With doctor reimbursements declining, patient premiums rising and insurance profits increasing, reform was needed. The Affordable Care Act may or may not fix some problems but not until insurance industry protection from antitrust regulatory violations is addressed will the playing field be leveled. In the meantime, will doctor's disillusionment with the system hurt the care you receive? Will we ever again have quality in our doctor patient relations?

 July 2013

‘A Profession in Decline’ Survey Highlights Physician Disillusionment with Medicine

At a time when physicians are in short supply, more than half the doctors responding to a recent national poll said they intended to cut back on patients, work part-time, switch to concierge medicine or otherwise take steps that may reduce patient access to care over the next three years.

The revelation raises questions about how the health system will accommodate the influx of newly covered patients expected as a result of insurance mandates included in the Patient Protection and Affordable Care Act.

The survey of more than 13,500 physicians -- released in September and conducted by the Physicians Foundation -- paints a bleak picture of current physician attitudes about medicine and skepticism about the impact of healthcare reform.

According to the survey:1

• More than 84% of physicians believe that the medical profession is in decline, with “too much regulation/paperwork” cited as the most important factor behind the decline, followed by “loss of clinical autonomy,” “physicians not compensated for quality” and “erosion of the physician/patient relationship.”
• More than 75% of physicians are somewhat pessimistic or very pessimistic about the future of the medical profession.
• More than one-third of physicians would not choose medicine if they had their careers to do over.
• About 57% would not recommend medicine as a career to their children or other young people.
• Nearly 60% of physicians indicate that the passage of the Patient Protection and Affordable Care Act has made them less positive about the future of healthcare in America.
• About 62% said that Accountable Care Organizations) are either unlikely to increase healthcare quality and decrease costs or that any quality/cost gains will not be worth the effort.
• More than 50% of physicians have limited the access Medicare patients have to their practices or are planning to do so.
• Approximately 26% of physicians have closed their practices to Medicaid.
• Physicians are seeing 16.6% fewer patients than they did in 2008, a decline that could lead to tens of millions fewer patients seen per year, according to the survey.
• Physicians spend about 22% of their time on non-clinical paperwork, resulting in a loss of some 165,000 full-time employees.

Dropping Insurance

The prospect of fewer physicians being available to treat new patients in the post-reform era was underscored in a recent article on NYTimes.com, which described how more and more doctors are no longer accepting health insurance.2 Instead, the physicians have adopted a `cash only’ or a concierge approach. The latter payment system typically involves an annual retainer paid by patients, along with other fees.

According to the article, efforts by insurers aimed at constraining healthcare costs by holding down physician reimbursement, especially for primary care doctors, appears to be accelerating the trend, and some patients report that it is becoming harder to find an in-network doctor.

The article notes that a June report by the Medicare Payment Advisory Commission found that 30% of privately insured individuals who were looking for a new primary care doctor in 2011 reported problems finding one, versus 26% in 2008.

According to the Association of American Medical Colleges, the U.S. will face a shortage of about 100,000 physicians by 2025. The shortfall will be especially critical in the primary care area, according to the New York Times article.

Said one anonymous physician in the comments section of the Physicians Foundation survey:

“Physicians continue to enjoy treating patients. However, we still run a small business and find it increasingly difficult to make ends meet, which decreases our employees’ salaries and benefits and decreases physicians’ willingness to provide indigent care.”

1 “A Survey of America’s Physicians: Practice Patterns and Perspectives,” Survey conducted on behalf of The Physicians Foundation by Merritt Hawkins, September 2012 

http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf

2 Roni Caryn Rabin, “When Doctors Stop Taking Insurance,” NYTimes.com, Oct. 1, 2012 http://well.blogs.nytimes.com/2012/10/01/when-doctors-stop-taking-insurance/