Physicians react to Tom Price nomination

At first glance, Congressman Tom Price, MD, looks like a solid pick to head the U.S. Department of Health and Human Services (HHS). Representing Georgia’s 6th District since 2004, he serves on the House Committee on Ways and Means and was named chair of the House Committee on Budget, but most importantly, he’s a doctor that can bring the physician viewpoint to an agency that is often accused of lacking empathy for those tasked with meeting HHS regulations while treating patients.

More here: Physicians retaliate against AMA for Price endorsement on Twitter

But when you go beyond the basic bio, some doctors fault-while others applaud-his outspoken opposition to the Affordable Care Act (ACA) and government spending, which includes support for privatizing Medicare. President-elect Donald Trump said during the campaign he would leave Medicare alone, so it remains to be seen what official policy will come out of the White House, but some physicians worry the appointment of such an ardent opponent of universal coverage and healthcare entitlement programs could have an adverse effect on patient health. Others say having a doctor in that position will bring some common sense to an agency sorely in need of an overhaul.

“I’ll gladly throw my support behind a physician to lead HHS,” says David Allison, a plastic surgeon in Gainsville, Virginia, in an email. “Does anyone really believe that Hillary Clinton (a lawyer) would improve the situation for doctors and their patients?”

Blog: 7 scariest acronyms of healthcare explained

Elizabeth Seymour, MD, a family practitioner in Denton, Texas, is also in favor of the appointment. “It’s refreshing that we have a third-generation physician appointed to HHS. With his family’s history, he knows the ropes of medicine. His stance on many healthcare issues is aligned with mine as a practicing physician.”

Her comments were echoed by Howie Mandel, MD, an OB/GYN in Los Angeles. “Dr. Price is a stellar choice for secretary of HHS-a physician’s physician who has actually practiced medicine, a surgeon who can operate as well as teach, a policy wonk that understands the interwoven bureaucracy of HHS as well as the American health system …”

Next: Physician organizations speak out

Physician organizations speak out

Professional organizations had varied reactions to the nomination, with the American Medical Association stating it “strongly supports the nomination” based on his leadership in the “development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs.” This stance sparked a letter of protest from Clinician Action Network, a grassroots organization committed to evidence-based policies that puts patients first. The letter received over 5,000 signatures in a week and sparked a #notmyAMA hashtag on Twitter.

Further reading: Obamacare rising costs creating challenges for physicians

The Association of American Medical Colleges stated that Price is “a strong choice for HHS secretary.” But the American Medical Student Association condemned the nomination, stating Price’s track record shows opposition to women’s health care services, “continued discriminatory rhetoric and votes cast against LGBTQ populations and failure to recognize the importance of mental health within our healthcare system.”

Much of the opposition to the nomination from physicians is based on concerns about what will happen to those currently receiving insurance from the ACA marketplaces and what will happen to underserved populations with Price at the helm of the HHS, a view stated by Tyler Winkelman, MD, an internist and pediatrician, in Ann Arbor, Michigan.

“Not only is Dr. Price willing to cut health insurance for the most marginalized members of society, but he also has shown little appetite for holding physicians accountable for the care they provide,” Winkelman said in an email. “Dr. Price has voted to pay physicians for the number of procedures they perform, rather than the quality of their work.”

Some of those concerns are also shared by Scott Helmers, MD, a family physician in Sibley, Iowa. “It is heartening that HHS may be headed by someone who has actually practiced medicine. I am wary, however. I would prefer the physician be someone with experience in primary care who has served citizens stressed by health care bills. Destroying the ACA without a superior plan will be a step backward.”

Related: 10 things to know about HHS Secretary-designate Tom Price

The disparity of opinions received by Medical Economics reflect the results of a Merritt Hawkins poll, which showed that of the 1,094 physicians surveyed, 46% feel generally positive about Price, 42% feel generally negative while 12% are neutral. When it comes to the ability of patients to access quality care, 47% believe Price will detract from that ability and 42% think he will improve it, with the remaining 11% neutral.

Price needs a simple majority to be affirmed by the Senate, where Republicans hold a 54-seat majority.

Next: Docs petitions against Price

Speaking for those who can’t, docs petition vs. Price

The American Medical Association has historically been seen as the de facto mouthpiece for physicians, but when it issued a strong endorsement of Tom Price for secretary of the U.S. Department of Health and Human Services, a trio of doctors stepped forward to oppose it.

The movement, dubbed the Clinician Action Network, was founded by Manik Chhabra, MD, Navin Vij, MD, and Jane M. Zhu, MD, MPP, all internists, a few weeks prior to Price’s nomination to harness the growing sentiment that the people making healthcare policies aren’t the ones practicing medicine. So it’s somewhat ironic that the first major action taken was to oppose the potential appointment of a physician to a cabinet post, a move the founders say was necessitated by Price’s views on healthcare.

Further reading: MACRA: Small practice hug or regulatory choke hold?

“The very strong endorsement of Dr. Price caught us off guard,” Chhabra told Medical Economics. “Especially when his views are not aligned with the goals of the AMA. His policies are not in the patients’ best interest.” None of the founders is a current member of the AMA, but all have been in the past.

The goal of the letter is to show the AMA that not everyone agrees with their endorsement and to point out to non-physicians that the organization does not represent all doctors. The letter, which has more than 5,200 signees, is being sent to both AMA leadership and members of Congress.

The founders of the group are concerned that access to care will be curtailed, hurting those who need it the most. While they don’t claim the Affordable Care Act or other programs are perfect, they agree that Price represents a danger to accessible care.

Zhu says that Price should be judged on his policies and positions and should not be given a free pass just because he is a physician.

 “Part of our responsibility is to advocate for patients who can’t advocate for themselves,” says Vij. “It’s important to think about patients that are most vulnerable and the issues they face.”

Zhu says that no matter what happens, the group will continue to advocate to support evidence-based policies that put the patient first.

“I think a lot of my colleagues have seen improvements in access to care,” says Chhabra. “I’m scared to see what happens if most of it is dismantled.”