An Exploratory Investigation of Negative Perceptions of the Affordable Care Act among Patient-facing Professionals and Intentions to Leave

Abstract

HEALTH CARE EXPENDITURES INCLUDING HOSPITAL visits, medications, and other services represent approximately 17% of the U.S. gross domestic product (GDP) (Center for Medicare & Medicaid Services, 2014). Through a combination of hospitals, clinics, and other types of health care organizations, the health care industry employs over 11 million people including 7.84 million as health care practitioners and technical occupations and 3.94 million in health care support occupations (Bureau of Labor Statistics, 2014). However, as an industry that is now heavily regulated by the federal government, it is greatly affected by public policy changes. It is unsurprising, then, that health care in the U.S. significantly changed when the Patient Protection and Affordable Care Act (hereafter ACA) was signed into law in 2010 (Department of Health & Human Services, 2015). Forbes notes that the health care industry, which for several years has been on brink of upheaval, is now in a state of emergency with the launch of the ACA (Llopis, 2014). One of the major critiques of this public policy is that it requires more of health care providers but, ultimately, pays them less. This not only creates a disincentive to join the health care profession, but also threatens the profitability and sustainability of the thousands of health care organizations across the country that are already dealing with increasing health care costs rising faster than inflation (Patton, 2015).Compounding these business concerns resulting from the ACA, the industry faces the challenge of attracting and retaining health care professionals, as analysts have projected the health care industry to be the fastest growing segment of the U.S. economy over the next decade (ASHHRA, 2011), in part due to the increase in baby boomers who will need medical care. Despite the ever-growing need for health care workers, many are leaving the industry entirely. Research indicates that 30-50% of all new nurses elect to change positions or leave nursing entirely within the first three years of working in the field (AACN, 2003; Aiken et al., 2002; Cipriano, 2006). In addition to nurses prematurely exiting the field, there is a substantial exodus of nurses from patient care in general, one reason being, according to Lafer (2005), the suboptimal working conditions and the high amount of stressors (e.g. job tension) placed on nurses. The ACA is predicted to add to these stressors due to the increased bureaucracy. As a result, nursing workforce projections indicate that by 2025 the RN shortage may exceed 500,000 (AACN, 2010). Unfortunately, nurses are not the only professionals exiting direct patient care. A recent poll suggests that 34% of physicians plan to leave patient care within the next 10 years, citing health care reform as a primary reason for departure (Sofranec, 2012). Doctors surveyed about the ACA believe that it should be repealed (55%) and that it would not improve the quality of health care (61%) (Sofranec, 2012). Health care professionals, due to the ACA, are also considering transitioning to administration from patient care and are pessimistic about the future of medicine (Richardson, 2013).However, in spite of these doomsday statistics, the authors have yet to find empirical research that tests the assumption that the ACA influences professionals to leave patient care. It is important to understand what influences intentions to leave patient care, as lack of direct patient-care providers is the main challenge facing society and health care organizations as a whole. Health care organizations (from small, private clinics to large, public hospitals) will face challenges in staffing if patient-facing health care professionals leave. These challenges will not only pose fiscal obstacles, but also put increased strain on those who do stay. Societally speaking, a lack of direct patient-care providers will result in increased wait times not only in emergency rooms, but also for time-sensitive surgeries and access to health care (Rajczi, 2014). …