Saturday, January 12, 2008

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.

1 comment:

Unknown said...

Those numbers actually look better than I thought they would. Income is dramatically better than I expected, although there were obviously problem areas. I'm not sure I believe the overhead estimates. As far as job satisfaction, I bet you get an identical response from many different jobs. That was actually the area tha surprised me the most. Maybe selection bias in the respondents who took the time to answer?