A new study of the nation’s physicians suggests wide-ranging changes under Obamacare. Second of a series.
By Travis Singleton
Each year, physicians in America conduct more than 1.2 billion patient visits, treating illnesses ranging from the minor to the life threatening. Though they are ably aided in their efforts by nurses, therapists, and a host of other qualified healthcare professionals, physicians remain at the center of the healthcare system. It is primarily physicians who diagnose patients, admit them to the hospital, order tests, perform procedures, and supervise treatments. Physicians typically are the first people we see coming into the world and among the last we see leaving it.
How physicians practice—and what they think about their profession—is therefore of profound importance to both the quality of care patients receive and the access to care they are able to obtain.
With A Survey of America’s Physicians, The Physicians Foundation has endeavored to provide a “state of the union” of the medical profession. Our goal was to reveal a snapshot of what physicians are thinking in the year 2012: about the practice of medicine, about their career plans, and about the current state of the healthcare system. The survey was sent to more than 630,000 physicians—or more than 80 percent of physicians in active patient care—and represents The Physicians Foundation’s effort to provide as many physicians as possible with a voice.
The survey was conducted in the context of one of the most transformative eras in the history of modern healthcare. Health reform—considered as both the Patient Protection and Affordable Care Act (PPACA) and ongoing market forces—is changing how healthcare is paid for and how it is delivered. An epic experiment is in progress to determine if access to healthcare can be expanded while quality of care is simultaneously improved and costs curtailed.
Physicians are at the vortex of these changes. How physicians are organized, how they are evaluated, how they are reimbursed, and how they interact with patients are all subject to partial or complete modification. It is a challenging and uncertain time to be a doctor.
The results of the survey reflect this uncertainty and should be taken in the context of current events. As the course of healthcare reform becomes clearer, attitudes and perspectives may change. However, we believe the survey reveals what doctors are thinking today and is relevant to healthcare professionals, policy makers, media members, and to anyone who has been seen by a physician or who will be.
Responses to the survey combined with some 8,000 written comments submitted by physicians reflect a high level of disillusionment among doctors regarding the medical practice environment and the current state of the healthcare system.
How physicians will respond to ongoing changes now transforming healthcare delivery varies. Many physicians plan to continue practicing the way they are, but more than half of physicians surveyed have reached a tipping point and plan to make changes to their practices. Many intend to take one or more steps likely to reduce patient access to their services, limiting physician availability at a time when doctors already are in short supply.
Key findings of the survey include:
- More than three quarters of physicians (77.4 percent) are somewhat pessimistic or very pessimistic about the future of the medical profession.
- More than 84 percent of physicians agree that the medical profession is in decline.
- The majority of physicians (57.9 percent) would not recommend medicine as a career to their children or other young people.
- More than one third of physicians would not choose medicine if they had their careers to do over.
- Physicians are working 5.9 percent fewer hours than they did in 2008, resulting in a loss of 44,250 full-time- equivalents (FTEs) from the physician workforce.
- Physicians are seeing 16.6 percent fewer patients per day than they did in 2008, a decline that could lead to tens of millions of fewer patients seen per year.
- Physicians spend more than 22 percent of their time on non-clinical paperwork, resulting in a loss of some165,000 FTEs.
- More than 60 percent of physicians would retire today if they had the means.
- Physicians are not uniform in their opinions—younger physicians, female physicians, employed physicians and primary care physicians are generally more positive about their profession than older physicians, male physicians, practice owners and specialists.
- More than 52 percent of physicians have limited the access Medicare patients have to their practices or are planning to do so.
- More than 26 percent of physicians have closed their practices to Medicaid patients.
- In the next one to three years, more than 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
- More than 59 percent of physicians indicate passage of the Patient Protection and Affordable Care Act (i.e., “health reform”) has made them less positive about the future of healthcare in America.
- More than 82 percent of physicians believe doctors have little ability to change the healthcare system.
- Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now.
- More than 62 percent of physicians said Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs or that that any quality/cost gains will not be worth the effort.
- Physicians are divided on the efficacy of medical homes, and many (37.9 percent) remain uncertain about their structure and purpose.
- More than 47 percent have significant concerns that EMR poses a risk to patient privacy
- More than 62 percent of physicians estimate they provide $25,000 or more each year in uncompensated care.
Travis Singleton is senior vice president of Merritt Hawkins, an AMN Healthcare company.