Medical doctors are largely overwhelmed by their work and disengaged from key healthcare reform measures such as value-based payments, accountable care organizations, and electronic health records, survey data shows.
Half of physicians are disengaged, burned out, and demoralized and plan to either retire, cut back on work hours, or seek non-clinical roles, according to a new nationwide survey commissioned by The Physicians Foundation.
"Many physicians are dissatisfied with the current state of the medical practice environment and they are opting out of traditional patient care roles," said Walker Ray, MD, president of The Physicians Foundation, in remarks accompanying the survey.
"The implications of evolving physician practice patterns for both patient access and the implementation of healthcare reform are profound."
The majority of the 17,236 physicians surveyed (54%) describe their morale as somewhat or very negative, 63% are pessimistic about the future of the medical profession, 49% always or often experience feelings of burn-out, and 49% would not recommend medicine as a career to their children, according to the survey.
Physicians identified regulatory/paperwork burdens and loss of clinical autonomy as their primary sources of dissatisfaction. They spend 21% of their time on non-clinical paper work duties, according to the survey, while only 14% said they have the time they need to provide the highest standards of care. About two-thirds (72%) said third-party intrusions detract from the quality of care.
In response to regulatory burdens and other concerns, physicians are seeking alternatives to traditional, full-time private practice.
The survey indicates that only 33% of physicians now identify as private practice owners, down from 49% in 2012, while 58% identify as employees, up from 44% in 2012.
A growing number of physicians (13.5%) said they will seek non-clinical, administrative jobs, 21% will cut back on hours worked, 11.5% will take temporary (locum tenens) positions, 10% will switch to part-time practice, 14% will retire, and 9% said they will switch to concierge medicine.
Docs Drop Out
Physicians also signaled that they're disengaged from key initiatives of healthcare reform. Only 43% said their compensation is tied to value. Of these, the majority (77%) have 20% or less of their compensation tied to value. Only 20% are familiar with the Medicare Access and CHIP Reauthorization Act (MACRA) which will greatly accelerate value-based payments to physicians.
While 36% of physicians participate in accountable care organizations (ACOs), only 11% believe ACOs are likely to enhance quality while decreasing costs. Physicians also are dubious about hospital employment of doctors, another mechanism for achieving healthcare reform.
Two-thirds (66%) do not believe hospital employment will enhance quality of care or decrease costs. Even 50% of physicians who are themselves employed by hospitals, do not see hospital employment as a positive trend.
Though the great majority of physicians have adopted electronic health records, only 25% said EHR has improved efficiency in their practices while 54% said EHR has detracted from efficiency.
"Clearly, more physician participation in and acceptance of the key levers of healthcare reform will be needed for a true transformation of the healthcare system from volume to value," Ray said.
Additional survey findings include:
- 80% of physicians are overextended or are at capacity, with no time to see additional patients
- 48% of physicians said their time with patients is always or often limited
- Employed physicians see 19% fewer patients than practice owners
- 46.8% of physicians plan to accelerate their retirement plans
- 20% of physicians practice in groups of 101 doctors or more, up from 12% in 2012
- Only 17% of physicians are in solo practice, down from 25% in 2012
- 27% of physicians do not see Medicare patients, or limit the number they see
- 36% of physicians do not see Medicaid patients, or limit the number they see
- Only 6% of physicians said ICD-10 has increased efficiency in their practices
The survey was conducted by the physician recruiting firm Merritt Hawkins.