Is Physician Unhappiness Important, and Are Physicians’Saying They Will  Leave Practice an Idle Threat?

Idle threat,  noun,  deficient threat, empty threat, harmless threat, ineffectual threat, meaningless threat, menacing, mere notice, mere talking, mere warning, only words, subtle intimidation, testing, trial balloon, veiled threat

Burton's Legal Thesaurus, by William C. Burton, 2007

 July 31, 2012 – A July 27 piece by John Commins in Health Leaders Media, opens:

“Blaming low compensation and the hall healthcare reform, 34% of physicians say they plan to leave the practice of medicine over the next decade, according to new National survey.

John Commins,  "Of of Three Doctors Say They Will leave Medicine,' Healthleaders Media, July 27, 2012)

July 31, 2012 -  Is physician unhappiness important?Are physician complaints of low pay and reform hassles justified? Are threats to leave practice just idle threats, or just a form of whining by spoiled doctors accustomed to independence  and high pay?  Are repeated  physician surveys indicating doctors plan to leave  practices simply an ideal threat, designed to win sympathy from patients and voters? Will physicians follow through?   Where can they go and how would they make money commensurate with what they make now?

I’m biased, but I think;

1)       Physician unhappiness is important, especially when you consider doctors spend 11 to 15 years getting where they are, at considerable expense and delaying gratifications.  When the joy of practice is gone,  why continue doing something you have come dislike?

2)      Physician compensation has been flat for a decade with expenses rising 3% to 5% per year.   And on surveys doctors say hassles drive up expenses ever further, and take up to 1/3 of their time.

3)      Are doctor saying they wii leave practice  ideal threats? Maybe not, many have nowhere else to go outside of medicine, and they have those educational debts of up to $250.000 to pay.  But they are abandoning private practice in record numbers, and  hospitals now own about ½ of physician practices.    Add to this to the fact,  that less than ½ of doctors now accept Medicaid patients and about 1/3 now longer take new Medicare patients, and you will realize the threat to leave their current practices is not idle.  It is real, and it is why the physician shortage, now estimated at 62,000 and projected to be 125,000 in ten years, is growing.

4)       Where can they got make money matching what they make now?   They can become medical directors, administrators, or leaders of health care organizations?  They can into medical related enterprises – such a pharmaceutical companies, medical device firms, or health care finance and management companies?  They can become entrepreneurs, creating start-ups, backed by venture capitalists and others. They drop out of practices  paid by 3^rd parties, including Medicare and Medicaid, and form direct pay or concierge practices.

Let me conclude with a few details from the latest physician survey to put some meat on the bones. Jackson Heathcare, an Atlanta-base recruiting form, surveyed 2,218 phyicians – 16% said they will, or are strongly considering leaving practice in 2012, and 34% said they would be gone by 2022.  Of those saying they would leave in 2012, 55% were under 55 years of age. They said they were not retiring,  They were quitting. Among the entire sample,   56% cited economic reasons for departing medicine, 51% complained of health reform.

Specialists most inclined to leave were: oncologists and hematologists, 57%. otolaryngologists 49%, general surgeons 49%, cardiologists 45%, and urologists 42%.  Why  no primary care groups – family physicians, generalist internists, and pediatricians – on the list?

 I do not know.  Perhaps it is because primary care physicians could not afford to leave, perhaps it is  because the health law promises a 10% rise in primary care pay; perhaps it was because Obamacare is in the process of cutting specialist pay by 30% to 40%.

Tweet:  A doctor survey indicates 16% say they will leave medicine this year, 34% by 2022 because of low pay,  practice hassles, and health reform.