48 percent of surveyed physicians plan to cut back on hours, retire, take a non-clinical job, switch to “concierge” medicine or take other steps…
By Walker Ray, MD and Tim Norbeck, Forbes, Contributor
Oct 25, 2016 @ 10:47 AM – The Physicians Foundation recently released its findings from this year’s biennial physician survey. What surprised us the most, or should we say amazed us, were the 10,170 physicians who took the additional time to send us commentaries that filled more pages than in Gone with the Wind. That act alone demonstrates how strongly physicians feel about what is happening today to the practice of medicine. We will close our remarks with a sampling of theirs.
U.S. physicians continue to struggle to maintain morale levels, adapt to changing delivery and payment models, and provide patients with reasonable access to care. According to the research titled “2016 Survey of America’s Physicians: Practice Patterns and Perspectives,” 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains consistent with the findings reported in the 2014 survey from the Foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative, with 49 percent saying they are either often or always feeling burnt out.
Conducted by Merritt Hawkins, the survey findings are based on a sizable response of over 17,000 physicians and address professional morale, practice patterns, career plans and their perspectives on recently passed government regulations.
Other interesting findings include:
- 3 percent gave the Affordable Care Act (Obamacare) an “A” rating, while 48% gave it a “D” or “F” rating.
- 6 percent indicated that ICD-10 has improved efficiency in their practice, while 42.5% reported that ICD-10 has detracted from efficiency. On a lighter note, neither of us has yet to find a physician who has used the code for a patient who was sucked into a jet engine. We will keep asking!
- 11 percent found that EHRs have improved patient interaction, while 60 percent indicated that they have detracted from patient interaction.
- Only 8 percent of physicians agreed that the Maintenance of Certification (MOC), required by specialty boards, accurately assesses their clinical abilities.
The answers to two questions in our biennial physician survey since 2008 have remained constant. First of all, a common theme throughout our surveys since 2008 is that physicians continue to find patient relations to be the most satisfying factor in their medical practice – a full 74 percent. The “least satisfying” factor is the regulatory and paperwork burdens (58 percent), followed by the erosion of clinical autonomy (32 percent). Medicine is one of the most, if not the most highly regulated profession in the United States, with Medicare compliance rules and regulations alone running into the tens of thousands of pages – and they are constantly increasing. For example, the new MACRA law revamping Medicare payments to physicians, is 932 pages long. And physician compliance and paperwork burdens are being exacerbated by emerging reimbursement methods. New value-based payment models, such as the aforementioned MACRA, require physicians to track countless “quality measures.” Combined with EHRs, the overall effect serves to divert physician eye contact with patients – something both parties increasingly resent.
A study published in the March 2016 issue of Health Affairs indicates that physicians and their staff spend 785.2 hours annually just tracking and reporting quality measures for Medicare, Medicaid and private insurers, at a cost of $15.5 billion. On top of that, new regulations keep popping up with no end in sight. Physicians spend four years in college, four years in medical school, and three to seven years (and sometimes even more) in residency or fellowship training in order to practice in their chosen specialty. Unfortunately, as all physicians know too well, they often find that their ability to choose what is best for their patients is compromised or obstructed by bureaucratic requirements or third parties who are non-physicians and neither have the training nor the knowledge of the patient that the physician possesses. They also force physicians to be box checkers instead of maintaining important eye contact with their patients.
Speaking of all of these experiences plus new and expensive (to physicians) reporting mechanics and regulations which have the effect of turning patients into data machines, we were taken recently with what is now considered to be the favorite joke in Canada. Substitute health care regulators for NASA, and the joke unfortunately is on us. It goes as follows: