New report warns of 'silent exodus' of physicians

If you believe you are working fewer hours and seeing fewer patients than 4 years ago, you have company. Physicians increasingly are pessimistic about the course the practice of medicine is taking-so pessimistic, in fact, that more than half of the doctors polled recently said they would not recommend that others enter their field, and one-third said they would not become doctors again if they were given the chance to start their careers over.

At this rate, the equivalent of more than 44,000 full-time physicians could be lost from the workforce over the next 4 years, concludes a new study, “A Survey of America’s Physicians,” conducted by physician search and consulting firm Merritt Hawkins at the request of The Physicians Foundation.

“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,” says Walker Ray, MD, vice president of the foundation and chairman of its research committee. “Combine this with changes in practice patterns that reduce the number of hours physicians spend seeing patients and the situation is truly alarming. These practice changes amount to a silent exodus of physicians from the workforce. 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.”

The study collected data from nearly 14,000 doctors-35% in primary care practice and 65% in surgical or specialty practice. Roughly half were employed by a group or hospital, and the other half were practice owners, partners, or associates. The majority of respondents were males aged 50 to 69 years.

Aimed at providing a “snapshot” of the physicians’ view of multiple facets of the healthcare industry, the study reveals that the majority of doctors (84%) believe the medical profession is in a state of decline, and more than three-fourths of those polled are pessimistic about the future of the medical profession. They are seeing 16.6% less patients than 4 years ago and spending more than 22% of their time on non-clinical paperwork, according to the study. Not every demographic within the study felt the same-younger doctors, female physicians, and primary care physicians generally were more positive about the profession than older doctors, male physicians, practice owners, and specialists. But the study still reveals some key trends to consider as healthcare reform moves forward.

Whereas patient relationships were ranked as the aspect that physicians like most about practicing medicine, practicing defensive medicine, dealing with Medicare and government regulations, and reimbursement issues all were listed as the profession’s biggest pitfalls. More than 52% of physicians already have limited access to Medicare patients or plan to do so, and another 50% say they plan to cut back on patients, work part-time, switch to concierge medicine, retire or otherwise reduce patient access to their services over the next one to three years, according to the study.

“The level of pessimism among America’s physicians is very troubling,” says Lou Goodman, PhD, president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “More than 84% of physicians feel that the medical profession is in decline, and nearly 58% 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.”

Roughly 60% of surveyed physicians say the passage of the Affordable Care Act for the drop in their positivity, with 82% now believing that doctors have little ability to change the healthcare system. Few polled physicians said they believed that accountable care organizations would help solve healthcare cost problems-although primary care physicians were among the most optimistic-and respondents were divided over the efficacy of medical homes. On other healthcare reform topics, nearly half of those surveyed say electronic health records pose a risk to patient privacy, and 62% estimated they already provide $25,000 or more each year of uncompensated care.

The survey also suggests that doctors believe defensive medicine drives cost more than fee-for-service reimbursement, which is often to blame for rising healthcare costs. Only 12.5% of physicians indicated that fee-for-service medicine, which pays physicians based on volume of services provided, is a major healthcare cost driver, and 3.8% of those surveyed rated “physician fees” as a major driver of healthcare costs.

The survey was conducted by email from late March to early June by Merritt Hawkins for The Physicians Foundation and included 48 separate questions with multiple responses possible on some questions. The Physicians Foundation is a nonprofit 501(c)(3) organization that has stated goals of advancing the work of practicing physicians and helping to facilitate the delivery of healthcare to patients.

Look for the results of Medical Economics' 2012 Exclusive Physician Productivity Survey in the October 25, 2012, issue of Medical Economics.

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