What's the biggest source of job dissatisfaction for primary care physicians?

Doctors as a group are pessimistic about the future of their profession-worrying about clinical autonomy and income-but primary care physicians are the least satisfied in their work when compared with their specialist peers, according to a new report.

Doctors as a group are pessimistic about the future of their profession-worrying about clinical autonomy and income-but primary care physicians (PCPs) are the least satisfied in their work when compared with their specialist peers, according to a new report.

Nearly 60% of PCPs are satisfied with practicing medicine, compared with 63% of surgical specialists and 67% of non-surgical specialists. Younger physicians-aged 25 to 39 years-and those with 10 or fewer years of experience also were more satisfied than their older counterparts, according to the 2013 Survey of U.S. Physicians from the Deloitte Center for Health Solutions.

Patient relationships offer the most important element of physician job satisfaction, along with protecting and promoting health and intellectual stimulation. Solo and small group practice physicians, as well as female physicians, place the most importance on patient relationships, according to the third annual survey from Deloitte.

For PCPs, the biggest source of job dissatisfaction was less time for each patient, whereas surgical specialists cited longer hours and work weeks. Other physicians who say they are not satisfied with practicing medicine place the blame on dealing with government regulations like Medicare and Medicaid.

Six out of 10 physicians say they believe many in the profession will retire earlier than they planned-in the next 1 to 3 years. This trend may be attributed to the fact that 57% of doctors polled say the practice of medicine is in jeopardy, and roughly three-fourths believe that the best and brightest individuals won’t pursue careers in medicine in the future.

Eight in 10 physicians polled agree that the changes facing the profession over the next decade will lead to more interdisciplinary teams and care coordinators. Larger medical groups, health systems, and hospitals will outnumber solo practices because larger practices will offer the perception of greater security and financial success, the report notes. Clinical autonomy will remain a primary benefit in solo practices.

Nearly half of the doctors say their take-home pay dropped from 2011 to 2012-with more than half reporting a decrease of 10% or less-and about 40% of those physicians that reported decreases say the Affordable Care Act (ACA) is to blame. In Deloitte’s 2011 survey, 48% of physicians believed that their income would drop in 2012 because of the ACA. In this survey, another half reported that they believed incomes will fall more dramatically over the next 1 to 3 years, with solo and small group physicians expecting their incomes to drop the most.

In addition to pessimism about their profession, doctors also report doubts about healthcare reforms. Only 26% say they believe the sustainable growth rate will be repealed within the next 3 years, and, nine in 10 cite concerns about receiving adequate reimbursement under bundled payment models and being penalized for factors beyond their control.

PCPs are more likely than specialists to participate gain-sharing or incentives programs, and younger physicians are more likely to have faith in healthcare reform efforts. The study reports that many physicians believe the U.S. healthcare system is “flawed and underperforming” and think some elements of the ACA can help address these problems. Forty-four percent-the same number as in 2011-say the ACA is a good start at healthcare reform, but there was a 6% jump in this year’s poll in the number of physicians who believe the ACA is a step in the wrong direction.

Only 20% of those polled believe health insurance exchanges actually will be up and running by the 2013 deadline set by the ACA, and eight in 10 think midlevel providers will play a bigger role in direct primary care delivery and that insurers will aggressively negotiate to preserve margins.

Nearly all the doctors surveyed-90%-say they don’t think that Medicaid reimbursements will rise to match Medicare rates for primary care services within the next 3 years. If Medicare lowered payments or switched to vouchers, physicians would react, according to the poll, with a fourth of physicians saying they would place new or additional limits on Medicare acceptance. Increased practice consolidation also is anticipated, with 31% reporting consolidating their practice or considering it in the past 2 years.

The survey was completed by a random sampling of 613 primary care and specialist physicians selected from the American Medical Association's master file of physicians.

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