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Plastic & Reconstructive Surgeonsí Views On A Single Payer Health Care Alternative: Implications For Patients And Practice
Ishani D. Premaratne, BA, Jason A. Spector, MD, FACS.
Weill Cornell Medicine, New York, NY, USA.

PURPOSE: As health care costs become an increasingly large share of the U.S. economy while millions remain uninsured, a single payer alternative has been increasingly espoused, even by leading presidential candidates. We examine the views of U.S. plastic and reconstructive surgeons on a single payer healthcare system and its implications for patients and practice.
METHODS: 3,431 U.S. plastic and reconstructive surgeons were sent a 28-item Qualtrics survey from September 1st to November 1st, 2019. Demographic and opinion data were analyzed.
RESULTS: There was a 11.16% response rate (n=383). The majority of respondents were male (84% compared to 85% of plastic surgeons nationally) with an average age of 55.2; 64% of respondents were in private practice (significantly lower than the 80% national proportion, p < 0.0001), and 17% in academic practice (significantly higher than the 4% national proportion, p < 0.0001). Among survey respondents, there is a significant relationship between respondentsí practice region and practice type (p=0.0005), with the Northeast having the highest percentage of academic practitioners (29.7%), and the Southeast having the highest percentage of private practitioners (100%). There is also a significant relationship between political affiliation and practice type (p = 0.0085). Among private practitioners, 43.3% identify as Republican and 16.2% Democrat, compared to 24.6% Republican and 33.9% Democrat among academic practitioners. Forty three percent believe it is the governmentís responsibility to ensure that care is provided for all. The proportion of plastic surgeons that chose single payer as the most optimal health care system is significantly different between academic (41.5%) and private practice (24.6%, p=0.011). Among academic plastic surgeons, 22% would consider leaving if single payer were enacted and 59.5% would decrease the reconstructive portion of their practice (p <0.01). Seventy percent of all respondents, regardless of practice type, agreed that losing the economic incentive of doing more cases would adversely affect how hard they work, with 63 percent saying they would not work the same number of hours under single payer (p<0.05). Thirty four percent are willing to give up income in order to reduce their paperwork and administrative burden.
CONCLUSION: Most U.S. plastic and reconstructive surgeons in 2019 do not support the enactment of a single payer health care system, and the majority believe that losing the economic incentive associated with doing more cases will adversely affect their incentive to perform non-fee-for-service surgery. While the majority of plastic surgeons are private practitioners, those in academia will likely be disproportionately affected by sweeping health care reform because academic medical centers with nonprofit status typically treat a higher percentage of Medicaid and Medicare patients than do private practices. Surgeon reimbursement rates for these patients stand to decrease if single payer were enacted. Given this reduction in incentive to perform cases including complex reconstruction, there is a strong likelihood that implementation of universal coverage will in fact decrease access to these procedures due to limited availability of providers willing to perform them, in addition to the possibility of driving an even fewer number of trainees into academic practice.


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