One of the largest physician surveys ever conducted in the United States identified some disturbing trends in practice.1 The comprehensive survey of 13,575 physicians, commissioned by the nonprofit Physicians Foundation, found that physicians are working fewer hours, seeing fewer patients, and limiting access to their practices as a response to significant changes to the medical practice environment.
If these patterns continue, as many as 44,250 full-time–equivalent physicians may leave the workforce over the next 4 years. The survey also found that, over the next 1 to 3 years, more than 50% of physicians will cut back on the number of patients they see, switch to part-time work or concierge medicine, retire, or take other steps likely to reduce patient access. And if 100,000 physicians transition from practice-owner to employed status over the next 4 years (eg, moving to a hospital setting), this shift will lead to 91 million fewer patient encounters.
“It is clear that the introduction of nearly 30 million new patients into the US health-care system through health-care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, MD, vice president of the Physicians Foundation and chair of its Research Committee. “The rate of private practice physicians leaving the medical field, as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients, is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”
More than half of physicians (52%) have limited the access of Medicare patients to their practices or are planning to do so, and one out of four physicians (26%) have already closed their practices to Medicaid patients, the survey reveals. Physicians cited rising operating costs, time constraints, and diminishing reimbursement as the primary reasons they are unable to accept additional Medicare and Medicaid patients.
Physician morale is flagging
An overwhelming 80% of physicians cited “patient relationships” as the most satisfying part of their job. Yet, 77% of respondents are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the health-care system.
Among the variables cited as driving discontent:
- medicolegal risk and the pressure to practice defensively
- Medicare, Medicaid, and government regulations
- reimbursement issues
- uncertainty about the changes imposed by health reform.
“The level of pessimism among America’s physicians is very troubling,” said Lou Goodman, PhD, president of the Physicians Foundation and chief executive officer (CEO) of the Texas Medical Association. “More than 84% of physicians feel that the medical profession is in decline, and nearly 58% are reluctant to recommend medicine as a career to their children. That means that we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine.”
Other notable findings
- Sixty-nine percent of physicians cited defensive medicine as the No. 1 cost driver, and 65% cited the “aging population.” Older patients visit physicians three times as often as younger patients, on average. Other expense drivers cited were the cost of pharmaceuticals, advances in technology and treatment, and “social conditions.”
- Close to 92% of physicians are unsure where the health-care system will be or how they will fit into it 3 to 5 years from now.
- More than 62% of physicians said Accountable Care Organizations are either unlikely to increase the quality of health care and decrease costs, or that any quality/cost gains will not be worth the effort.
- Although almost 70% of physicians have implemented electronic medical records, 47.4% have significant concerns that these records pose a risk to patient privacy.
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