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Survey of physicians demonstrates growing challenges for patient access

BY Antoinette Alexander

BOSTON — If shifting patterns in medical practice configurations and physician workforce trends continue, U.S. patients are likely to face growing challenges in access to care, according to a survey of 20,000 physicians commissioned by the Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of health care to patients.

It is no secret that the country is facing a growing physician shortage. The survey, titled “2014 Survey of America’s Physicians: Practice Patterns and Perspectives,” not only addresses the changes impacting the medical profession but, it demonstrates the importance of alternate sites of care, such as retail-based health clinics, as patients seek access to health care.  

According to the survey, 81% of physicians describe themselves as either over-extended or at full capacity, while only 19% indicate they have time to see more patients. Forty-four percent of physicians surveyed plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of full-time-equivalents. As the ranks of Medicare and Medicaid patients increase — in 2011, more than 75 million baby boomers began turning 65 and qualifying for Medicare — and millions of new patients are insured through the Affordable Care Act, patient access to care could pose significant health delivery and policy challenges.

“America’s physician workforce is undergoing significant changes,” said Walker Ray, VP of the Physicians Foundation and chair of its research committee. “Physicians are younger, more are working in employed practice settings and more are leaving private practice. This new guard of physicians report having less capacity to take on additional patients. These trends carry significant implications for patient access to care. With more physicians retiring and an increasing number of doctors — particularly younger physicians — planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the U.S. healthcare system to properly care for millions of new patients.”

The survey, conducted online from March 2014 through June 2014 by Merritt Hawkins for the Physicians Foundation, is based on responses from 20,088 physicians across the United States.

Physician workforce demographics and patterns — A changing of the guard
In comparing the physician surveys conducted by the Physicians Foundation in 2008 and 2012, the 2014 respondents are younger, more work in employed settings (e.g., hospital systems), there are more females and more work in primary care. In 2014, the average age of the respondents is 50 years old, versus an average age of 54 years in 2012. In 2014, 33% of the survey respondents are female, versus only 26% in 2012. Survey respondents mirror the composition of the current U.S. physician workforce — providing a representative understanding of the diversity of attitudes and perspectives inherent among America’s doctors.

In addition to changing workforce demographics, the survey captured significant transitions underway in physician workforce patterns and practice settings. For instance, in 2014, only 17% of physicians indicate that they are in solo practice, down from 25% in 2012. In 2014, only 35% of physicians describe themselves as independent practice owners, down from 49% in 2012 and 62% in 2008. Fifty-three percent of respondents describe themselves as employees of a hospital or medical group, up from 44% in 2012 and 38% in 2008. More than two-thirds of employed physicians (68%) expressed concerns relative to clinical autonomy and their ability to make the best decisions for their patients.

Physician morale — Outlook improving, but pessimism still remains high
In 2012, many physicians described high levels of government regulation, malpractice liability pressures, inadequate and inconsistent reimbursement and eroding clinical autonomy as factors leading to discontentment. In 2014, survey questions focused more on clinical autonomy, given the significant patient implications. When asked about levels of clinical autonomy and the ability to make the best decisions for patients, 69% of physicians indicate that their decisions are often compromised — demonstrating a strong potential bearing on quality of patient care.

As seen in previous survey years, a majority of physicians (56%) continue to describe their morale as somewhat to very negative However, optimism levels increased between 2014 and 2012. In 2014, 44% of physicians characterize themselves as somewhat or very positive about the current state of the medical profession, compared to 32% in 2012.

The reason for this increase could be attributed to the changing composition of the survey respondents. Specifically, 54% of younger physicians (ages 45 years or younger) surveyed are optimistic about the state of medicine, versus 30% of older physicians (ages 46 years or older). Female physicians are slightly more optimistic about the current state of medicine (49%) than their male counterparts (42%). Fifty-one percent of employed physicians are optimistic about the current state of the medical profession, compared with 33% of physicians who own their own practice.

When asked about what grade physicians would give the Affordable Care Act (ACA), 46% give a D or F grade. Younger (ages 45 years or younger), employed physicians were more inclined to give the ACA favorable marks than older (ages 46 years or older), private practice owners. In fact, 63% of younger physicians (ages 45 years or younger), would give the ACA a grade of C or above.

“The state of the physician workforce, and medicine in general, is experiencing a period of massive transition,” said Lou Goodman, president of the Physicians Foundation and CEO of the Texas Medical Association. “As such, the growing diversity of the physician workforce will reflect different perspectives and sentiments surrounding the state of medicine. While I am troubled that a majority of physicians are pessimistic about the state of medicine, I am heartened by the fact that 71% of physicians would still choose to be a physician if they had to do it over, while nearly 80% describe patient relationships as the most satisfying factor about practicing medicine.”

Electronic medical records and additional findings
Eighty-five percent of physicians surveyed indicate that they have implemented electronic medical records. Yet, only 24% say that EMR systems have improved efficiency and only 32% indicate that it has improved quality of care. Nearly half of respondents (47%) noted that EMR systems detract from patient interaction. Additional survey findings include:

  • Thirty-nine percent of physicians indicate that they will accelerate their retirement plans due to changes in the healthcare system;
  • Twenty-six percent of physicians now participate in an ACO, though only 13% believe ACOs will enhance quality and decrease costs;
  • Fifty percent of physicians indicate implementation of ICD-10 will cause severe administrative problems in their practices;
  • Physicians spend 20% of their time on non-clinical paperwork;
  • On average, physicians surveyed said 49% of their patients are enrolled in Medicare or Medicaid, yet 24% of physicians surveyed either do not see Medicare patients or limit the number Medicare patients they see;
  • Thirty-eight percent of physicians either do not see Medicaid patients or limit the number of Medicaid Patients they see; and
  • Physicians surveyed said they work an average of 53 hours per week and see approximately 20 patients per day

“The more than 20,000 physicians who participated in this survey also submitted more than 13,000 written comments — demonstrating the eagerness of doctors to voice their perspectives on the critical issues impacting America’s patients and healthcare system,” said Tim Norbeck, CEO of the Physicians Foundation. “With more than one million data points derived from this survey, our hope is that policy makers, healthcare influencers, media and other stakeholders will use the findings as a valuable resource to better understand the underlying challenges facing our healthcare system, and formulate effective policies that will advance the health and interests of our patients.”

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