Patients to face ‘access crisis’

Survey estimates physicians will leave practice in droves

Despite health care overhaul, the future of medicine looks pretty bleak—at least according to doctors. New research suggests that if physician practice trends continue, more than 44,000 physicians will be lost from the workforce in the next four years.

The survey of 13,575 U.S. physicians commissioned by The Physicians Foundation, a nonprofit organization, finds that physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of significant changes to the medical practice environment.

And if those patterns continue, the medical landscape will change significantly—and patients will be the ones who pay.

Over the next one to three years, more than 50 percent of physicians will cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access, the survey finds. And should 100,000 physicians transition from practice-owner to employed status over the next four years (such as working in a hospital setting), the survey indicates that this will lead to 91 million fewer patient encounters.

The survey echoes other research about the future of physicians. Last month, a nationwide survey of U.S. physicians found that 34 percent said they'll quit practicing medicine in the next decade, blaming health care reform and economic woes. And other research from the Mayo Clinic found that doctors are burning out “at an alarming level.”

“It is clear that the introduction of nearly 30 million new patients into the U.S. health care system through health care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” says Walker Ray, vice president of The Physicians Foundation and chair of its research committee. “The rate of private practice physicians leaving the medical field—as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients—is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”

More than half of physicians (52 percent) have limited the access of Medicare patients to their practices or are planning to do so, while one out of four physicians (26 percent) have already closed their practices altogether to Medicaid patients, the survey shows. Physicians cited rising operating costs, time constraints and diminishing reimbursement as the primary reasons why they are unable to accept additional Medicare and Medicaid patients.

Physician morale

An overwhelming majority of physicians (77 percent) are pessimistic about the future of medicine, and 82 percent believe they have little ability to change the health care system. Even more, 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now.

The reasons for widespread feelings of discontent were plenty: Liability/defensive medicine pressures (related to potential malpractice lawsuits) topped the list, followed by Medicare/Medicaid/ government regulations; reimbursement issues and uncertainty/changes of health reform.

Those issues tend to distract or interfere with the time physicians spend with their patients, survey respondents said.

Lou Goodman, president of The Physicians Foundation and CEO of the Texas Medical Association, says the level of pessimism among U.S. physicians is “very troubling,” while also citing that almost 60 percent are reluctant to recommend medicine as a career.

“That means we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine,” he says.

 

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