About half of U.S. MDs, and many nurse practitioners and physician assistants, wish their field could go back in time, before the advent of quality metrics and penalties for failure to meet certain national standards.

With the medical industry coming under increasing scrutiny for quality and cost performance, The Commonwealth Fund and the Kaiser Family Foundation decided to ask the caregivers what they thought about such matters. They were also asked whether advances in IT services made their jobs better or worse.

The study reported was divided into two categories: responses by physicians and the combined responses of nurse practitioners and physician assistants, despite the fact that the training received by NPs and PAs, and their job descriptions, are quite different from one another.

Here are some of the major findings of the study:

50 percent of primary care physicians say the increased use of quality metrics to assess provider performance is having a negative impact on quality of care, and 22 percent say it has a positive impact. Others either aren't sure or say it has no impact.
38 percent of NP and PA respondents cited metrics as a negative, and 27 percent as a positive.
52 percent of physicians say programs that impose financial penalties for unnecessary hospital admissions or readmissions are having a negative effect on quality of care, while 12 percent said such programs have a positive effect.
41 percent of nurse practitioners and physician assistants said penalties have a negative effect on their practice; 15 percent said it was positive.
50 percent of physicians said IT advances have had a positive effect on their practice; 28 percent said it was a negative.
64 percent of NP and PA respondents cited IT advances as a positive, with 20 percent saying it had negative effects on the practice.
Physicians viewed the increasing role of nurse practitioners and physician assistants as a negative trend in the industry. Meanwhile, NP and PA responses indicated they view this new collaborative trend much more positively.
55 percent of primary care physicians reported receiving financial incentives based on quality or efficiency measures, which the study authors called “an indication of the reach of ongoing efforts by public and private payers to reward providers for quality of care rather than for the amount of services delivered to patients.”

But these emerging trends aren't sitting well with many of the nation's primary caregivers, and early retirement now seems like a good idea to many. Some 47 percent of physicians and 27 percent of nurse practitioners and physician assistants agreed that they are considering retiring early as a result of the new paradigm in medical care.

Instant Insights /

Doctors have mixed feelings about increasing scrutiny, technology

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