Primary Care Practice – The State of Affairs

For the last five years or so, the argument has been advanced in many quarters that primary care – family practice, general internal medicine, and pediatrics – is on the verge of collapse because of low morale, low reimbursement, high overhead, low incomes, and low job satisfaction.


What follows are facts gathered by Merritt, Hawkins, and Associates (MHA) - for full survey results, see www.merritthawkins.com.


MHA conducted the survey for Physician Practice, a practice management publication with a readership of 300,000. MHA sent the survey to a random sample of 10,000 physicians – 4000 FP, 4000 IM, and 2000 pediatricians. The response rate was 44.1% FP, 32.3% IM, and 23.5% Peds. Because of space limitations, I have not, in general, split the responses by specialty. You can find that information at the MHA website. No all figures add up to 100% because of rounding. As you scan the income statistics, keep in mind Christmas bonuses on Wall Street this year averaged more than $1 million, senior partners in large law firms pulled down an average of $1.2 million, CEOs of the nation’s health plans earned a mean income of $10 million, and medical specialists rarely make over $1 million.

1. Years in practice -- 0-5 years, 14.5%, 6-10 years, 19.7% , 11-15 years, 21.2%, 16-20 years, 19.1%, 21+ years, 25.5%, No Answer, 0.6%

2. Type of practice – solo, 30.3%, two physicians, 9.4%, three of more, 60.3%

3. Busyness of practice – too busy, 34.6%, not busy enough, 16.9%, as busy as I want, 48.3%

4. Net income – excellent 8.7%, appropriate, 32.8%, disappointing, 58.5%, No Answer, 0.8%

5. Net income ($ in thousands) – 300 or greater, 9.5%, 275 to 300, 3.6%, 250-275, 2.2%, 225-250, 3.9%, 200-225, 5.5%, 175-200, 9.3%, 150-175, 11.4%, 125-150, 15.0%, 100-125, 17.8%, 0-100, 15.4%, No Answer, 5.5%

6. Net Income by specialty ($ in thousands)

0-100, FP, 18,2%, IM, 13,3%, Ped, 25.6%

100-125, FP, 13.5%, IM 11,4%, Ped, 12.8%

125-150, FP, 18.9%, IM, 20.0%, Ped, 6.4%

150-175, FP, 14.2%, IM, 17.1%, Ped, 7.7%

175-200, FP, 8.1%, IM, 11.4%, Ped, 8.8%

200-225, FP, 2.7%, IM, 4.8%, Ped, 12,8%

225-250, FP, 4.2%, IM, 4.8%, Ped, 5.2%

250-275, FP, 4.7%, IM, 1.9%, Ped, 3.,8%

275-300, FP, 4.7%, IM, 0.0%, Ped, 1.4%

> 300 FP, 10.8%, IM 15,3%, Ped, 15.5%


7. Overhead as % of income - 0-10%, 5.8%. 11-20%, 3.4%, 21-30%, 3.4%%, 31-40%, 9.2%, 41-50, 16.1%, 51-60%, 27.4%, 61-70%, 22.9%, 71-80%, 5.2%, 81-90%, 1.4%, 90-100%, 3.8%

8. Your overhead – able to support, 31.5%, not able to support, 13.6%, doubtful to support, 22.2%, hopeful to support, 32.7%, No Answer, 12.0%

9. Your socioeconomic status - lower middle class, 4.4%, middle class, 29.7%, upper middle class, 59.5%, upper class, 6.4%, No Answer 0.0%,

10. Your status in medical hierarchy – top dogs, 0.1%, equal partners 14.7%, junior partners, N.A., 2nd class, N.A..

11. Job market in five years – more robust, 31.2%, less robust, 35.0%, same, 33.8%

12. Severe shortage in five years – GP, 79.2%, IM, 67.5%, Ped, 58.0%

13. Primary care will eventually disappear – FP, 17.5%, IM, 15.9%, Ped 3.7%

14. Primary care destined to be taken over by PAs and NPs - FP, 27.3%, IM, 33.6%, Ped, 27.1%

15. Continue to pay vital role – FP, 39.0%, IM, 38.1%, Ped, 48.1%

16. Career satisfaction – very satisfied, 18.3%, somewhat satisfied, 43.0%, somewhat dissatisfied, 25.5%, very dissatisfied, 13.2%

17. If you had to do over – stay in primary care, 39.5%, become surgical/diagnostic sub-specialist, 38.7%, would not choose medical career, 21.8%

18. If you had financial resources – would retire today,44.7%, would maintain practice for a few more years, 55.3%

19. What reforms will happen – single payer, 36.5%, no major reform, 2.4%, market-driven, 68.4%

Summary

Primary care physicians will be in demand, most are ambivalent about their careers, most would not choose to become primary care physicians if given a choice, and most would prefer a market-driven system.