24 Survey Results of Physician Attitudes Toward Reform and Health System Future

I am not fond of uttering platitudes

In stained-glass attitudes.

W.S. Gilbert (1836-1911)

June 17, 2012 – I try to avoid platitudes about physician attitudes.   Instead I seek to mirror their attitudes by being specific.  Physician attitudes can make a big difference for the future of the health system – which stays in practice, which keeps seeing Medicare and Medicaid patients, how they view health reform, and what they plan to do during the rest of their careers.

Here are 24 physician attitudes in response to a survey of 669 physicians in different parts of the country conducted by the Doctor Patient Medical Association, the existence of which I was previously unaware.   Of those surveyed, 81% were in solo or small group practice and 89% were office-based.   The results are not promising for the future of independent small practices.

1.      How do current changes in the medical system affect your desire to practice medicine?

-          Makes me think about quitting, 83%

-          Unsure/no opinion, 15%

-          I’m re-energized, 5%        

2.       How do you assess the overall current path of the medical system in the U.S.?

-          Wrong track, 90%

-          Right track, 4%

-          Unsure, no opinion, 2%

3.       Is it getting easier or more difficulty for you to adhere to a Hippocratic ethic of medicine?

-          More difficult, 61%

-          Samir, 33%

-          Unsure, 4%

-          Easier, 2%

4.      In general, do you think the patient-physician relationship is improving or declining?

--Declining, 85%

- Same, 10%

- Improving, 4%

--Unsure/no opinion, 2%

5.       Do you have more or less autonomy in your practice now than you expected when you started?

-          Less, 89%

-          Same, 6%

-          More 3%

-          Unsure/no opinion, 2%

6.       If you answered LESS to the last question, what are your top three reasons?

      -Government regulations, 88%’

-          Insurance & 3^rd party  contracts, 81%

-          Health care contracts,  60%

-          Fear of lawsuits, 35%

-          Fear of prosecution, licensure, admin; actions, 24%

7.       Who’s most to blame for current problems in medicine?

-Government involvement in general” 65%

- Health plans/insurance, 50%

-Third-party payers, 42%

- Lawyers, 42%

- President, 27%

-Congress, 26%

- Medicare/Medicaid, 15%

- Doctors, medical professionals 12%

- Hospitals, 7%

 - Patients, 7%

8.      Who is most likely to improve problems in medicine?

-          Doctors/medical professionals, 80%

-          Patients, 64%

-          Congress, 30%

-          Government involvement in general, 18%

-          Hospitals, 16%

-          President, 16%

-          Health  plans/insurance, 15%

-          Third-part payers, 9%

-          Lawyers, 4%

-          Medicare/Medicaid, 2%         

9.       Will pay-for-performance improve quality of care?

-          No, 65%

-          Unsure/no opinion, 14%

-          Slightly,12%

-          Yes, 9%

10.   Will pay-for-performance reduce overall costs?

-          No, 70%

-          Unsure/No opinion 15%

-          Yes, 8%

-          Slightly, 7%

11.   How would quality of care be affected by expanding scope of practice for nurses?

-          Worse, 45%

-          Greatly worsen, 19%

-          Improve, 13%

-          No effect, 11%

-          Unsure/no opinion, 11%

-          Greatly improve, 2%-           

12.  Are you planning to join an ACO (Accountable Care Organization) in the next 3 to 5 years?

    -          No, 48%

         -Only if I am required, 26%

-Unsure/no opinion, 13%

- Giving consideration, 10%

- Yes, great idea, 3%

13.   How will you respond to lower Medicare/Medicaid payments?

-          Stop taking new Medicaid patients, 4(%

-          Stop taking new Medicare patients, 42%

-          Stop practice medicine or retire, 33%

-Opt out of Medicare completlel1, 31%

-Restrict services to current Medicare, 27%

-Seek employment with hospital, 15%

- Seek a partnership/affiliation, 10%

- Increase patient load, 10%

- Unsure/not applicable, 10%

- No changes, 9% 

14.   I would be willing, or prefer, to treat some Medicaid, Medicare patients for free rather than file a claim?

– No, 39%

-Yes, 35%

- Maybe, 17%

- Unsure/No opinion, 9% 

15.  Do your third-party contracts restrict your ability to post or disclose prices?

-          Unsure/no opinion, 37%

-          Yes, 28%

-          No, 23%

-          Somewhat, 12% 

16.  Do you support more price transparency by posting prices in your office?

-          Yes, 41%

-          No, 27%

-          Probably, 18%

-          Unsure/No opinion, 15%

-           

17.   How do electronic health records medical privacy and confidentiality?

-          Compromise, 67%

-          No effect, 16%

-          Unsure/no opinion, 10%

-          Improve, 8%

    

19.  Are you hesitant to voice your opinion about health care politics, policy or legislation because of traction from your patients, colleagues, or administrators?

           – Not at all, 62%

-          Very hesitant, 10%

-          no opinion, 2%

20. Which of the following most accurately reflects your current financial situation?

-          In the black, just sneaking by, 37%

-          In the black, 33%

-          Breaking even, 12%

-          In the red, 10%

-          Black, end & and I can’t continue like this 5%

-          Unsure/no opinion, 3%

21.   What do you anticipate for your financial situation in the next 5 years?

-          Worse, 37%

-          Same, 18%

-          I plan  to retire in 5 years, 15%

-          Greatly  worsen, 12%

-          Improve. 11, %

-          Unsure/no opinion, 4%

-          Greatly improve, 2%

21.  Will requiring individuals to purchase insurance result in improved access to actual medical care?

-          No, 48%

-          Unlikely 23%

-          Maybe, 13%

-          Yes, 12%

-          Unsure, no opinion

     

22.  In general, should private self-pay individuals pay the same prices as third-party contracts?

-          Same, 43%

-          Lower, 32%

-          Higher, 13%

-          Unsure/no opinion, 12%

          

23.   Would you be willing to charge your private self-pay patient’s s less than third-party payers?

-          Yes.  46%

-          No, 29(

-          Maybe 18%

-          Unsure/no opinion, 5%

-          My group/employers won’t allow, 2%

24.   Is medicine too controlled by large corporations or systems at the expense of independent practice?

-          Yes, 95%

-          Unsure/no opinion, 3%

-          No, 2%

Tweet:  A survey of 669 doctors reveals almost unanimous opinion that medicine is on wrong track and overwhelmingly blames government.