Thursday, September 27, 2012

Physician Morale at All Time Low
September 27, 2012 -  This article is from, a respected website directed mostly at hospital leaders, but at leaders of other health sector leaders as well. If the material sounds familiar,  it may because you read my September 24 post , which was also based on an interview with Walker Ray, MD, health of the research committee for the Physicians Foundation.

6 in 10 Physicians Would Quit Today

John Commins, for HealthLeaders Media, September 26, 2012

Doctors are working less, seeing fewer patients, and many would quit if they could, a sweeping survey of 13,575 physicians from across the nation shows.

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."
"The problem to summarize it is there is an imparative now for physicians to care for more patients, to provide higher perceived quality at less cost with increased tracking and reporting demands in an environment of high liability and problematic reimbursements," he says.

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.

One hundred thousand physicians will transition to employees over the next four years, and more than 50% of physicians will cut back on patients seen, will switch to part-time, switch to concierge medicine, retire, or take other steps that will result in about 91 million fewer patient encounters, the survey shows.

Walker says that 75% of physicians don't believe that the migration to employment is a positive trend. That includes 62% of employed physicians who consider it a negative. Those physicians who are opting for employment are doing so, he says, for economic security and relief from "an extreme regulatory environment."

"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."

Walker acknowledges that some physicians could be speaking out of frustration and that they do not intend to leave practice. "But even if only a small percentage follow through on any of that it could be worrisome to the workforce," he says.

"We have 75 million Baby Boomers transitioning to Medicare starting last year over the next 12 or so years. We have a growing population. We have 32 million people who may be gaining health insurance and yet we have the same number of doctors. We have a bottle neck for training. We are training 25,000 or so doctors a year and the fact that we are finally building some new medical schools is not going to increase the doctor supply because the residency level is fixed at 25,000 or 26,000 positions."

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.

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.

"At the same time, you have this crosscurrent that says 'let's not reward them for volume. Let's reward them for quality and patient satisfaction and these subjective metrics.' So we have two trends working at cross purposes and at the end of the day the doctors are going to take the salary. They may achieve some of their production bonuses, but it is going to be more of a nine-to-five, do-your-job-and-go-home-type of profession," 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."

John Commins is an editor with HealthLeaders Media.

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