Category: Physicians

Physicians Relatively Happy with Their Careers

How happy are physicians with their careers?

In a recent survey of 1001 physicians,

• About 84% said they like being a physician.
• Nearly as many were happy with their choice of specialty.
• Yet, two-thirds said they used to enjoy being a physician much more than they do today.

More than half do not regret anything about their choice of a career path. However, one-in-five would choose a career outside of medicine if they could go back and do it all over again.

What bugs doctors?

• Four-in-ten believe there is too much interference by third-parties;
• Nearly 14% believe their ability to practice independently is slipping.
• Nearly three-quarters have no interest in becoming a patient-centered medical home.

About 10% are working in a direct-pay practice, while 43% are considering it. Yet, nearly 40% believe high deductible health plans and cost-sharing are a barrier to good health care for their patients.

Most docs are workaholics

• Only one-quarter work fewer than 40 hours per week,
• About 46% work more than 50 hours per week.
• Understandably, 70 percent don’t have as much personal time as they wish they had.

Only about half believe they have a good work/life balance. Just over half do not believe they can afford to sacrifice income to work less.

Physicians Report Declining Satisfaction with EHRs

This post is excerpted from an article, Physicians Report Declining Satisfaction with EHRs, from the American Academy of Family Physicians. The report was sent to us by Dr. Larry Pivnick, who authored a report on electronic health records.

“During the past decade, America’s physicians — particularly, family physicians — have invested lots of money and countless hours in implementing electronic health record (EHR) systems. Some physicians eagerly dived into the EHR pond; others were pushed by government initiatives, such as meaningful use, that were intended to spur technology uptake but that have become increasingly burdensome to physicians.”

[I]n 2010, 61 percent of respondents said they were “satisfied” or “very satisfied” with their EHRs, compared with just 34 percent in 2014.
Of physicians who responded to the 2014 survey,

  •  55 percent said it was difficult or very difficult to use their EHR to improve efficiency,
  •  72 percent said it was difficult or very difficult to use their EHR to decrease workload,
  •  54 percent indicated that their EHR system increased their total operating costs, and
  •  43 percent said they had not yet overcome productivity challenges associated with implementation of their EHR.

“From the physicians’ perspective, it appears that the significant investment in EHR system(s) over the past few years in the United States is failing to offer significant returns. Far from helping physicians to operate efficiently and have more time to spend with patients, the opposite appears to be the case.”

Source: Physicians Use of EHR Systems 2014

Medicare Accountable Care Organizations Cut Spending Two Thirds of One Percent

man-in-wheelchairThe Center for American Progress, previously a very pro-Obamacare organization, has published a study summarizing results of one of Obamacare’s most hyped tools to wring savings out of Medicare:

We first calculated overall savings by the Pioneer ACOs, finding that they reduced overall spending by 0.67 percent compared with the target amount of spending in the model’s second year.

Underwhelming, to say the least, don’t you agree?

In Forbes, Sally Pipes of the Pacific Research Institute cuts through the promotional rhetoric on ACO’s:

In the Obamacare case, the administration hand-picked the providers that could participate in the ACOs to maximize the chance of success. And even then, 13 of the original 32 organizations dropped out as a result of the program’s punishing complexity and costly regulations.

Most providers refused to join in the first place. Organizations such as the Mayo Clinic and the Cleveland Clinic — hospitals that President Obama has touted as excellent models of integrated care — declined to participate.

No wonder doctors are deeply skeptical of this model. A survey from the Physicians Foundation found that only one in ten actually think ACOs can improve quality while cutting costs.

 

The Physician Specialty Shortage

Many experts agree that the U.S. is about to face a serious shortage of physicians. At NCPA, we have endorsed broadening the scope of practice of nurse practitioners (NPs) and physician assistants (PAs).

However, these allied health professionals are most likely to be found working in primary practice. What can be done about the shortage of other specialists?

In an article at RealClearPolicy, NCPA Senior Fellow Thomas A. Hemphill and Gerald Knesek recommend changes to the training of allied health professionals:

PA programs vary in their length, and some don’t require a formal post-graduate specialty education. The basic PA curriculum should be standardized to two years, followed by one year for post-graduate didactic and clinical training in a certificate-awarded specialty, with the National Commission on Certification of Physician Assistants overseeing the process.

Where are the “Open Payments” from Government?

doctor-xray-2Well, now we know how much pharmaceutical companies and medical-device makers pay doctors for consulting and similar services. Paul Keckley aptly summarizes last week’s data dump from the Centers for Medicare & Medicare Services (CMS):

  • In the last five months of 2013, drug manufacturers made 4.4 million payments totaling $3.5B to 546,000 physicians and 1,360 teaching hospitals to encourage acceptance and use of their drugs/devices: $1.49B for research, $1.02B for ownership interests, $380M for speaking/consulting fees, $302M for royalties/licensing, $93M for meals, $74M for travel, and $128M for “other.”

Half of Doctors Give Obamacare D or F

Confident DoctorsThe Physicians Foundation and Merritt Hawkins (a physician recruiting firm) have just published their biennial physicians’ survey. The survey interviews over twenty thousand physicians in all fifty states and multiple specialties:

  • Only 19 percent say they have time to see more patients.
  • 44 percent plan to take steps to reduce services or find non-clinical employment.
  • Only 35 percent describe themselves as “independent practice owners,” down from 62 percent in 2008.
  • 53 percent describe themselves as hospital or medical-group employees, up from 38 percent in 2008.

Physicians’ Political Contributions Switched from Republican to Democrat in Twenty Years

One of the most interesting things about health politics and policy is that those mostly responsible for driving health costs — physicians — are the least concentrated interest group. If we want to know what the research-based pharmaceutical industry, the generic drug industry, the health insurers, the hospitals, or the medical-device makers want, we know where to go to find a fairly unified answer.

Physicians have no unified voice. The closest thing to a professional association for all physicians should be the American Medical Association, but it is not. It is a business that profits from a government-sanctioned monopoly on billing codes.

Paying Doctors for Performance Does Not Work

Aaron Caroll, in the New York Times:

doctor-xray-2“Pay for performance” is one of those slogans that seem to upset no one. To most people it’s a no-brainer that we should pay for quality and not quantity.

In Britain, a program was begun over a decade ago that would pay general practitioners up to 25 percent of their income in bonuses if they met certain benchmarks in the management of chronic diseases. The program made no difference at all in physician practice or patient outcomes, and this was with a much larger financial incentive than most programs in the United States offer.

Who’s Your Doctor?

Over at Forbes, Bruce Japsen reports that the Affordable Care Act is boosting demand for primary care providers. As we’ve said before, Obamacare does nothing to boost physician supply. The millions of newly insured will increase their demand for medical care — and someone has to provide it. This has caused a Gold Rush of sorts among medical practices and hospitals scrambling for primary care providers.

Physician staffing firm, MerrittHawkins reports primary care providers — family physicians and internists tops the list. The number of requests for nurse practitioners and physicians’ assistants it’s been ask to recruits is up more than three times (i.e. 320 %). Advance practice nurses and physicians’ assistants didn’t even make the top 20 of most recruited medical practitioners three years ago. Here’s the current list.

In many cases, increased use of nurse practitioners and physician assistants can provide high quality care at reduced costs. I have long advocated increasing these professionals’ scope of practice as an important part of innovation in delivering medical care. On the other hand, this should happen as a consequence of increased consumer-direction of healthcare spending, not as a response to increased government control, as imposed by Obamacare.

More Reasons Why Doctors Do Not Participate in Medicaid

doctor-xray-2This blog has many entries discussing how few doctors participate in Medicaid, the joint state-federal healthcare program for low-income people that ObamaCare expands. One reason is that fees are too low to induce doctors to participate. But even if doctors are willing to accept low fees, they find that Medicaid is the worst payer in their practices:

  • Medicaid programs have the highest number of days to collect payment (days accounts receivable): All payer average = 26 days; Medicaid average = 44 days.
  • Medicaid programs have the highest denial rate: All Payer average = 6.8%; Medicaid average = 18.5%.
  • Medicaid programs have the lowest transparency in electronic explanation of payment and adjudication of claims (electronic remittance advice): All Payer average = 95%, Medicaid average = 89.4%.