AMA meeting: AMA exhorts doctors to offer charity care, help the uninsured
■ Physicians also should become involved in the political process and help cut financial obstacles to care, says new ethics policy.
By Kevin B. O’Reilly — Posted June 29, 2009
Chicago -- As the debate on how to reform the health system and cover the country's approximately 47 million uninsured patients heats up on Capitol Hill, the American Medical Association House of Delegates adopted policy saying physicians have an ethical obligation to care for patients, regardless of their ability to pay.
So long as it is fiscally sustainable for physicians, the policy says, doctors should accept uninsured patients and maintain relationships with patients who lose health coverage. Doctors should help patients access public programs and charitable sources. They should take part in the political process to cut financial obstacles to health care access, delegates said.
Regina M. Benjamin, MD, outgoing chair of the AMA Council on Ethical and Judicial Affairs, said the Association's ethical stance on access to care dovetails with its lobbying efforts to cover the uninsured.
"This policy fits right into this entire debate at the base of what we do as physicians, which is to put the patients' needs first," said Dr. Benjamin, an Alabama family physician who last October was awarded a $500,000 MacArthur Foundation "genius grant." She founded a clinic in 1990 caring for patients in the medically underserved, remote area in and around Bayou La Betre, Ala.
"Right now, if a patient doesn't have access, they can't get our care," Dr. Benjamin said. "We need to use whatever resources we have, be it our voices or our advocacy -- and health reform is just part of that."
Charity care getting squeezed out?
The new policy comes when declining physician income appears to be affecting the amount of charity care doctors provide. A March 2008 Milbank Quarterly report found doctors' pay fell 7% from 1996 to 2005, when adjusted for inflation. In the same period, the proportion of doctors offering charity care dropped 10% to about two-thirds of physicians. A 2005 Health Affairs study found that among those who are insured, 61% skip care due to out-of-pocket costs.
Some delegates argued that the CEJA report's injunction that physicians provide charity care "when possible" would make medical practice fiscally unsustainable.
"What does 'when possible' mean?" asked Joy A. Maxey, MD, a pediatrician in the Georgia delegation. "In Georgia, you could be Andrew Carnegie and you can't run a practice based on all Medicaid patients."
Ob-gyn Stanley F. Brunn, MD, a member of the New York delegation, said in reference committee discussion that the proposal "overstepped the bounds" and amounted to "mandates that are unfunded."
CEJA member H.R. Greene, MD, said the report was not intended to put physician practices at fiscal risk.
"It's an overwhelmingly obvious good that physicians maintain their financial integrity," said Dr. Greene, an Elida, Ohio, medical oncologist. "We are not saying that the responsibility of ensuring health care access is solely that of physicians.
"What we are exhorting physicians to do is to do the best you can as individuals to help with this problem and advocate with other stakeholders to resolve this issue. We are not telling physicians to go broke."