Survey reveals dour physician outlook

A new survey of America’s physicians doesn’t offer any surprises but paints a gloomy picture of the state of mind of the country’s physician workforce.

The Physicians Foundation, a nonprofit organization supporting doctors, and physician search firm Merritt Hawkins, contacted more than 630,000 doctors in the United States to ask what they think about the current state of the medical profession; the level of satisfaction with their careers; what they think of accountable care organizations or other emerging delivery models; what they think of healthcare reform; and what changes they foresee making to their practices.

The foundation and Merritt Hawkins received responses from 13,575 physicians. Among the findings of the survey:

• 77.4 percent of responding physicians are somewhat or very pessimistic about the future of the medical profession.
• More than 84 percent believe that the medical profession is in decline.
• Younger physicians, female physicians, employed physicians and primary care physicians reported feeling more positive about their profession than did older physicians, male physicians, practice owners and specialists.
• Doctors are working 5.9 percent fewer hours than they did in 2008 – a loss of 44,250 full-time equivalents (FTEs).
• More than 26 percent have closed their practices to Medicaid patients.
• In the next three years, more than 50 percent of doctors plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to services.
• More than 59 percent said the health reform law has made them less positive about the future of healthcare in the U.S.
• More than 82 percent of doctors said they are not sure where the health system will be or how they will fit into it three to five years from now.

The findings of the survey were an affirmation that Travis Singleton, Merritt Hawkins’ senior vice president, could have done without. “It’s kind of like a bad dream,” he said. “You wake up and you get an affirmation that it actually happened.”

What happened is that the survey confirmed for Singleton, and others, that as healthcare is being extended through the healthcare reform law, the shortage of doctors is a much deeper problem than just not having enough primary care doctors to work with more patients.

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Calling the situation a “silent exodus,” Singleton said the survey results show that not only does the country face a doctor shortage but a deepening access problem, because the physician workforce is largely demoralized and frustrated, which is leading to, among other things, presenteeism and reductions in work hours and patients seen.

“In some regard, even though it would be an awful day for our healthcare system, you would almost rather physicians just walk outside, hold up a picket sign, and strike, right?” Singleton said. “Instead it’s death by a thousand pinpricks. (Doctors are) voting with their feet and it’s really starting to effect us … .”

Uncertainty is the biggest driver of physician pessimism and right now it’s at an all-time high, said Lou Goodman, PhD, president of the Physicians Foundation. The uncertainty of the economy as a whole, the looming Medicare cut to physician pay and the changes brought by the Affordable Care Act are just a few of the factors unnerving doctors, he said.

It could be that when and if many of the factors contributing to their pessimism go away, doctors will become more optimistic, but that’s for the future. Right now, Goodman said, the problem of getting access to physicians is only getting worse. The healthcare community and policy makers, he said, have to start paying attention before more patients enter the system in 2014.