The survey, A Survey of America's Physicians: Practice Patterns and Perspectives, was commissioned by The Physicians Foundation. It is the latest, and perhaps the largest and most comprehensive of a number of surveys that have identified wide, deep and increasing discontent among the nation's physicians regardless of their age, gender, specialty, location, or employment status.
"It is downbeat and it is a concern. What we are documenting here is a trend and the trend is pretty solid," Walker Ray, MD, vice president of the nonprofit foundation, told HealthLeaders Media.
"Physicians feel powerless. They don't feel like their voices are being heard. They don't feel like they were heard on the run up to healthcare reform and they don't feel like they're being heard now."
Physicians report working about 6% less than they did in a 2008 foundation survey. "That doesn't sound like a whole lot until you calculate the full-time equivalent physicians who are lost from the workforce," Walker says.
"If this trend continues that would be 44,250 full-time equivalents lost from the physician workforce over the next four years and there is every reason to think that this will occur."
The survey shows that 52% of physicians have already limited the access of Medicare patients to their practices or are planning to do so and 26% have already closed their practices to Medicaid patients, blaming higher operating costs, time pressures and falling reimbursements.
"Physicians think of themselves as being autonomous in making decisions in the patient's best interest, but employed physicians have to have one ear open to what their employer is saying. Otherwise they put their jobs in jeopardy," he says.
Most physicians just want out.
"We found that 60% said they would retire today if given the opportunity. What was worrisome is that this is up from 45% in 2008," Walker says. "We also know from the survey that we disaggregated it into certain categories, 47% of physicians under 40 said they would retire today if given the opportunity."
The online survey was conducted from late March to early June by Merritt Hawkins with an overall margin of error of less than 1%. Phil Miller, vice president of communications at Merritt Hawkins, says physicians are caught amid crosscurrents in healthcare delivery and it's proven challenging to find incentives that work for everyone.
"We have a doctor shortage, so we want doctors to stay busy and be productive and see a lot of patients. But you are rewarding them with a salary which they know they are going to get regardless of how many patients they see. So you try to build in incentives that will keep them focused on volume," Miller says.
Walker says the issues that zap physicians' enthusiasm run deep. "We have to improve the medical practice environment and the things physicians are most concerned about are autonomy, regulatory issues, liability issues, and reimbursements," he says. "We've got to fix some of those things to keep the workforce together because we not only want to train more physicians, we want to retain more in their practices and that is not happening now."