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/

[Taco John]

Going to be interesting to see how this works out as more physicians limit their hours at the same time that they system is flooded with every sniffle and sore.

[La literatura]

Originally Posted by Taco John

Going to be interesting to see how this works out as more physicians limit their hours at the same time that they system is flooded with every sniffle and sore.

What does your understanding of economics tell you about what happens when the demand for something rises?

[Taco John]

Originally Posted by La literatura

What does your understanding of economics tell you about what happens when the demand for something rises?

You understand that demand interacts with supply, no? Your question doesn't seem to understand that. To answer the question, that would depend on the supply and the supplier. In this case it appears that as demand is increasing, supply is decreasing - which means higher prices.

Personally, I think we'll get to a place where we see more doctors refusing to accept insurance and dealing with patients on a cash only basis.

At this point, I expect the government to move to "increase supply" in order to control costs and meet the needs of the market. What happens after that depends on how the physicians react.

[tooge]

Originally Posted by Taco John

You understand that demand interacts with supply, no? Your question doesn't seem to understand that. To answer the question, that would depend on the supply and the supplier. In this case it appears that as demand is increasing, supply is decreasing - which means higher prices.

Personally, I think we'll get to a place where we see more doctors refusing to accept insurance and dealing with patients on a cash only basis.

At this point, I expect the government to move to "increase supply" in order to control costs and meet the needs of the market. What happens after that depends on how the physicians react.

The wrench in your supply and demand theory as it relates to medicine is that there is a third party involved that regulates prices allowed by the "supplier" (insurance) and another regulatory influence (government) that effects the cost of business for the supplier (hippa, osha). These factors don't apply to most industries, and the algorhythms that would be required to figure out supply and demand based economies of medicine are impossible.

I wish it were as simple as a doctor charges so much for an office visit, the patient pays it, and everyone is happy due to supply and demand setting the fee for said office visit. Unfortunately, the doctor has to order extra tests because the patient is a smoking fatass with diabetes, and if the doctor doesn't cover every base possible, the insurance won't pay him a cent. On top of that, the patients family will sue the doctor when the patient loses foot due to diabetes from an infection.

Bottom line is this. Despite the fact that many people think the doctor is a wealthy money grabber, the truth is, the doctors are trying to help their patients, but most of them (just look around at people these days) are out of shape, don't eat well, and do things that they know will hurt them. Meanwhile, the amount of money that the insurance pays the doctor to treat these patients has gone down steadily for years.

I get reimbursed less for a crown today than I got in 2002. Imagine if everything else cost less than it did in 2002.

The medical professions are taking it in the shorts, have been for over a decade, and will continue to do so as long as big Pharm and insurance continue to rule the game.

[Cephalic Trauma]

Originally Posted by tooge

The wrench in your supply and demand theory as it relates to medicine is that there is a third party involved that regulates prices allowed by the "supplier" (insurance) and another regulatory influence (government) that effects the cost of business for the supplier (hippa, osha). These factors don't apply to most industries, and the algorhythms that would be required to figure out supply and demand based economies of medicine are impossible.

I wish it were as simple as a doctor charges so much for an office visit, the patient pays it, and everyone is happy due to supply and demand setting the fee for said office visit. Unfortunately, the doctor has to order extra tests because the patient is a smoking fatass with diabetes, and if the doctor doesn't cover every base possible, the insurance won't pay him a cent. On top of that, the patients family will sue the doctor when the patient loses foot due to diabetes from an infection.

Bottom line is this. Despite the fact that many people think the doctor is a wealthy money grabber, the truth is, the doctors are trying to help their patients, but most of them (just look around at people these days) are out of shape, don't eat well, and do things that they know will hurt them. Meanwhile, the amount of money that the insurance pays the doctor to treat these patients has gone down steadily for years.

I get reimbursed less for a crown today than I got in 2002. Imagine if everything else cost less than it did in 2002.

The medical professions are taking it in the shorts, have been for over a decade, and will continue to do so as long as big Pharm and insurance continue to rule the game.

Great post. But they are taking it in the shorts for two main reasons.

One thing I would like to add is one-third of US health care spending is on administration costs of this system.

Second, there is way too much variation by region in how much we pay per medicare enrollee. However, those regions who spend more do not have better outcomes. The weirdest trend is that more spending actually leads to worse outcomes.

[listopencil]

Originally Posted by La literatura

What does your understanding of economics tell you about what happens when the demand for something rises?

What happens when the demand for something rises in an industry that is going through a transition to more and more government involvement and control? Also consider that supply is bottle necked by a substantial certification process, and that the product can not be manufactured.

[Saul Good]

Originally Posted by La literatura

What does your understanding of economics tell you about what happens when the demand for something rises?

Prices increase.

Source: I have a degree in Finance.

[Cephalic Trauma]

Originally Posted by Saul Good

Prices increase.

Source: I have a degree in Finance.

What if compensation is fixed? Or, in this case, decreased?

[Cephalic Trauma]

Dear teachers,

I love you and you made me smart. But there are far too many of you to compensate you fairly, and it sucks.

Edit: I would also like to pledge 50% of my future salary spread evenly to every teacher that 'fed my little brain' from K-12. I am not worthy of the salary that I will "earn" during college, graduate, and residency. I will also wait to pay off my six figure debt in order to pay you for the work you've done.

Thanks,
Cephalic "Forever in Debt" Trauma

[Saul Good]

Originally Posted by Cephalic Trauma

What if compensation is fixed? Or, in this case, decreased?

Then the laws of free market supply/demand no longer apply. Supply will continue to drop while demand increases.

The wealthy will be able to go outside the "system", and the rest will get rationed care.

[BucEyedPea]

Originally Posted by Saul Good

Prices increase.

Source: I have a degree in Finance.

Finance is not economics....but I'm sure you covered economics as part of it.

[patteeu]

Originally Posted by La literatura

What does your understanding of economics tell you about what happens when the demand for something rises?

Prices go up?

[La literatura]

Originally Posted by patteeu

Prices go up?

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.

[patteeu]

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.

If we didn't already have a short supply (relative to the demand created by our third party payment system), we wouldn't have the high prices we already have. Where is this extra supply going to rush in from?