Physician Survey: Health Reform May Lead to Significant Reduction in Physician Workforce
NEJM Career Center ^ | Mar. – Apr. 2010
Posted on Thursday, March 11, 2010 12:51:53 AM by Ooh-Ah
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What if nearly half of all physicians in America stopped practicing medicine? While a sudden loss of half of the nations physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.
The Medicus Firm, a national physician search firm based in Dallas and Atlanta, conducted a survey of over 1,000 physicians to determine their expectations as to the impact of health reform on their practices, income, job satisfaction, and future career plans. In discussing career plans as part of the recruitment process, physicians have increasingly expressed apprehension and uncertainty regarding health reform’s impact on their practices, and The Medicus Firm wished to investigate this trend further. Additionally, the firm wanted to determine how doctors anticipate health reform to affect physician supply and the quality of medical care nationwide, as these are issues that will directly influence the physician recruiting industry. These factors are in addition to health reform’s more obvious impact on patients and providers of health care services. A total of 1,195 physicians from various specialties and career levels in locations nationally completed the survey.1
The results from the survey, entitled “Physician Survey: Health Reform’s Impact on Physician Supply and Quality of Medical Care,” were intriguing, particularly in light of the most recently published career projections from the Bureau of Labor Statistics (BLS). The BLS predicts a more than a 22 percent increase in physician jobs during the ten-year period ending in 2018. This places physician careers in the top 20 fastest-growing occupations from 2008 to 2018. Meanwhile, nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.
“What many people may not realize is that health reform could impact physician supply in such a way that the quality of health care could suffer,” said Steve Marsh, managing partner at The Medicus Firm in Dallas. “The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients.”
It’s probably not likely that nearly half of the nation’s physicians will suddenly quit practicing at once. However, even if a much smaller percentage such as ten, 15, or 20 percent are pushed out of practice over several years at a time when the field needs to expand by over 20 percent, this would be severely detrimental to the quality of the health care system. Based on the survey results, health reform could, over time, prove to be counterproductive, in that it could decrease patients’ access to medical care while the objective is to improve access.
Furthermore, even if physicians are unable to act upon a desire to quit medicine, there could be an impact in quality of care due to a lack of morale in physicians who do continue to treat patients despite feeling significantly stressed.
Skeptics may suspect that physicians exaggerate their intent to leave medicine due to health reform. Some experts point to the malpractice crisis of years ago, when many doctors also expressed a desire to leave medicine. Some did quit; many did not. However, health reform could be the proverbial “last straw” for physicians who are already demoralized, overloaded, and discouraged by multiple issues, combining to form the perfect storm of high malpractice insurance costs, decreasing reimbursements, increasing student loan debt, and more.
Do physicians feel that health reform is necessary? The survey indicates that doctors do want change. Only a very small portion of respondents — about four percent — feel that no reform is needed. However, only 28.7 percent of physicians responded in favor of a public option as part of health reform. Additionally, an overwhelming 63 percent of physicians prefer a more gradual, targeted approach to health reform, as opposed to one sweeping overhaul. Primary care, which is already experiencing significant shortages by many accounts, could stand to be the most affected, based on the survey. About 25 percent of respondents were primary care physicians (defined as internal medicine and family medicine in this case), and of those, 46 percent indicated that they would leave medicine — or try to leave medicine — as a result of health reform.
Why would physicians want to leave medicine in the wake of health reform? The survey results, as seen in Market Watch, indicate that many physicians worry that reform could result in a significant decline in the overall quality of medical care nationwide.
Additionally, many physicians feel that health reform will cause income to decrease, while workload will increase. Forty-one percent of respondents feel that income and practice revenue will “decline or worsen dramatically” as a result of health reform with a public option, and 31 percent feel that a public option will cause income and practice revenue to “decline or worsen somewhat” as a result. This makes for a total of 72 percent of respondents who feel there would be a negative impact on income. When asked the same question regarding health reform implemented without a public option, a total of 50 percent of respondents feel that income and practice revenue will be negatively impacted, including 14 percent of total respondents who feel that income and practice revenue will “decline or worsen dramatically.” Additionally, 36 percent feel it would “decline or worsen somewhat.”
What do physicians propose for effective health reform? In the survey, physicians were prompted to provide ideas, and some common themes emerged among the hundreds of comments. Tort reform appeared repeatedly, as did patient responsibility and ownership in their health care and costs. Additionally, many physicians emphasized a need for addressing specific issues with separate legislation, as opposed to one sweeping, comprehensive bill.
What does this mean for physician recruiting? It’s difficult to predict with absolute certainty, but one consequence is inevitable. After health reform is passed and implemented, physicians will be more in demand than ever before. Shortages could be exacerbated further beyond the predictions of industry analysts. Therefore, the strongest physician recruiters and firms will be in demand. Additionally, hospitals and practices may be forced to rely on unprecedented recruitment methods to attract and retain physicians. “Health reform, even if it’s passed in a most diluted form, could be a game-changer for physician recruitment,” said Bob Collins, managing partner of The Medicus Firm in Texas. “As competitive as the market is now, we may not even be able to comprehend how challenging it will become after health reform takes effect.”
The survey sample was randomly selected from a physician database of thousands. The database has been built over the past eight years by The Medicus Firm (formerly Medicus Partners and The MD Firm) from a variety of sources including, but not limited to, public directories, purchased lists, practice inquiries, training programs, and direct mail responses. The survey was conducted via emails sent directly to physicians.
1This article was written in January 2010. The survey was conducted by The Medicus Firm, a nationally retained physician search firm, based on the health reform legislation in process at that time.
For more information on the study’s methodology, please contact survey author Andrea Santiago, Director of Communications and Media Relations for The Medicus Firm.
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