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Physicians Inch Toward Boiling Point

 |  By jcantlupe@healthleadersmedia.com  
   October 04, 2012

So, six out of 10 of you docs want to quit. Turn out the lights. Lock the door. Goodbye.

Walker Ray, MD, remembers his feelings when he shut down his Georgia pediatric practice, for good, after 35 years, and why he had to leave it behind: The 60-hour work weeks. The rolling tide of reduced reimbursements. The missed family gatherings, "the ballet recitals, the swim meets, even the funerals." Then the questions from his kids: "Dad, how long are you going to keep doing this?"

"You look in the mirror…" Ray told me, recalling that moment of self-realization. "I packed it in." 

Ray blames an oppressive regulatory and business climate. "At first, I thought it was only me having this problem. It wasn't," he says. Now, Ray takes doctors' pulse, trying to gauge their feelings about their practices.

Their professional heart rates are elevated. It seems they are feeling the same way he did.  Now, Ray is vice president of the Physicians Foundation, which commissioned an extensive survey of nearly 13,575 physicians. The result? Six out of 10 want out. Meritt Hawkins, the physician search and consulting firm, conducted the survey.

The survey found that 60% of physicians would retire today, if given the opportunity—an increase from 45% in 2008. And it's not just disgruntled and tired Baby Boomers who want to abandon their healing work. At least 47% of physicians under 40 also said they would retire today, if given the opportunity.

The numbers tell the story: Physicians in droves want to leave their practices. We keep hearing that. Now what are we doing about it? 

The key is to start by focusing on the major problem areas. Ray says the survey points to two specific issues above all others–malpractice concerns, and the lack of a cohesive voice among all physician groups.

Defensive Medicine
The survey is certainly the latest, and—by sheer numbers—one of the more telling reports on physician attitudes about defensive medicine and malpractice concerns. It also reveals what doctors see as a major cost driver of healthcare.

When asked what two factors "do you find least satisfying about the medical practice," 40.3% said it was "liability/defensive medicine pressures." Other reasons lagged much further behind. Other "least satisfying" aspects included dealing with Medicare/Medicaid/government regulations (27.4%) and  reimbursement issues (27.3%).

In the meantime, 69.1% of physicians said defensive medicine is the "number one ranked factor" driving up healthcare costs. The survey described the ordering of tests, prescribing of drugs, and conducting of procedures done "partly or solely to drive a wedge against potential malpractice lawsuits." 

Defensive medicine costs approximately $45.6 billion a year in the U.S., according to The Physicians Foundation survey.

"Physicians understand to some degree that's the cost of doing business, but the defensive medicine goes deeper than that, in the ordering of extra tests, doing the extra procedures, and extra scans to protect [oneself]  against a malpractice suit. It's that four-legged stool, the liability that [prompts] defensive medicine."

The survey notes that while many policy makers, academics, and others identify fee-for-service reimbursement as a key driver of health care costs, physicians believe that "defensive medicine is a far more important cost driver."

"Medical malpractice lawsuits, a rarity prior to the era of medical specialization, now are common, adding an additional layer of paperwork, expense, and stress in virtually every physician's work day," the report adds.

While states have enacted tort reform, it has been sporadic nationwide, with no clear national focus, Ray says. "Individual states have taken their own strides," Ray says. "Some states have never gotten tort reform going."

Medical malpractice goes to the heart of overspending in American healthcare, yet has not been fully addressed either by states, the federal government, or in healthcare reform, Ray says.  "It is ironic that part of the Patient Protection and Affordable Care Act was to bend the cost curve, to prevent unnecessary testing," he says.

"Why do many physicians move ahead with all those unnecessary procedures? Because of the fear of malpractice. And one of the things that stood out in the PPACA was its failure to address tort reform. It's really ironic to physicians what's going on."

Lack of a Cohesive Voice
Another major problem for physicians, as Ray sees it, is that they are not represented by a forceful organization.  "There is a systematic, endemic series of problems," Ray says. "Everywhere there [are]  defensive medicine, regulation issues, reimbursement issues. We are all in the same boat. But physician representation is balkanized. There is not a national organization that represents a majority of physicians."

One of the largest organizations, the American Medical Association (AMA), only represents 15% of physicians, according to the Physician Foundation report. That's in sharp contrast to the early 1950s, when about 75% of physicians were members of the AMA.

A coalition of state medical societies has coalesced, and groups of activist physicians have formed organizations, Ray says, but that hasn't been nearly enough to prompt change. "It's pretty hard to counter the full force of the federal government and the huge insurance companies," he says.

No wonder the survey finds that physicians are "at a tipping point" as they seek ways to "further disengage from today's medical practice environment, reducing their hours, decreasing the number of patients they see and accepting the status of salaried employees–trends that should be of urgent concern to both policy makers and the public."

Ray can relate, and if this report is a bellwether, soon others will recognize the ramifications, too.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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