"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."