Survey: Pysicians reducing their hours/access

[Taco John]

Comprehensive Survey of 13,575 U.S. Physicians Points Toward Substantial Challenges

Research Commissioned by The Physicians Foundation Also Examines Physician Morale and Perspectives on Current / Future State of U.S. Healthcare System

Boston, MA, September 24, 2012— American patients are likely to experience significant and increasing challenges in accessing care if current physician practice patterns trends continue, according to a comprehensive new survey of practicing physicians. One of the largest physician surveys ever undertaken in the U.S., the research was commissioned by The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients.

Physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of significant changes to the medical practice environment, according to the research, titled “A Survey of America’s Physicians: Practice Patterns and Perspectives.” The research estimates that if these patterns continue, 44,250 full-time-equivalent (FTE) physicians will be lost from the workforce in the next four years. The survey also found that over the next one to three years, more than 50 percent of physicians will cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access. In addition, should 100,000 physicians transition from practice-owner to employed status over the next four years (such as working in a hospital setting), the survey indicates that this will lead to 91 million fewer patient encounters.

“It is clear that the introduction of nearly 30 million new patients into the U.S. healthcare system through healthcare reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its Research Committee. “The rate of private practice physicians leaving the medical field, as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients, is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”

More than half of physicians (52 percent) have limited the access of Medicare patients to their practices or are planning to do so, while one out of four physicians (26 percent) have already closed their practices altogether to Medicaid patients, the survey shows. Physicians cited rising operating costs, time constraints and diminishing reimbursement as the primary reasons why they are unable to accept additional Medicare and Medicaid patients.

The survey, fielded online from late March to early June 2012 by Merritt Hawkins for The Physicians Foundation, is based on responses from 13,575 physicians across the U.S. The overall margin of error (MOE) for the entire survey is (μ ± 0.998 percent), which indicates a “low to very low” sampling error for a survey designed to draw opinions and beliefs from a large population. Generally, an overall MOE at 99 percent confidence is considered highly trustworthy at +/- 2 percent or less, and all questions within the survey met this criterion.


Physician Morale

An overwhelming 80 percent of physicians cited “patient relationships” as the No. 1 most satisfying part of their job. Yet the survey also found an overwhelming majority of physicians, 77 percent, are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the healthcare system.

Multiple factors were cited as driving widespread feelings of discontent among the nation’s physicians. “Liability / defensive medicine pressures” (related to potential malpractice lawsuits) was cited first, followed by “Medicare / Medicaid / government regulations,” “reimbursement issues” and “uncertainty / changes of health reform.” These issues and others cited throughout the study tend to distract or interfere with the time physicians spend with their patients, according to survey respondents.

“The level of pessimism among America’s physicians is very troubling,” said Lou Goodman, Ph.D., president of The Physicians Foundation and CEO of the Texas Medical Association. “More than 84 percent of physicians feel that the medical profession is in decline and nearly 58 percent are reluctant to recommend medicine as a career to their children. That means we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine.”

Healthcare Cost Drivers

When asked about the factors driving increases in healthcare costs, “defensive medicine” was cited as the No. 1 cause for 69 percent of physicians, followed by an “aging population” (65 percent). On average, older patients visit physicians three times as often compared to younger patients. Other factors ranked included “cost of pharmaceuticals,” “advances in technology / treatment” and “social conditions.”

Additional survey findings of note include:

• Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now
• More than 62 percent of physicians said Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs, or that any quality / cost gains will not be worth the effort
• Physicians are divided on the efficacy of the “medical homes” concept, and many (37.9 percent) remain uncertain about their structure and purpose
• While close to 70 percent of physicians have implemented electronic medical records (EMR), 47.4 percent have significant concerns that EMR poses a risk to patient privacy

“The 13,000 plus physicians who participated in this landmark survey, which included nearly 8,000 open-ended responses, strongly demonstrates the overwhelming desire of America’s physicians to share their perspectives and concerns about the current state of medicine,” said Tim Norbeck, CEO of The Physicians Foundation. “The accuracy, rigor and sheer scope of this survey should make it an invaluable piece of research to policy makers, healthcare providers, media and other stakeholders that truly want to understand the challenges that face America’s healthcare system.”

http://www.physiciansfoundation.org/...al-challenges/

[patteeu]

Originally Posted by La literatura

I suspect Osteopathic schools and an increased graduate rate of nurses, particularly nurse practitioners.

Perfect. Our young people can rush to take out bigger loans to pay for a more costly education so they can end up stuggling to pay off their debt with lower paying jobs delivering a lesser quality healthcare product. That's an Obama plan if I ever heard one. Wonderful.

[Cephalic Trauma]

Originally Posted by La literatura

I suspect Osteopathic schools and an increased graduate rate of nurses, particularly nurse practitioners.

MD's are not superior to DO's, and this is coming from an MD student. They get compensated the same.

[La literatura]

Originally Posted by Cephalic Trauma

What do insurance companies base their compensation on? Medicare. Company A will pay 300% of medicare, Company B 200%, etc etc. Cut medicare in half, cut compensation for physicians by even more (overhead, cost of procedures stays the same).

How is the accessibility part odd? That is the basis of the ACA. Individuals who didn't have health insurance before have it now.

Are you referring to the fiscal cliff measures related to medicare payouts?

[La literatura]

Originally Posted by patteeu

Perfect. Our young people can rush to take out bigger loans to pay for a more costly education so they can end up stuggling to pay off their debt with lower paying jobs delivering a lesser quality healthcare product. That's an Obama plan if I ever heard one. Wonderful.

No, rather than art history, women's studies, and history, more people graduate with degrees in nursing.

[King_Chief_Fan]

Originally Posted by Cephalic Trauma

You have not made a single valid point since joining the thread.

nor do I intend to.... watching the grown ups talk business is enough for me.

seriously, the part about Dr.'s getting paid less needs more explanation.

I don't know how the medical profession establishes the charges for services which in turn pays for the salaries of their team or themselves not to mention all the other expenses involved.
Or, how the Insurance companies, Medicare, Medicade or Obamacare determines the worth and pays a reduced % accordingly.

I do admire your willingness and your passion to go to the medical field. I wish you luck

[La literatura]

Originally Posted by Cephalic Trauma

MD's are not superior to DO's, and this is coming from an MD student. They get compensated the same.

I'm not saying anything related to the comparative quality, only that historically, state MD boards wanted nothing to do with having DOs around. Like physical therapists and chiropractors today.

[Cephalic Trauma]

Originally Posted by La literatura

Are you referring to the fiscal cliff measures related to medicare payouts?

I'm referring to the way physicians are compensated by third-party payers. It's relative. Cut medicare, third-party insurance companies cut compensation because they base their compensation on medicare.

[Cephalic Trauma]

Originally Posted by La literatura

I'm not saying anything related to the comparative quality, only that historically, state MD boards wanted nothing to do with having DOs around. Like physical therapists and chiropractors today.

No, it's nothing like that. They take the same boards now. MD and DO are essentially synonymous, and for our purposes in this discussion, are pretty much the same. The only difference is their access to competitive specialties.

Physical therapy is evidence-based, the practice of chiropractic "medicine" is based on voodoo. Like homeopaths (gag).

[KILLER_CLOWN]

Note to self: Stay healthy and *hope the govt stays as far out of my business as possible.

* Denotes faith in something never seen nor heard before..ie hopey change.

[Cephalic Trauma]

I'm bowing out. I have a lot of work to do, and not enough time.

But I get the absolute privilege of serving people who don't know the amount of work that I'm putting in to get this degree. Yay!!!

[KILLER_CLOWN]

Originally Posted by Cephalic Trauma

I'm bowing out. I have a lot of work to do, and not enough time.

But I get the absolute privilege of serving people who don't know the amount of work that I'm putting in to get this degree. Yay!!!

Enjoy being in debt for a good long time, it's the American Dream ya know?

[La literatura]

Originally Posted by Cephalic Trauma

No, it's nothing like that. They take the same boards now. MD and DO are essentially synonymous, and for our purposes in this discussion, are pretty much the same. The only difference is their access to competitive specialties.

Physical therapy is evidence-based, the practice of chiropractic "medicine" is based on voodoo. Like homeopaths (gag).

Cmon man! Again, I'm not saying that DOs are like chiropractors. I'm saying that historically, until really very recently, MDs held the monopoly on physician care in states, shutting out osteopathy. Now, of course, we view them all as doctors. But that's now.

[HonestChieffan]

Originally Posted by BucEyedPea

That is the law of supply and demand still working. Just like black markets were a market response to soviet socialism.

There is no such thing as the law of supply and demand. There are two laws. The law of supply and the law of demand.

In the example where price (compensation) is fixed by the government as in reimbursements, the law of supply explains why fewer doctors will continue in the profession or will reduce hours and patient load. In essence as price decreases or is not allowed to rise, supply (doctors/HC professionals) will fall.

What does wrong in classic economic models is that when price is set artificially, the market is no longer allowed to respond with greater supply. Demand will grow and as a result lower quality care will be delivered. It will be slower, longer waits, and reflect the same quality of almost all situations where government is involved.

It is easy to see how a secondary market could develop for those who can afford better care for cash.

[chiefzilla1501]

Originally Posted by La literatura

Possibly. Here's what I'm thinking: Supply rushes in to meet the demand. Yeah, if there's no supply, then prices will go up. If there's no way we can take care of 300 million people, but only 270 million, then there will be a fight. But the United States doesn't have a short supply of human capital and medical brilliance.

Umm... what? America is absolutely short-staffed on doctors, and the attractiveness of getting into the medical profession is going to drop significantly as long as school is a gazillion dollars to afford and overall medical income is dropping like a rock. Doctors will have to work more hours to take care of more people and get reimbursed less. That's what happens when you create a medical system that incentivizes people to go to a doctor because their tummy hurts vs. when you have an actual emergency. They are going to have spend a GINORMOUS amount of cost to just comply with the insane government bureaucratic bullshit. They are going to continue to pay an ungodly amount of malpractice insurance. They are going to have to invest a shitload of their hard-earned money on new electronic records capability. And all the while, they are going to have to provide lesser quality care and be exposed to a lot more liability, because the government is telling them how to treat their patients.

Health care reform is absolutely needed. That means insurance reform. Pricing reform. Better electronic systems. And yes, something has to be done to demand non-insureds or illegal immigrants pick up health insurance. I don't like how they did it, but it has to be done. But reform could have been achieved without the ridiculous micromanagement of doctors. And it scares the shit out of me, because we decided that in order to reform health care, we are going to make our medical field a hell of a lot worse. I want my doctor taking care of me, not some government bureaucrat.

[Brock]

Originally Posted by HonestChieffan

There is no such thing as the law of supply and demand. There are two laws. The law of supply and the law of demand.

Nonsense. There are not only one, but four laws of supply and demand.