 |
Your Voice >
Where Expectations Meet Frustration
Physicians wonder: what has happened to focusing the
practice of medicine on patient care?
By Pamela mckemmie
“Give the practice of medicine back to the physician.”
“Get rid of lawyers, HMO, Managed Care Medicine and federal regulations.”
“Eliminate the hassles of getting reimbursed for an honest day’s work.”
“Malpractice issues—stop [the] practice of defensive medicine.”
“Free medicine of the stranglehold that the insurance industry has on
reimbursement and practice styles.”
These are just a few of the more-than-2,000 open-ended comments we received in
summer 2007 when we asked physicians what one thing they would change about
practicing medicine if given the chance.
Out of almost 2,400 physicians responding to LocumTenens.com’s 2007 national survey, only 3 percent said they were not frustrated by
nonclinical aspects of practicing medicine. The remaining respondents
identified with a list of possible frustrations as follows:
• Reimbursement issues - 29%
• Administrative and business agendas interfere with clinical decisions - 22%
• Medical liability issues - 19%
• Lifestyle issues: Too much time at work - 15%
• Federal regulations, policies, procedures - 8%
A comparison of our last two year’s physician survey results indicates an increasing level of frustration among
physicians, since 6 percent of the more than 2,800 physicians responding to the
same question in 2006 said they were not frustrated by nonclinical aspects of
practicing medicine. That comparison also suggests that reimbursement is a
growing concern, with 29 percent of 2007 respondents indicating reimbursement
was what frustrated them most about practicing medicine today, compared to 22
percent of 2006 respondents.
[It was a close call, but Congress recently staved off a 10.6 percent reduction
in payments to physicians who treat Medicare patients by overriding a
presidential veto of legislation to delay the cut for 18 months.]
Contrast the increasing level of physician frustration with a sample of
physicians’ survey responses regarding what they like most about practicing medicine:
“The people-to-people interaction and the thrill of the diagnosis and treatment
thereof.”
“Getting to know the patients and finding an interesting disorder that would
otherwise have been missed.”
“The challenge of solving problems for people. I can actually see that I am
making a difference in the community.”
“I like to solve the puzzle and make people feel better. I enjoy the teaching
part.”
“Being given the privilege of providing a highly skilled and rewarding service to
those in need of medical attention.”
It’s evident that their frustration lies primarily with the “business” of practicing medicine, not with actual patient care.
PHYSICIAN FRUSTRATION WELL-DOCUMENTED
In a recent essay published online by the New York Times, Sandeep Jauhar, MD,
described a conversation with a fellow cardiologist that began with the latter’s saying, “I love being a doctor but I hate practicing medicine.” To illustrate his contention that his work was never done, the colleague
pointed to the stack of five large manila packages on his office shelf that
represented reports he still had to finish that day. “As a physician, I could empathize. I too often feel overwhelmed with paperwork,” Jauhar said. “But my friend’s discontent seemed to run much deeper than that. Unfortunately, he is not
alone. I have been hearing physician colleagues voice a level of
dissatisfaction with medical practice that is alarming.”
Almost 60 percent of the 1,250 physicians responding to a 2006 survey from the
American College of Physician Executives said they had considered leaving
medical practice over discouragement with the state of U.S. healthcare. Nearly
70 percent of survey respondents said they knew at least one physician who had
done so already. The top five contributing factors cited by survey respondents
were:
1. Low reimbursement
2. Loss of autonomy
3. Bureaucratic red tape
4. Patient overload
5. Loss of respect
UNIVERSAL HEALTHCARE THE FINAL STRAW?
With events like these as a backdrop, the suggestion that a significant portion
of U.S. physicians anticipates even greater frustration from universal
healthcare is hardly surprising.
That is the upshot of an early 2008 physician survey on healthcare reform
conducted by physician recruiting firm LocumTenens.com. Among almost 1,400
respondents to our survey, more than 20 percent said they’d stop practicing medicine if universal healthcare coverage is implemented under
the new president. While 63 percent said they would continue practicing like
they do today, 11 percent indicated they would change occupations and 9 percent
said they would retire.
Among the 17% of physician survey respondents who provided an “other” answer to the question of what they’d do if universal healthcare is implemented were some who said it would depend
on how universal coverage is structured. Three percent said they’d adapt their practices or practice less than they do today, 3 percent said they
were not sure what they would do, and 1 percent said they would stop accepting
insurance and go to a fee-for-service reimbursement model.
PHYSICIAN SHORTAGE AN INCREASING CONCERN
Data from government sources, the American Medical Association (AMA), the
Council of Graduate Medical Education (COGME), and physician specialty
associations indicate there has been a growing “silent shortage” of physicians in a number of specialties for the past few decades.
AMA data show that 318,459 physicians, or 44 percent of the total population of
physicians in patient care as of year-end 2006, are age 55 or older. For
example, the mean age of U.S. radiologists is 61.7, according to the AMA. The
mean age of physicians practicing psychoanalysis is 70.6, while the mean age of
psychiatrists is 52.5.
