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Physicians: Turning the Corner

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The worst economic downturn in decades seems to have bottomed out, and the coming year promises greater growth and an easier financial climate. At least, that's how physician leaders see it according to the results from the HealthLeaders Media Industry Survey 2010.

More than 60% of physician respondents expect their practices to be "in the black" this year, suggesting a newfound confidence about the healthcare economy. When physicians were asked the same question in September 2008, just as the stock market crashed and exacerbated the recession, only 43% were expecting positive growth and about 45% predicted their practice's bottom line would remain essentially flat.

The pessimism about 2009 proved prescient, as nearly 80% of physician leaders said the recession weakened their organization's financial position, and more than 70% said it has negatively affected morale.

Physician leaders' revived optimism about the business of healthcare is tempered by uncertainty about the future of the healthcare system, particularly when it comes to reimbursement and finances. Overall, respondents had mixed feelings about healthcare reform efforts. The components of reform that were well-received were enacted early last year. The majority of physicians view funding for electronic health record adoption and comparative effectiveness research—both components of the American Recovery and Reinvestment Act passed in February 2009—either neutrally or positively.

Roughly one-third said the stimulus package overall will have a positive effect on their organization, and about half viewed its effects as neutral. About 40% of respondents expect to be ready to receive to receive HITECH funds when first eligible in 2011, and only about 10% expect they won't participate in the program at all, either because physicians aren't on board or because adoption is still too expensive.

Other hot-button reform issues—including the public option, bundled payments, and the prospect of a Medicare payment commission—generated more negative feedback. Contrary to other physician surveys that showed widespread support for a public insurance option, 46% of respondents to our physician leaders survey had a negative view of the public plan, and 38% viewed it favorably.

Perhaps the negativity about reform proposals stems from dissatisfaction about the way the reform process has been handled. Fifty-eight percent of our respondents disapprove of how President Barack Obama has handled reform efforts, and disapproval rates for both parties in Congress are around 70%. Drug and device makers had the worst marks, with roughly 80% disapproval, but no one—not even physicians and the public—received net approval. By a slim margin of just one respondent, the majority of physician leaders disapproved of how physician industry leadership has handled the reform debate.

The discontent may be caused by confusing and conflicting information about reform and about where physicians stand on the issue, according to Erin Tracy, MD, MPH, an OB/GYN at Boston's Massachusetts General Hospital. Rifts between the American Medial Association and other groups have made physician unity elusive. "I hope while legislators work this out, physicians will be engaged in the process," she says.

Interestingly, during this time of profound and rapid change for the healthcare industry, our results suggest that physician-owned organizations may be faring better than their counterparts that are owned by hospitals or health systems. Physician-owned practices were less likely to say the recession had weakened their organization financially by a margin of about 10 percentage points. They were also more likely to be ready to receive stimulus funding in 2011. Nearly half of physician-owned practices (48%) expect to receive funds for meaningful use of an EHR system in 2011, compared to only about 35% of practices owned by hospitals and health systems.

Elyas Bakhtiari

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