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Survey of 12,000 Physicians Shows Doctors at the Breaking Point

Jan. – Feb. 2009

Source: ”The Physician’s Perspective: Medical Practice in 2008,” was conducted by the Physician’s Foundation, a grant-making organization dedicated to improving the medical practice environment for physicians and patients. Phillip Miller, the author of this article, is vice president of communications for Merritt Hawkins & Associates, a national physician search and consulting firm and a division of AMN Healthcare, who was commissioned by the Physician’s Foundation to conduct the study. Mr. Miller may be reached at pmiller@mhagroup.com.

Physician recruiters hear daily from doctors who are dissatisfied with their practices and who wish to either find more favorable practice settings or opt out of medicine altogether.

Health care policymakers and the general public, however, are generally less attuned than recruiters are to the rising levels of stress and professional dissatisfaction that many physicians are experiencing. There is a common perception that the majority of physicians today are wealthy and that medicine remains the lucrative and satisfying career it has long been perceived to be.

It is for this reason that the Physician’s Foundation, a national group of physician and medical society leaders, decided to conduct one of the most comprehensive physician surveys ever attempted. Established as a result of a lawsuit brought by 20 medical societies against the managed care industry, the Physician’s Foundation is a grant-making organization dedicated to improving the medical practice environment for physicians and patients (See Physician’s Foundation for more information and complete survey results). The Physician’s Foundation’s goal for the survey was to determine to the greatest extent possible how physicians themselves feel about medicine and the overall environment in which they practice today.

The Physicians’ Foundation commissioned Merritt Hawkins & Associates to develop the survey, which was mailed to over 320,000 physicians in all 50 states. Of these physicians, 270,000 are in primary care, defined as family practice, general internal medicine, pediatrics, and obstetrics/gynecology, and the remaining 50,000 are in a variety of surgical and diagnostic specialties. The Physician’s Foundation decided to emphasize primary care doctors in the survey because it is perceived that these types of physicians are under the greatest financial, professional, and personal stress. In addition, primary care physicians provide the foundation of health care delivery, since they coordinate care for the entire patient and are the gatekeepers to the system. Without a sufficient number of primary care doctors, health care delivery becomes untenable.

Fifty-two percent of the respondents were 51 years of age or older; the remaining 48 percent were 50 or younger. The survey population, therefore, is a few percentage points older on average than the general physician population. One-third of the respondents were female and the remaining two-thirds were male, so the survey population includes slightly more females than the overall physician population.

The survey consisted of 48 questions regarding medical practice today, with a number of questions having multiple subsets, each requiring a response. Approximately 12,000 physicians responded to the survey, which includes well over 800,000 individual data points. In addition, the survey provided space for physicians to submit written comments regarding what they would tell the general public and policymakers about the state of medical practice today. Over 4,000 physicians provided comments, ranging from one-word exclamations such as “Help!” to multiple pages of detailed exposition. Survey results and methodologies were submitted to Chad Autry, PhD, of the Neeley School of Business at Texas Christian University, for evaluation and analysis. Dr. Autry concluded the survey has an error rate of less than one percent.

The survey, entitled “The Physician’s Perspective: Medical Practice in 2008,” paints a sobering picture of today’s medical workforce and has important implications for anyone concerned with the issues of physician supply and patient access to medical services. Key findings of the survey, grouped under subject headings, are shown in this month’s Market Watch. What emerges from the survey responses is a sense that many physicians, particularly primary care doctors, are being pushed to the brink by declining reimbursement, higher thresholds of third-party paperwork and interference, the threat of malpractice, and time constraints imposed by the need to work harder and longer. Many appear eager to take steps that would reduce patient access to physician services at a time when the nation already is experiencing a physician shortage.

In particular, 11 percent said they plan to retire in the next one to three years. Even many of the younger physicians surveyed said that they soon plan to retire. Thirteen percent of physicians indicated they plan to seek non-clinical jobs, such as management positions, that would remove them from direct patient care. Twenty percent indicated they plan to reduce the number of patients they see, and 10 percent said they plan to work part time. Over seven percent indicated they plan to work on a locum tenens basis, which would keep them in patient care roles, but would likely reduce the volume of patients they see. Seven percent also indicated they plan to open concierge practices. In the conciergemodel, physicians typically charge an upfront retainer to a limited number of patients in return for open access to their services. Concierge medicine may offer a higher quality of care to patients who can afford it, but is likely to reduce overall patient access to physicians by making such access more expensive. In addition, 78 percent of respondents indicated they are already at full capacity or are “overwhelmed.” Asking physicians who already are overworked to work harder is no solution to the doctor shortage.

Interestingly, it is commonly observed that younger physicians work fewer hours than older physicians, contributing to the physician shortage. This is not bourne out by the survey, however, which indicates the hours worked by physicians ages 35 to 50 are virtually the same as those worked by physicians 51 and older. The survey also indicates that female physicians work approximately the same number of hours as male doctors. In speaking to physicians about why they became doctors, it is common to hear that they were inspired by a relative, mentor, or other role model who encouraged them to enter the medical field. It is therefore disturbing to note that 60 percent of physicians surveyed said they would not recommend medicine as a career to their own children or to other young people.

These trends do not bode well for the state of physician supply in the future. Survey results are particularly relevant in light of the renewed interest in health care reform brought about by the recent presidential election. Candidates from both political parties pledged to expand access to health care to virtually every American. This goal cannot be accomplished without a physician workforce that is both adequate in numbers and otherwise prepared to see a growing volume of patients. The survey strongly suggests that today’s physician workforce is unequipped for the challenges that universal access would present.

Survey responses are dramatically reinforced by the thousands of comments physicians included on the surveys—comments that reflect a deeply demoralized physician workforce. There are too many to cite here, but one comment is particularly indicative of the sentiments many doctors expressed: “Something has got to be done, and urgently, to incentivize medical students to go into primary care and help those of us who are burned out to find renewed joy in seeing patients. Malpractice, government regulations... the whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The hassles are just too burdensome.”

If there is positive news in the survey, it is the fact that physician recruiters are in a position to assist physicians and make their lives easier. Many physicians believe that the challenges and frustrations they face are universally pervasive and that their only recourse is either to retire or to cut back in some way. The fact is, however, that the pattern of medical practice in the United States is not uniform, but instead resembles a mosaic. There are differences between regions of the country and between individual practices. Recruiters who can offer doctors a refuge from uncertain reimbursement, burdensome paperwork, extended hours, high malpractice rates, and other ills (and who can convince doctors that the grass really is greener at their opportunities) stand a very good chance of succeeding in today’s problematic medical practice environment.

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