FMES - Florida Educational Medical Services

Will a “silent exodus” from medicine worsen doctor shortage?

Issue 69 - 10/2/2012

Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.

Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors saw 16.6% fewer patients, according to a survey of nearly 14,000 doctors released in September. If the trend continues through 2016, it would equate to the loss of 44,250 full-time physicians, said the report, conducted by the doctor-recruiting firm Merritt Hawkins & Associates for the Physicians Foundation. 

“This is a silent exodus,” said Mark Smith, president of Merritt Hawkins. “Physicians are feeling extremely overtaxed, overrun and overburdened.”

Only half of doctors will continue their current practice during the next three years, the survey said. Many plan to cut back on hours, retire, see fewer patients, seek hospital employment, work part time, transition to a concierge model or seek a nonclinical job in health care. 

A quarter of doctors cited long hours and lack of personal time as among the least satisfying elements of their careers. Nine in 10 physicians agreed that most doctors “are unsure where the health system will be or how they will fit into it” during the next five years.

“There’s a great degree of uncertainty and angst related to problematic reimbursement, the high-regulation environment and many other things,” said Walker Ray, MD, a retired pediatrician and vice president and research committee chair for the Physicians Foundation. “Now, what this all is about is more than professional grumbling. All professions at times have unhappiness surfacing. What we’re looking at are trends where physicians are in their own individual minds and their own individual practices, making decisions that may affect the supply of physicians going forward.”

Hospitals directly employ about 20% of practicing physicians, according to the American Hospital Assn. Many other physicians are employed in group practices owned by health systems. The proportion of doctors in independent practice is now a minority, says the MGMA-ACMPE, the entity formed by the merger of the Medical Group Management Assn. and the American College of Medical Practice Executives. That matters because hospital-employed physicians work fewer hours and see fewer patients than do independent doctors, the foundation’s survey showed.

“We know that an employed physician is less productive than a practice owner,” said Smith of Merritt Hawkins. “Physicians are looking for a safe harbor [in hospital employment], for someone to say, ‘I think I see what’s coming, and I can mitigate this risk for you.’ ”

“People in small and solo practices are struggling, with all the administrative and regulatory burden of insurance and payment challenges,” said Dr. Stream, an employee at a hospital-owned clinic in Spokane, Wash. “In a small group, you don’t have any negotiating power with insurance companies. If you’re in small or solo practice, life is hard.”

Shortage sparks debate over NPs’ role

The looming physician shortage is drawing more attention to the use of nurse practitioners (NP), physician assistants (PA) and other midlevel health professionals to help maintain access to care. But the shift toward more team-based care in patient-centered medical homes should occur in a physician-led environment, the AAFP said in a Sept. 18 report. The American Academy of Nurse Practitioners objected to the report, arguing that NPs could help fill the physician gap by independently treating patients.

Dr. Stream, of the AAFP, said a two-tier system of primary care — physicians for some, nurse practitioners for others — is untenable.

“To the people who propose that to fill this gap that we should somehow alter our expectations of the kind of care people should get — that is not what we want in this country,” he said. “It’s not a viable, ethical or reasonable solution.”

Primary care doctors complete 21,700 hours of education and training over 11 years, said the AAFP report. That compares with 5,350 hours of training and education NPs get during five to seven years. The AMA backed the academy’s report, noting a recent survey showing that 86% of patients believe they benefit from a physician-led primary care team.

“Physicians and other health professionals have long worked together to meet patient needs for a reason — the physician-led team approach to care works,” said AMA President Jeremy A. Lazarus, MD. “Patients win when each member of their health care team plays the role they are educated and trained to play.”

This e-mail was sent to you by:

FMES-Florida Medical Educational Services

PO BOX 700, BOSTWICK, FL. 32007-0700 386/325-5790

Visit Our Site

© 2009 FMES. All Rights Reserved.  |  Unsubscribe

Back to Listings