Is There A Doctor In The House?

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According to the new survey results, eight out of ten (81 percent) physicians describe themselves as either over-extended or at full capacity, while only 19 percent indicate they have time to see more patients. In fact, 13 percent of physicians no longer accept Medicare patients – this is up 49 percent in 2014 from 2012.

By Walker Ray

There is ongoing debate over whether there are enough physicians to care for millions of new patients. According to the Association of American Medical Colleges, the United States currently faces a shortage of 20,000 physicians – a shortfall that could exceed 130,000 physicians by 2025. In addressing these challenges, it is critical to take into consideration the shifting patterns in medical practice configurations, changing dynamics inherent within physician workforce trends, and the potential impact on patient access to care.

The Physicians Foundation’s new survey of more than 20,000 physicians examines these issues and provides insight into physician capacity and morale, changing medical practice configurations, and shifting physician workforce trends and demographics.

Physician Capacity and Morale – What Does This Mean for Patient Access?

According to the new survey results, eight out of ten (81 percent) physicians describe themselves as either over-extended or at full capacity, while only 19 percent indicate they have time to see more patients. In fact, 13 percent of physicians no longer accept Medicare patients – this is up 49 percent in 2014 from 2012.

Physician capacity also bears an impact on how physicians feel about the state of medicine overall. A majority of physicians (56 percent) continue to describe their morale as somewhat or very negative, despite optimism levels ticking up a bit. The survey shows that a chief factor affecting morale has to do with the quality of patient relationships declining. Part of this deterioration includes a lack of clinical autonomy, liability concerns, a continuing struggle for reimbursement, and a lack of patient face-time.

On average, physicians see nearly 20 patients per day – with some doctors, indicating, anecdotally (in focus group sessions), that they see 30 patients per day. Pair this with the fact that one-fifth of a physician’s day (20 percent) is spent on paperwork or non-clinical duties, and it’s not surprising that nearly 40 percent of physicians surveyed say they intend to accelerate retirement plans.

What is more, 44 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 (FTEs).

The stats cited above pose significant implications for patient access to care. 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 will present significant health delivery and policy challenges.

A Changing of the Guard – The New Face of Medicine

The face of U.S. medicine is undergoing significant changes. More physicians are working in employed practice settings and more are leaving private practice.

Compared to the physician surveys conducted by The Physicians Foundation in 2008 and 2012, the respondents in 2014 are younger: two years ago the average age was 54; today it is 50. There also are more female physicians: they represented 26 percent of survey respondents in 2012, today it is 33 percent. Physicians today are more likely to work in primary care and in employed settings such as hospital systems.

This new guard of younger physicians working in employed settings report having less capacity to take on additional patients. If this trend continues, patient access to quality care could become increasingly problematic.

Medical Practice Configurations – A Move Toward Consolidation

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 percent of physicians indicate that they are in solo practice, down from 25 percent in 2012. In 2014, only 35 percent of physicians describe themselves as independent practice owners, down from 49 percent in 2012 and 62 percent in 2008.

Fifty-three percent of respondents describe themselves as employees of a hospital or medical group, up from 44 percent in 2012 and 38 percent in 2008. In addition, 13 percent of physicians, a sizable portion of whom are younger, plan to switch in whole or in part to concierge medicine.

Physicians transitioning to employed settings show no signs of abating. Having a diversity of practice settings from which to choose is important for patient choice and access. Yet, according to the practice workforce patterns exhibited in the survey and broader trends in the marketplace, consolidation continues to accelerate at an exponential rate. As seen in many other industries, trends toward less competition lead to higher prices, less consumer choices, and increasing regulatory burdens.

Is There a Doctor in the House?

The question facing policy makers and, more broadly, the entire U.S. healthcare system remains: With millions of new patients requiring access to care, will there be enough doctors to properly care for them?

According to the survey, 71 percent of physicians feel there is a physician shortage and a critical need to train more. Based upon the insights and stats shared above, it seems that this problem is likely to get worse before it gets better.

My hope is that policy makers will take these findings into consideration as they grapple with the challenge of ensuring that all patients receive the quality care they so desperately deserve.

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