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Background: The Patient Protection and Affordable Care Act (ACA) commonly known as Obamacare was signed into law in March of 2010. This law will have significant effects on nearly every aspect of healthcare in the United States. This study aimed to examine the attitudes of hand surgeons toward the ACA.
Methods: An electronic survey was sent to the members of American Society for Surgery of the Hand (ASSH). The survey consisted of 31 questions and was sent two times one month apart per ASSH guidelines. The questions collected data including demographics, training background, and practice profile as well as the respondents’ understanding of and attitudes towards the ACA.
Results: A total of 974 hand surgeons responded to the survey (33% response rate). The majority were male (89%) trained in orthopaedic surgery (81%), who are currently in private practice (75%) and have more than 15 years of experience (56%). Most hand surgeons rated their knowledge of the ACA as average (41%). Only 15% reported that they received training on the expected healthcare changes related to the ACA and only 10% reported good or excellent preparation provided by their professional organizations in anticipation of these changes. In general, hand surgeons disagreed that the ACA would improve healthcare in the United States (median 2, mean 2.06, range 1-5, 1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree), while agreeing that the ACA would decrease reimbursements specific to hand surgery (median 4, mean 4.11, range 1-5). They also disagreed that the ACA would improve access to emergent (median 2, mean 2.10, range 1-5) or elective (median 2, mean 2.30, range 1-5) hand surgery. Approximately one in three hand surgeons (37%) believed that implementation of the ACA would cause them to retire earlier than planned and one in two hand surgeons (51%) believed that they would alter their individual practice as a result of the ACA. Stratified analysis revealed that private-practice hand surgeons had a more negative outlook on the ACA compared to their academic-practice counterparts (p ≤ 0.0013 for all of the assessment questions). Male hand surgeons had a more negative outlook on the ACA compared to their female colleagues in several categories, including the ability of the ACA to improve care quality (p 0.0021) and access (p 0.02) for hand surgery patients without affecting the surgeon’s retirement timeline (p 0.007) or practice type (p 0.002).
Conclusion: Hand surgeons as a group have a fairly negative outlook on the ACA and its impact on the quality of healthcare, reimbursement rates, access to emergent/elective hand surgery, retirement plans, and individual practice type. Private-practice members are more pessimistic than their academic-practice counterparts and male members are more pessimistic than their female colleagues. Notably, only a small percentage of hand surgeons report sufficient preparation for the coming changes related to the ACA. This indicates a need for increased education and advocacy from professional organizations, which may change hand surgeons’ outlook on the ACA.