Almost one year after the passing of the Patient Protection and Affordable Care Act (PPACA), also known as the Health Care Reform Act of 2010 (HCRA) legislation, doctors appear to be "frustrated and dismayed" by the expected impact of the legislation. This is according to a new national survey of 2,958 doctors in the U.S. in September of 2010.

In general, the results convey a negative feeling among doctors regarding health care reform. For example, 65% of doctors believe that the quality of health care in the U.S. will deteriorate in the next five years. Only 18% believe that it will improve, while 17% believe that it will stay the same. The reasons for this pessimism include political motives, anger directed at insurance companies, and a feeling that the health care reform act was poorly planned.

When asked specifically about the impact of the reform act on doctors themselves, an overwhelming majority (78%) believed that it will be negative. Only 8% thought it will be positive and 14% thought it will be neutral. As for the impact of the act on patients, 58% of doctors believed it will be negative (vs. 27% positive and 15% neutral).

The most optimistic specialties were pediatricians and psychiatrists, as half of them believed the act will have a positive effect on patients. On the other hand, surgeons and ophthalmologists were the most pessimistic, as they had the highest number of the least positive and most negative comments.

Part of the hidden reasons behind physician discontent is possibly their belief that they will be replaced by less-educated nurse practitioners (NPs) and physician assistants (PAs). One the main aspects of the law are that it will provide insurance coverage to an additional 32 million Americans by the year 2019. When asked about who they thought will be handling this increased patient population, 45% of the doctors surveyed indicated that it will be nurse practitioners rather than primary care physicians. Around 22% thought it will be physician assistants.

According to the report:

"Primary care providers expressed concern that hospital and specialty-run care systems would not recognize their value, as specialists see their income and autonomy waning as health systems organize. The majority of physicians believe that under PPACA, the process for physician reimbursement will become less fair for them. Physicians overall have a clear frustration with non-physician providers' compensation, which is comparable to primary care physicians, citing that Nurse Practitioners and Physician Assistants are not as well trained or as educated."

These responses are very worrying: How can we expect reform to work when one of the most important players in our health care systems — doctors — are very anxious about their future and are extremely concerned for their practices and their patients?