U.S. physicians continue to struggle to maintain morale levels, adapt to changing delivery and payment models, and provide patients with reasonable access to care. The combination of these factors leaves a majority of physicians feeling that they lack time to provide the highest level of care.
These findings are based on a biennial survey of over 17,000 U.S. physicians commissioned by the Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients.
According to the research, titled “2016 Survey of America’s Physicians: Practice Patterns and Perspectives,” 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains steady with the findings reported in the 2014 survey from the Foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative, with 49 percent saying they are either often or always feeling burnt out.
In response to these and other challenges, 48 percent of surveyed physicians plan to cut back on hours, retire, take a non-clinical job, switch to “concierge” medicine or take other steps that will further limit patient access – an increase from those who answered similarly in the 2014 survey. These patterns are likely to reduce the physician workforce by tens of thousands of full-time equivalents (FTEs) at the time that a growing, aging and more widely-insured population is increasing overall demand for physicians.
“Many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles,” said Walker Ray, M.D., President of the Physicians Foundation and chair of its Research Committee. “By retiring, taking non-clinical roles or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce. This trend is to the detriment of patient access. It is imperative that all healthcare stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment.”
The survey was conducted online from April 2016 through mid-June 2016 by Merritt Hawkins, a leading physician search and consulting firm, on behalf of the Physicians Foundation. The findings are based on responses from 17,236 physicians across the U.S. The overall margin of error (MOE) for the entire survey is less than one percent, indicating a very low sampling error for a survey designed to draw opinions and perspectives from a large population.
Impact of Physician Morale on Patient Access
This survey, conducted biennially since 2008, has consistently demonstrated that the professional morale of physicians is declining. In addition to challenges in morale, 62.8 percent of those surveyed are pessimistic about the future of the medical profession. About half of survey respondents would not recommend medicine as a career to their children. Close to one-third would not choose to be physicians if they had their careers to do over. This sentiment has larger implications outside of the profession itself, given that physicians manage larger clinical teams comprised of nurse practitioners, physician assistants and more who also play a pivotal role in healthcare economics.
Physicians identify regulatory / paperwork burdens and loss of clinical autonomy as their primary sources of dissatisfaction. Respondents indicate that they spend 21 percent of their time on non-clinical paper work duties, while about two-thirds (72 percent) say third-party intrusions detract from the quality of care they can provide.
What is also consistent in each biennial survey since 2008 is physicians’ primary source of professional satisfaction: the patient relationship. In the 2016 survey, 73.8 percent of respondents list this as the most satisfying aspect of their jobs, followed by “intellectual stimulation” at 58.7 percent. Similarly, in a patient survey commissioned by the Physicians Foundation earlier this year, 95 percent of patient respondents reported they were satisfied or very satisfied with their primary care physician’s ability to explain information in a manner they understand, while 96 percent feel their physicians are respectful of them. Physicians note that issues such as a lack of clinical autonomy, liability concerns, struggle for reimbursement and decreased patient face-time can all negatively impact the patient-physician relationship – thereby undermining physician satisfaction.
Challenges with Healthcare Reform
As a central player in determining patient treatments and care plans, physician participation and leadership is critical to transforming healthcare from a system driven by the volume of services to one focused on the value of services. However, the survey indicates that the majority of physicians are not convinced to sufficiently engage or support the mechanisms of healthcare reform to achieve its stated aims.
Only 43 percent of physicians surveyed say their compensation is tied to value. Of these, the majority, (77.2 percent) have 20 percent or less of their compensation tied to value. Additionally, only 20 percent of physicians surveyed are familiar with the Medicare Access and CHIP Reauthorization Act (MACRA) which will greatly accelerate value-based payments to physicians.
Another perceived barrier is the new ICD-10 system, which added thousands of new codes intended to allow physicians to be more efficient, bill more precisely and improve patient care. However, the majority of physicians have not realized these benefits. Most surveyed indicated that ICD-10 has had little to no impact in practice efficiency, revenue or patient care. Similarly, physician’s opinions of electronic health records (EHR) have not improved, with even more physicians stating that it detracts from patient interaction compared to findings of the 2014 survey. Only 11.9 percent of respondents indicated EHR has improved patient interaction, while the remaining 89.1 percent say it has had little or no impact or has detracted from patient interaction.
Finally, physician assessments of Accountable Care Organizations (ACO), which covers 15 percent to 17 percent of the U.S. population, have not changed appreciably since the earlier 2012 biennial survey. The percent of physicians that agree ACOs are likely to enhance quality and lower costs decreased, while there was an increase in physicians who feel ACOs are unlikely to increase quality or decrease cost.
Additional Key Findings
- Employed physician respondents see 19 percent fewer patients than practice owners
- 46.8 percent of respondents plan to accelerate their retirement plans
- 20 percent of respondents now practice in groups of 101 doctors or more, up from 12 percent in 2012
- Only 17 percent of survey respondents are in solo practice, down from 25 percent in 2012
- 27 percent of respondents do not see Medicare patients, or limit the number they see; this number is 36 percent for Medicaid patients
“It is striking that so many physicians across the U.S. once again took time to respond to our survey, reinforcing key issues but also bringing to light new challenges,” said Tim Norbeck, CEO of the Physicians Foundation. “Since 2008, this survey has allowed us to explore and amplify the voice of America’s physicians in a data-rich, meaningful way. Our goal is to educate stakeholders on the rising concerns related to medical practice in order to encourage change that will better the lives of both patients and physicians, ultimately improving the delivery of healthcare for all.”