Physicians Foundation data shows that 44% of physicians surveyed said they would reduce the number of patients they see to alleviate the demands of the profession.
As the nation adjusts to Medicaid expansion, a graying demographic, and extended health insurance coverage for millions of Americans through the public exchanges, 81% of physicians say they're either overextended or at full capacity, The Physicians Foundation survey shows.
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Joseph Valenti, MD |
While 19% of the 20,088 physicians surveyed said they would take on more patients, 44% said they would reduce the number of patients they see, either by reducing their workload, working part-time, retiring, or transitioning to non-clinical jobs.
"The biggest thing that physicians are concerned about is their ability to spend time with their patients. Eighty percent of them will still say the most important thing is their relationship with the patients," says Joseph Valenti, MD, an OB/GYN practicing in Denton, TX, and a member of The Physician Foundation board.
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"But many say that between entering data and calling for prescriptions permission and trying to avoid Medicare penalties, when is there time to see my patients? The thing we found most impressive about this survey, besides its actual breadth and depth, is that physicians want to spend time with their patients, but there are so many forces keeping them from doing that."
In 2014, the average age of the respondents was 50, versus an average age of 54 in 2012, the last time The Physician Foundation conducted such a survey. In 2014, 33% of the survey respondents were female, versus 26% in 2012.
Along with the changing workforce demographics, the survey verified the profound transitions underway in physician practice settings. In 2014, only 17% of physicians were in solo practice, down from 25% in 2012. In 2014, only 35% of physicians were independent practice owners, down from 49% in 2012 and 62% in 2008.
Fifty-three percent of respondents were employees of a hospital or medical group, up from 44% in 2012 and 38% in 2008. More than two-thirds of employed physicians (68%) said they were concerned about their clinical autonomy.
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"Things are changing that rapidly," Valenti says. "We are seeing a lot more people wanting to go to an employed situation because they are so pessimistic about private practice. There is so much rapid consolidation in healthcare to control referrals and business that physicians are being swept up in that consolidation."
"Certainly they're paid better with better contracts in groups that are larger, whereas a small group such as mine doesn't have the latitude to negotiation contracts. And a lot are becoming more family-oriented. It creates a problem for physician shortages because replacing FTE who used to work 60–70 hours a week with two people who want to work 35–40 hours a week creates a physician shortage for us."
In 2014, 56% of physicians described their morale as somewhat to very negative. However, 44% said they were somewhat or very positive about the current state of the medical profession, compared to 32% in 2012.
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A physician's pessimism or optimism about medicine seems to depend, in part, on generation and gender. Specifically, 54% of physicians ages 45 or younger are optimistic about the state of medicine, versus 30% of physicians ages 46 or older.
Among female physicians, 49% are slightly more optimistic about the current state of medicine than their male counterparts (42%.) Fifty-one percent of employed physicians are optimistic about the current state of the medical profession, compared to 33% of physicians who own their own practice.
Generation and job model appeared to help determine if a physician supports or dislikes the Affordable Care Act. Sixty-three percent of employed physicians ages 45 or younger were more inclined to give the ACA a favorable rating.
The survey also found that:
- 39% of physicians said that they will accelerate retirement plans due to changes in the healthcare system
- 26% of physicians now participate in an Accountable Care Organization, but only 13% believe ACOs will enhance quality and decrease costs
- 50% said implementation of ICD-10 will cause severe administrative problems in their practices
- Physicians spend 20% of their time on non-clinical paperwork
- On average, physicians said 49% of their patients are in Medicare or Medicaid
- 38% either do not see Medicaid patients or limit the number of Medicaid Patients they see
- Physicians work an average of 53 hours per week and see approximately 20 patients per day
The survey commissioned by the Physicians Foundation in 2012 concluded that 6 in 10 Physicians Would Quit Today.
John Commins is the news editor for HealthLeaders.