Survey: Pysicians reducing their hours/access

[Taco John]

Comprehensive Survey of 13,575 U.S. Physicians Points Toward Substantial Challenges

Research Commissioned by The Physicians Foundation Also Examines Physician Morale and Perspectives on Current / Future State of U.S. Healthcare System

Boston, MA, September 24, 2012— American patients are likely to experience significant and increasing challenges in accessing care if current physician practice patterns trends continue, according to a comprehensive new survey of practicing physicians. One of the largest physician surveys ever undertaken in the U.S., the research was 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.

Physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of significant changes to the medical practice environment, according to the research, titled “A Survey of America’s Physicians: Practice Patterns and Perspectives.” The research estimates that if these patterns continue, 44,250 full-time-equivalent (FTE) physicians will be lost from the workforce in the next four years. The survey also found that 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. In addition, 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.

“It is clear that the introduction of nearly 30 million new patients into the U.S. healthcare system through healthcare reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, M.D., 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.

The survey, fielded online from late March to early June 2012 by Merritt Hawkins for The Physicians Foundation, is based on responses from 13,575 physicians across the U.S. The overall margin of error (MOE) for the entire survey is (μ ± 0.998 percent), which indicates a “low to very low” sampling error for a survey designed to draw opinions and beliefs from a large population. Generally, an overall MOE at 99 percent confidence is considered highly trustworthy at +/- 2 percent or less, and all questions within the survey met this criterion.


Physician Morale

An overwhelming 80 percent of physicians cited “patient relationships” as the No. 1 most satisfying part of their job. Yet the survey also found an overwhelming majority of physicians, 77 percent, are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the healthcare system.

Multiple factors were cited as driving widespread feelings of discontent among the nation’s physicians. “Liability / defensive medicine pressures” (related to potential malpractice lawsuits) was cited first, followed by “Medicare / Medicaid / government regulations,” “reimbursement issues” and “uncertainty / changes of health reform.” These issues and others cited throughout the study tend to distract or interfere with the time physicians spend with their patients, according to survey respondents.

“The level of pessimism among America’s physicians is very troubling,” said Lou Goodman, Ph.D., president of The Physicians Foundation and CEO of the Texas Medical Association. “More than 84 percent of physicians feel that the medical profession is in decline and nearly 58 percent are reluctant to recommend medicine as a career to their children. 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.”

Healthcare Cost Drivers

When asked about the factors driving increases in healthcare costs, “defensive medicine” was cited as the No. 1 cause for 69 percent of physicians, followed by an “aging population” (65 percent). On average, older patients visit physicians three times as often compared to younger patients. Other factors ranked included “cost of pharmaceuticals,” “advances in technology / treatment” and “social conditions.”

Additional survey findings of note include:

• Close to 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
• More than 62 percent of physicians said Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs, or that any quality / cost gains will not be worth the effort
• Physicians are divided on the efficacy of the “medical homes” concept, and many (37.9 percent) remain uncertain about their structure and purpose
• While close to 70 percent of physicians have implemented electronic medical records (EMR), 47.4 percent have significant concerns that EMR poses a risk to patient privacy

“The 13,000 plus physicians who participated in this landmark survey, which included nearly 8,000 open-ended responses, strongly demonstrates the overwhelming desire of America’s physicians to share their perspectives and concerns about the current state of medicine,” said Tim Norbeck, CEO of The Physicians Foundation. “The accuracy, rigor and sheer scope of this survey should make it an invaluable piece of research to policy makers, healthcare providers, media and other stakeholders that truly want to understand the challenges that face America’s healthcare system.”

http://www.physiciansfoundation.org/...al-challenges/

[La literatura]

Originally Posted by patteeu

So it sounds like what Obamacare is bringing us is healthcare delivered by nurses instead of more highly trained doctors. Is that supposed to be progress?

Yes, it is. Think of it like realtors doing semi-legal work at much less the cost than a lawyer. This doesn't mean that we're throwing nurses into surgical rooms to conduct triple-bypasses. It means the healthcare system is adapting to train more people to do more tasks, at less the cost of a traditional doctor (who retain their low number). When I have a physical, do I need a doctor to come talk to me about whether I smoke, drink, or have high blood pressure, diabetes, etc.? Not at all. Nurses are perfectly educated and trained to be able to know, diagnose, and educate me on that. And the more highly trained and educated nurses, the more they can do: write me a prescription for something or do follow-ups for surgeries.

We'll always need doctors, but it's okay to allow them to do the most important, intensive healthcare issues, while a hierarchy of nurses take care of 95% of health care issues.

By the way, most of our health care costs are relegated to a small percentage of the population (the elderly, and the chronically ill). Geriatric care is a nursing issue. Chronically ill is a nursing issue. Despite the naysaying and doomsday prophesies about the end of doctors, I think 1) that's ridiculous and 2) there is a lot of cause to be optimistic about the medical profession.

[Cephalic Trauma]

Originally Posted by La literatura

On second thought, I guess I don't really care if you find the news ridiculous. I'll keep posting them because they should be posted.

Here's an interesting development:

New NCIN Project Will Encourage Doctoral Education Among Nurses



http://www.newcareersinnursing.org/c...n-among-nurses

You have no idea what you are talking about.

[Cephalic Trauma]

Originally Posted by La literatura

Yes, it is. Think of it like realtors doing semi-legal work at much less the cost than a lawyer. This doesn't mean that we're throwing nurses into surgical rooms to conduct triple-bypasses. It means the healthcare system is adapting to train more people to do more tasks, at less the cost of a traditional doctor (who retain their low number). When I have a physical, do I need a doctor to come talk to me about whether I smoke, drink, or have high blood pressure, diabetes, etc.? Not at all. Nurses are perfectly educated and trained to be able to know, diagnose, and educate me on that. And the more highly trained and educated nurses, the more they can do: write me a prescription for something or do follow-ups for surgeries.

We'll always need doctors, but it's okay to allow them to do the most important, intensive healthcare issues, while a hierarchy of nurses take care of 95% of health care issues.

By the way, most of our health care costs are relegated to a small percentage of the population (the elderly, and the chronically ill). Geriatric care is a nursing issue. Chronically ill is a nursing issue. Despite the naysaying and doomsday prophesies about the end of doctors, I think 1) that's ridiculous and 2) there is a lot of cause to be optimistic about the medical profession.

So, you're saying that nurses can help "diagnose" diseases when they know nothing about their pathophysiology?

Also, you are largely ignoring the fact that the salaries of doctors are a very small portion of the pie.

1. Administration costs
2. Unnecessary tests

Those are your two main culprits.

You can't simply water down the profession by "adding more nurses". You are, in effect, reducing the quality to account for increased costs.

[La literatura]

Originally Posted by Cephalic Trauma

You have no idea what you are talking about.

These are just small changes I've found that show a positive growth of the nursing education and training that I predict will occur because of ACA, and which will prevent the healthcare system from going off the cliff. If you don't think there is going to be measurable growth in their numbers and their responsibility, I'd like to know why.

[La literatura]

Originally Posted by Cephalic Trauma

So, you're saying that nurses can help "diagnose" diseases when they know nothing about their pathophysiology?

I don't know Cephalic Trauma. Is that what I'm saying? Does it make any logical sense to infer that from my post? [No it doesn't, unless you're entering your own assumptions and premises into this equation that I'm not. Feel free to explain those.]

Also, you are largely ignoring the fact that the salaries of doctors are a very small portion of the pie.

1. Administration costs
2. Unnecessary tests

Those are your two main culprits.

You can't simply water down the profession by "adding more nurses". You are, in effect, reducing the quality to account for increased costs.

It's not watering down the profession. In fact, with increased students and increased training at good schools, it's building up the profession.

I'm not ignoring administrative costs or unnecessary tests. That has little to do with my prediction that a stronger flow of nurses and increased responsibilities of nurses will help meet the demand made by ACA.

[Cephalic Trauma]

Originally Posted by La literatura

These are just small changes I've found that show a positive growth of the nursing education and training that I predict will occur because of ACA, and which will prevent the healthcare system from going off the cliff. If you don't think there is going to be measurable growth in their numbers and their responsibility, I'd like to know why.

Read my post above.

There will be a measurable growth across the board. That's not being debated. But, to say that an increase in nurses will meet the demand is extremely simplistic and will not adress the problem.

The problem with healthcare is spending. Not the number of healthcare providers.

We have a shortage, yes, but that has many different factors contributing to it. Among those factors is an unwillingness of professionals to practice in rural areas and of decreased compensation(as stated in the OP).

[Cephalic Trauma]

Originally Posted by La literatura

I don't know Cephalic Trauma. Is that what I'm saying? Does it make any logical sense to infer that from my post? [No it doesn't, unless you're entering your own assumptions and premises into this equation that I'm not. Feel free to explain those.]



It's not watering down the profession. In fact, with increased students and increased training at good schools, it's building up the profession.

I'm not ignoring administrative costs or unnecessary tests. That has little to do with my prediction that a stronger flow of nurses and increased responsibilities of nurses will help meet the demand made by ACA.

You said it explicitly by stating nurses are trained to diagnose. i did not assume that, you said it.

Nurses diagnosing anomalies they know nothing about is watering down the quality of care.

[Cephalic Trauma]

Additionally, who's going to pay them? Medicare cuts are taking effect, and private insurers negotiate prices based on medicare.

Are these colleges providing us with volunteer nurses?

[La literatura]

Originally Posted by Cephalic Trauma

The problem with healthcare is spending. Not the number of healthcare providers.

We have a shortage, yes, but that has many different factors contributing to it. Among those factors is an unwillingness of professionals to practice in rural areas and of decreased compensation(as stated in the OP).

I think there are a few problems with healthcare. Obviously, I'm not in the industry and (in the vein of this thread) don't have my thumb on its pulse, but 30 million more people coming into a system means the jobs of those in the healthcare industry are very stable, they're in large demand. The better you are, the more wanted you will be. And that's why I believe, as I stated in my first post in this thread, that there's never been a better time to be in the profession.

Medicare (and Medicaid) made the healthcare industry rich. Anytime you have the full backing of the United States to support your paycheck because you are doing operations and checkups and testing, you're going to see a stable monetary benefit (not to mention, an increase in the amount of operations, checkups, and testing -- that age-old incentive issue).

Even supposing Medicare payments to doctors are cut, even drastically, my belief is that the healthcare system will be a well-compensated profession.

[La literatura]

Originally Posted by Cephalic Trauma

You said it explicitly by stating nurses are trained to diagnose. i did not assume that, you said it.

Nurses diagnosing anomalies they know nothing about is watering down the quality of care.

Here are some possible missing premises:

1) Nurses are currently trained to diagnose anything
2) Nurses can not take pathology courses

I'm not advocating that nurses diagnose anomalies they know nothing about.

[La literatura]

Originally Posted by Cephalic Trauma

Additionally, who's going to pay them? Medicare cuts are taking effect, and private insurers negotiate prices based on medicare.

Are these colleges providing us with volunteer nurses?

First, I think you are over-simplifying the way private insurers negotiate prices with providers. It's not as simple as "Well, what's the gov't paying? Okay, let's do that." If it were that simple, then all operations would cost the same everywhere.

Secondly, it's silly to think that if Medicare payments are reduced, there will be no way to pay nurses, including the nurses for the 30 million that are going to purchase private health insurance.

[Cephalic Trauma]

Originally Posted by La literatura

I think there are a few problems with healthcare. Obviously, I'm not in the industry and (in the vein of this thread) don't have my thumb on its pulse, but 30 million more people coming into a system means the jobs of those in the healthcare industry are very stable, they're in large demand. The better you are, the more wanted you will be. And that's why I believe, as I stated in my first post in this thread, that there's never been a better time to be in the profession.

Medicare (and Medicaid) made the healthcare industry rich. Anytime you have the full backing of the United States to support your paycheck because you are doing operations and checkups and testing, you're going to see a stable monetary benefit (not to mention, an increase in the amount of operations, checkups, and testing -- that age-old incentive issue).

Even supposing Medicare payments to doctors are cut, even drastically, my belief is that the healthcare system will be a well-compensated profession.

Being in high demand and being compensated for being in high demand are two very different things. Like I said, we are cutting Medicare funding, yet treating more patients. So, I'll see more patients, but get paid less for each. How does that benefit me?

Hypothetically, because I don't have exact numbers, if I see 20 patients in a day, and get paid $50 for each pt, I make 1000 bucks (these are not real numbers). Now, with more people being insured, I will see 30 patients, AND my compensation will decrease to $30 a patient, and make 900 dollars a day. I'm essentially getting paid less to do more. Follow?

[Cephalic Trauma]

Originally Posted by La literatura

First, I think you are over-simplifying the way private insurers negotiate prices with providers. It's not as simple as "Well, what's the gov't paying? Okay, let's do that." If it were that simple, then all operations would cost the same everywhere.

Secondly, it's silly to think that if Medicare payments are reduced, there will be no way to pay nurses, including the nurses for the 30 million that are going to purchase private health insurance.

That's exactly how it works. They take the government number, determine how much they will pay based on that figure (i.e. 120% of medicare), and pay it. I have physicians in my family, and I get lectures from physicians every day, so I'm sure they aren't lying.

And that's not what I'm saying. I'm saying if you increase the NUMBER of nurses, while decreasing the overall compensation then you will pay them all less. It's a simple math problem.

[La literatura]

Originally Posted by Cephalic Trauma

Being in high demand and being compensated for being in high demand are two very different things. Like I said, we are cutting Medicare funding, yet treating more patients. So, I'll see more patients, but get paid less for each. How does that benefit me?

Hypothetically, because I don't have exact numbers, if I see 20 patients in a day, and get paid $50 for each pt, I make 1000 bucks (these are not real numbers). Now, with more people being insured, I will see 30 patients, AND my compensation will decrease to $30 a patient, and make 900 dollars a day. I'm essentially getting paid less to do more. Follow?

What kind of Soviet-style system do you have built up in your mind for our healthcare system? You honestly don't have to see patients unless you want to. Also, these 10 extra patients are privately insured (not Medicare patients).

[La literatura]

Originally Posted by Cephalic Trauma

That's exactly how it works. They take the government number, determine how much they will pay based on that figure (i.e. 120% of medicare), and pay it. I have physicians in my family, and I get lectures from physicians every day, so I'm sure they aren't lying.

This doesn't make sense. Think about it: why are there differences between costs for similar operations, then? Under your theory, there should be a uniform cost in the healthcare system.

The reality is that hospitals and insurance companies negotiate on payment plans. I'm sure Medicare plays a role in it, but it's one of many roles.