About half of physicians say they plan to retire, reduce their hours, or leave their clinical positions as a result of regulatory burdens and other concerns, according to a report from The Physicians Foundation released last week.
The report is based on The Physicians Foundation's Survey of America's Physicians, which the organization conducts every two years. The survey assesses physicians' opinions on the state of the medical profession. Merritt Hawkins, a physician recruitment and staffing firm, helped conduct the survey, which included responses from 17,236 physicians.
Fifty-four percent of respondents characterized their morale as somewhat or very negative. Further, the survey found that:
- 63 percent of respondents said they have negative feelings about the future of the medical profession;
- 49 percent of respondents said they often or always experience feelings of burnout; and
- 49 percent of respondents would not recommend a career in medicine to their children.
According to the survey, respondents said regulatory and paperwork burdens, as well as a loss of clinical autonomy, were the main reasons they felt dissatisfied. Respondents reported spending 21 percent of their time doing non-clinical paperwork. Further, just 14 percent of respondents said they have sufficient time to provide the highest standards of care. According to the survey, nearly three-quarters of respondents said external factors, such as third-party authorizations, detract from the quality of care they provide.
About 54 percent of respondents said EHRs have had a negative effect on their practices' efficiencies, while about 25 percent said EHRs have increased efficiency for their practices.
The survey found that regulatory burdens and other concerns are driving physicians to seek alternatives to full-time private medical practice.
According to the survey, the percentage of physicians who identify as private practice owners fell to 33 percent in 2016, down from 49 percent in 2012.
In addition, the survey found that 46.8 percent of respondents said they plan to "accelerate" their retirement plans because of the changes taking place in health care. Over the next one to three years:
- 21 percent of respondents said they plan to scale back their hours;
- 14.4 percent said they plan to retire;
- 13.5 percent said they plan to seek a non-clinical job in health care;
- 11.5 percent said they plan to take temporary provider positions;
- 10 percent said they plan to move to part-time practice; and
- 9 percent said they plan to move to concierge medicine.
The report stated, "The concern from the public's perspective is that physicians, as a consequence of poor morale or related reasons, will choose to practice medicine in ways that reduce patient access to their services."
Disengagement from health care reforms
According to HealthLeaders Media, the findings also suggest that physicians are disengaged from health care reform efforts.
About 43 percent of respondents said they are paid through value-based models. Of those respondents, 77 percent said no more than 20 percent of their compensation was value-based.
Further, the survey found that 36 percent of respondents said they participate in accountable care organizations (ACOs), but only about 11 percent said ACOs are likely to improve health care quality and reduce costs.
The survey also found that 66 percent of respondents do not believe hospital employment of physicians will improve health care quality or reduce costs, including 50 percent of respondents who said they were employed by hospitals.
In addition, the survey found relatively few respondents were familiar with the Medicare Access and CHIP Reauthorization Act (MACRA), which includes various payment reforms. According to the survey:
- About 20 percent of respondents said they are "familiar" with law;
- 14 percent said they were "somewhat" familiar with the law; and
- 5.9 percent said they were "very familiar" with the law.
Meanwhile, 56 percent of respondents said they were "somewhat unfamiliar" or "very unfamiliar" with MACRA.
The Physicians Foundation President Walker Ray said, "Many physicians are dissatisfied with the current state of the medical practice environment and they are opting out of traditional patient care roles."
Merritt Hawkins President Mark Smith, said, "Doctors have been on a slow boil over a variety of issues for years." He added, "Implementing value-based care and adjusting to MACRA on the fly has turned up the heat a few more degrees," and "the result is more than hard feeling."Ray also touched on physicians' resistance to health care reforms, saying, "Clearly, more physician participation in and acceptance of the key levers of health care reform will be needed for a true transformation of the health care system from volume to value" (HealthLeaders Media, 9/21; Survey of America's Physicians, 9/20; Japsen, Forbes, 9/21).
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