Stanley Feld M.D.,FACP,MACE
Barack Obama’s goal is to institute a universal healthcare system. I have pointed out that America has a demoralized primary care physician work force. It also has a shortage of primary care physicians. The physician workforce will not be able to care for the influx of patients that will occur in a universal healthcare system. This is especially true as the charity hospitals are on the verge of bankruptcy because of the Medicaid payment system and restrictions on Medicaid eligibility for indigent patients.
The Physicians Foundations completed a survey that asked physicians across the country how they see the medical practice environment? How do they feel about the state of their profession, and that of the industry at large? What plans do they have for the future of their individual practices? Do they believe there are enough of them to handle an influx of more patients?
The Physicians Foundation is an organization with $98 million dollars in available grant money that seeks to advance the work of practicing physicians and to improve the quality of healthcare for all Americans.
Interestingly the foundation was founded in 2003 as part of a settlement in an anti-racketeering lawsuit among physicians, medical societies, and insurer Aetna, Inc.
The survey was mailed to 270,000 primary care doctors and 50,000 practicing specialists. The survey managers received 11,950 responses. Chad Autry PhD, Professor of Statistics at Texas Christian University said the margin of error for this survey is less than one percent.
· An overwhelming majority of physicians – 78% – believe there is a shortage of primary care doctors in the United States today
· 49% of physicians – more than 150,000 doctors nationwide (extrapolation) – said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely. In that same time frame:
· 11%, or more than 35,000 doctors nationwide(extrapolation), said they plan to retire
· 13% said they plan to seek a job in a non-clinical healthcare setting, which would remove them from active patient care
· 20% said they will cut back on patients seen
· 10% said they will work part-time
· 60% of doctors would not recommend medicine as a career to young people
· 63% of doctors said non-clinical paperwork has caused them to spend less time with their patients
· 94% said time they devote to non-clinical paperwork in the last three years has increased
“Declining reimbursement” rated highest on list of issues physicians identify as impediments to the delivery of patient care in their practices, followed by “demands on physician time”
82% said their practices would be “unsustainable” if proposed cuts to Medicare reimbursement were made
65% said Medicaid reimbursement is less than their cost of providing care and 36% said Medicare provides reimbursement that is less than their cost of providing care
Over 33% of physicians have closed their practices to Medicaid patients and 12% have closed their practices to Medicare patients
· Only 17% of physicians rated the financial position of their practices as “healthy and profitable”
· If they had the financial means, 45% of doctors would retire today
· “Patient relationships” rated highest on the list of things physicians find satisfying about medicine, while “reimbursement issues” and “managed care issues” rated the highest on the list of issues physicians find unsatisfying about medicine
· Only 6% of physicians described the professional morale of their colleagues as “positive.” 42% of physicians said the professional morale of their colleagues is either “poor” or “very low”
· 78% of physicians said medicine is either “no longer rewarding” or “less rewarding”
· 76% of physicians said they are either at “full capacity” or “overextended and overworked”
The results are clear. America is destined to have a medical care system meltdown unless conditions are changed for primary care physicians. Most physicians trained in America are going into subspecialties. A good start for the Barack Obama’s administration would be to permit states and the federal government to redefine the antiquated definition of poverty, and recognize the value of cognitive services and increase reimbursement to attract more primary care physicians into this specialty.
Primary care physicians should be given incentives (educational support and reimbursement) to treat chronic diseases with systems of care that will prevent the complications of those diseases.
It would be a disaster to use physician substitutes for the treatment of chronic diseases. This approach would not only compromise the potential quality of medical care it would be wasting the valuable resource of physician education that both the physicians and society paid for dearly.