Thursday, November 25, 2010

A Physician Survey Shows Private Practice Decline and Disapproval of Health Reform

Today a booklet crossed my desk entitled Health Reform and the Decline of Physician Private Practice: A White Papers Examining the Effects of The Patient Protection and Affordable Care Act on Physician Practices in the United States. It contains a survey 0f 2600 randomly selected private physicians of various specialties from a cross-section of physicians across the country.

The survey makes for depressing reading.

Here are a few of the selected findings.

1) Are you in an independent, physician-owned practice or are you employed by a hospital, health system, or other entity?

Physician-owned practice 59%
Employed by hospital or other entity 41%

2) What was your initial reaction to passage of the 2010 Patient Protection and Affordable Care?

Very positive 12%
Somewhat positive 15%
Neutral 6%
Somewhat negative 15%
Very negative 52%

3) How do you now feel about health reform?

I am more positive than I was initially 10%
My feelings have not changed 51%
I am more negative than I was initially 39%

4) Do you believe the viewpoint of physicians was adequately represented in policy matters and the public during the run-up to passage of health reform?

Yes 14%
No 86%

5) How do you think reform will affect patient volume at your practice?

Patient volume will increase 54%
Patient volume will remain the same 35%
Patient volume will decrease 11%

6) Do you now have the time and resources to see additional patients in your practice while still maintaining quality of care?

Yes 31%
No 69%

7) How do you believe reform will affect the quality of care you are able to provide to your patients?

Improve 10%
No effect 19%
Diminish 56%
Unsure 15%

8) How do you believe health reform will affect the amount of time you are able to spend per patients?

I will be able to spend more time per patients 5%
There will be change in the amount of time I can spend per patient 24%
I will have less time per patients 59%
Unsure 24%

9) What effect do you believe reform will have on the financial viability of your practice?

Enhance 10%
No effect 9%
Diminish 68%
Unsure 13%

10) Health reform provides pilot projects to test “bundled (capitates) payments” for patients for episodic care. What is your view of bundled payments?

A generally good idea 11%
A generally bad idea 68%
Unsure 21%

11) Which is likely to have the greatest impact on your practice – health reform or a “fix” of Medicare’s Sustainable Growth Rare (SGR) formula?

Health reform 34%
SGR 36%
Unsure 30%

12) Do you believe reform will compel you to close or significantly restrict your practice to any category of patient?

Yes 60%
No 40%

What categories?

Close Significantly Restrict
Medicaid 51% 42%
Medicare 30% 57%
Indigent 43% 38%
Patients covered through exchanges 24% 44%
HMO 17% 42%
All new patients 5% 37%
Self-pay 10% 24%
Privately insured 5% 18%
Other 6% 9%

12) Consider your practice plans over the next three years as reform is phasing in. What do you plan to do?

Continue proctors as I am 26%
Cut back on hours 19%
Restore 16%
Switch to cash or concierge prate 16%
Relocate to another computer 14%
Work locum tenens 14%
Cut back on patents seen 12%
Seek a non-clinical job in health care 12%
Seek a job/business unrelated to health care 12%
Seek employment within a hospital 11%
Work 20 hours or less 8%
Close my practice to new patients 6%
Other 4%

13) How do you believe reform will affect the independent private practice?

Will enhance the viability of private practice 34%
Will have little or one affect on private practiced 36%
Will erode private practice 30%

14) Which best describes your view of independent, private practice?

It is a dinosaur soon to go extinct 28%
Is on shaky ground 58%
Is relatively robust and viable? 14%


Four of five physicians surveyed (2400 in all) believe that one of the consequences of health re4form will be the erosion of traditional independent private practice. 24% will continue to practice as is, but 74% will seek other forms of practice or employment or will retire. 65% of doctors have a somewhat negative or very negative attitude towards reform.


1) The majority of physicians responded unfavorably to passage of health reform.

2) The majority of physicians believe health reform will increase their patient loads while decreasing the financial viability of their practices.

3) The majority of physician plan to alter their practice patterns in ways they will reduce patient access to care, by retiring, working part-time or taking other steps.

4) Physician practice styles will be increasing less homogenous. The full-time, independent practitioners accepting third party payment will largely be supplanted by employed, part-time, locum tene4nes, and concierge practitioners.

For additional information about this survey, contact Phillip Miller of Merritt Hawkins and AMN Healthcare at 469-524-1400 or


Michael Kirsch, M.D. said...

Thanks for the cheerful Thanksgiving message. Wishing you the best.

Leone said...

Really useful data, much thanks for your article.