Whether you think the “first 100 days” marker of U.S. presidencies is indeed an important benchmark or just a media contrivance, most presidents try to make long legislative strides in this time. Donald Trump has been no exception.

Much of Trump’s legislative agenda is riding on his promise to repeal and replace the Affordable Care Act (ACA). The stakes are high–for both Trump’s legislative priorities and the country’s economic future. InCrowd wanted to hear physicians’ perspectives on President Trump, particularly their opinions on how his policies will impact the healthcare system.

Even Trump Voters Express Lack of Confidence in Healthcare Policy

Physicians surveyed had a 56% disapproval of Trump, with 28% approving of Trump’s performance. Judgments of Trump seem to follow physicians’ voting patterns, which we also tracked in this survey. Of the 1,003 US physicians polled by InCrowd, 46% voted for Hillary Clinton, 30% voted for Donald Trump, and 5% voted Gary Johnson. (12% did not vote for a Presidential candidate, with many physicians stating they did not care for the choices available.)

Physicians’ 56% disapproval rating is also slightly higher than the national approving of 41-54 points, according to a Gallup poll conducted around the same time. President Trump received the highest approval ratings on his handling of the economy (41%) and tax policy (40%). His lowest marks were on healthcare policy (21%) and education (20%). Of those physicians who voted for Trump (30%), education and healthcare received the lowest approvals, with a 50% approval rating for education and 54% for healthcare policy. In contrast, this group gave significantly higher marks in other areas, with 74% stating they approve of his overall performance so far, and approval ratings of 86% on the economy,  78% on tax policy, and 77% on and immigration.

Few Cheerleaders for AHCA

More than half of physicians surveyed say they approve of the ACA while 44% disapprove. This compares to just 28% who approve of the American Healthcare Act (AHCA) and 43% who disapprove. Notably, 17% of physicians state they are unsure where they stand on the AHCA, with parts of the bill sure to change as it makes its way through Congress. “The ACA is extremely imperfect,” said a pediatrician in Wisconsin. “However, the AHCA does nothing but exacerbate its flaws.”

Of the major proposals in the AHCA, the only one with slightly higher support (42%) than opposition (39%) is the ability of insurers to set premiums based on health status so long as the state has established a high risk pool. The majority oppose ending all federal funding for Planned Parenthood (65%), ending employer requirements to cover birth control (58%), or generally setting insurance premiums based on health status (58%).

Before passing the House, there was a late amendment to the AHCA allowing states to eliminate so-called essential health benefits, including coverage for prescription drugs, maternity care, mental health and substance abuse treatment, and other services currently required under the Affordable Care Act. More than two-thirds of physicians polled by InCrowd believe every Essential Health Benefit in the ACA should continue to be mandatory, with 8 of the 10 benefits supported by more than three-quarters of respondents.

Healthcare Challenges in the Next Four Years

Physicians were asked about a number of healthcare challenges facing the US healthcare system and whether they expected things to improve, get worse, or remain the same. Of these challenges, there were none which the majority expected to improve over the next four years. There were many which a majority of respondents expect to get worse, including reimbursement rates for physicians (65%), the cost of insurance premiums (63%), number of uninsured patients (59%), and the shortage of healthcare professionals (59%).

Many of the contextual comments mention frustration with Washington gridlock and a lack of confidence in either party. Funding for the National Institutes of Health is top of mind for many physicians, with a number expressing concern over how cost-cutting will impact public health. “You cannot defund research and expect to get results,” says a gastroenterologist in South Carolina. “Another aircraft carrier will not stop an epidemic.”

When it comes to shortage of healthcare professionals, physicians are pessimistic. Some wonder: Why become a physician?

“There is no incentive for intelligent students to go into healthcare with the large debt from tuition and limitations on income,” according to an OB/GYN from Pennsylvania. An emergency room physician from Florida points out that, “The smart kids are going to business school, not med school.”

The fact that there is not a single healthcare category where doctors feel optimistic is reflective of the complexity and uncertainty around the current state of affairs. Furthermore, InCrowd’s survey findings reveal an interesting finding around physicians who voted for Trump: that they seem to be compartmentalizing Trump’s performance on healthcare policy, versus other major issues affecting the country.