CANADA: Doctors feeling adrift as sea change sweeps US medicine

American physicians say they are under pressure to do more, faster, with government and insurance companies looking over their shoulder.
By: Canadian Medical Association (CMAJ)
April 16, 2013 | You’d think this would be a fine time to practise medicine in the United States.A steady march to universal health insurance is about to bring some 30 million uncovered Americans in from the health care cold. The government is backing a battery of medical reforms with money that is scarce elsewhere in the federal budget. And science has opened opportunities for healing barely imagined a decade ago.So why all the grumbling?

An ambitious survey of physicians has found discontent at almost every turn.

Doctors see their clinical autonomy eroding, their regulatory and liability responsibilities rising and pressure intensifying to do more, faster, with government and insurance companies looking over their shoulder. Nonclinical paperwork consumes the equivalent of one of every five workdays and constitutes their leading beef with the state of the profession ( Foundation_2012_Biennial_Survey.pdf).

Altogether, more than half of the 13 575 doctors who participated in the Physicians Foundation survey said they plan to cut back on seeing patients, work part-time, switch to cash-based concierge medicine, retire or take other steps that would reduce patient access to their services in the next one to three years.

“It pretty much adds up to burnout,” says Phillip Miller, vice president of corporate communications for Merritt Hawkins in Irving, Texas. The firm, which conducted the foundation’s study, is part of AMN Healthcare, the largest medical care staffing organization in the country.

The study provides snapshots of a profession in flux, as more doctors flee private practice to work for hospitals or physician organizations and President Barack Obama’s health care law begins to take hold.

One clear trend is the decline of the solo practitioner, once the mainstay of American medicine.

Another, says the study, is that physicians are seeking ways to disengage from today’s medical practice environment, which “should be of urgent concern to both policy makers and the public.”

Among findings:

  • Physicians are seeing nearly 17% fewer patients each day than in 2008.
  • More than 62% of physicians estimate they provide at least $25 000 worth of uncompensated care every year.




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