programs, etc. -- that will help patients understand their treatment options. That is part of the law's general intent to make medical care more patient-centered.
In one of its more controversial parts, the law establishes a Patient-Centered Outcomes Research Institute to underwrite and direct "comparative-effectiveness research" seeking to determine the best and most economical treatment for common diseases. While the law specifically says that comparative-effectiveness findings can't become mandates that tell doctors how to practice, many champions of reform think that such research is essential to improving care.
When Brown's article jumped to an inside page, there was a large picture of Speaker Pelosi (with her oversized gavel) and other Democrats marching across the street to pass ObamaCare. The caption read "Democratic congressional leaders joined hands in March on their way to approving landmark changes in the nation's health-care system. The new law promotes 'comparative-effectiveness research' seeking to determing thebest most economical treatment for common diseases."
