How well do doctors know the ACA?

In the article “Physician Knowledge of and Attitudes toward the Patient Protection and Affordable Care Act,” the authors survey otolaryngology surgeons using the Kaiser Family Foundation’s (KFF) 10 question health reform quiz. KFF published results from the general adult population (n=2,207) in February 2011 demonstrating that 76% answered less than 70% of questions correctly. In this study,  the investigators, sought to assess physician knowledge and compare knowledge of the ACA to bias concerning the law.

Researchers emailed all members of the American Academy of Otolaryngology—Head and Neck Surgery (OHNS) (n=9,972) a modified online 10 question quiz and surveyed attitudes towards the ACA with a four category favorability rating. They attempted to screen for bias in knowledge answers and found no significant difference whether or not the ACA was mentioned. Additionally, authors collected information concerning basic demographics, political affiliation, and academic affiliation of respondents.

There was 6.5% response rate, consisting of almost 6:1 males: females, majority Republicans, and a minority affiliated with an academic medical center. Overall, participants averaged 7.18 (74% of attempted) questions correct. The following trends were noted for those more likely to correctly answer: academic affiliation, political independent or Democrat, and favorable opinion of the ACA. Compared to the KFF survey, OHNS physicians scored higher for all questions with the exception of one question concerning tax credits for small businesses. Both the general public and OHNS physicians scored 70% or less in the domains of small business tax credits, benefits for undocumented immigrants, Medicare benefits, creation of government-run insurance plan, and compulsory insurance for all businesses. OHNS physicians scored higher than the general public in all areas except the presence of small business tax credits to offset the cost of health insurance.

Commentary

Although this study attempts to provide important information concerning physicians’ knowledge and attitudes of the ACA, the study is barely relevant to the physician body as a whole. OHNS physicians – of whom the majority are male (87.3%) and more than one-third are age 55 years or older – represent only 10% of all practicing US physicians. Other than intrinsic selection bias – with the sample overwhelmingly male, Republican, and biased against the law – the study suffers from a poor response rate. In the literature there is no broad-based study of physician knowledge of the ACA. A survey of self-reported knowledge by Deloitte Center reports 71% of physicians as “somewhat informed” and 23% as “very informed” on health reform. This study indicates there is fair knowledge of the ACA among this select group of physicians.

Physicians represent major stakeholders and ambassadors of health reform, and as such, they should be highly informed of the changes caused by the ACA. Patients trust physicians with intimate medical problems and look to them for valued information on reform. In fact, physicians are more trusted than the media, insurance companies, or government regarding health reform. So docs, have you taken the quiz?

Rocke, DJ, et al. Otolaryngology – Head and Neck Surgery. 2013; published online.

by

Laura Grubb, MD, MPH, FAAP