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March 26, 2010

Great Physician Exodus?

Joe Charlebois

If a recent survey is accurate, then the eventual care of patients will fall more and more upon the shoulders of physician assistants, nurse practitioners and far fewer doctors.


The Medicus Firm, a nationally recognized physician recruiting group based out of Atlanta, GA, and Dallas, TX, released the results of their December 2009 survey of 1,195 physicians. The survey, which had a response of over 53%, produced some surprising and startling results.


The doctors who responded were described as primary care physicians (family practice, internal medicine, or pediatrics) and specialists, 34.3% and 65.7% respectively.


Sixty-seven percent of the respondents have between 1 and 20 years of experience. The other respondents are either in training or have over 20 years of experience under their lab coat.


The survey was produced at a time when the “public option” was still a prominent fixture in the House of Representatives legislation. The survey does reflect the opinions of these physicians with and without the “public option.”


Even without the “public option,” 40.1% of physicians stated that the Quality of Practice would decline or worsen with only 13.8% stating it would improve. Forty-six percent of the same physicians predict a decline in Satisfaction with only 14.2% predicting an increase. Without the “public option,” 50% see a decrease in Income and Practice Revenue, only 10% see an increase.


A majority of respondents – 56% – foresee the Supply of Physicians decreasing (14% dramatically) while only11% see it improve. Quality of medical care would decrease said 54% of respondents, only 12% feel that quality would increase.


Even though the “public option” isn’t in the current legislation, the responses from the respondents to the same five items – Quality of Practice, Satisfaction, Income and Practice Revenue, Supply of Physicians and Quality of Medical Care – become polarized.


As the survey was done by a physician recruiting group, the last two questions focus on the movement of physicians in and out of the market.

The last two questions were worded as such:


“How do you think the passage of health reform (WITH or) WITHOUT a public option would affect your professional/practice plans, if at all?”


The responses are instructive. The healthcare reform package – without the public option – wouldn’t change 70% of respondents’ plans, but 22% would try to retire early and 8% would try to retire early even if not at retirement age. With the “public option,” the numbers change drastically. The number of physicians who wouldn’t change their professional/practice plans drops to 53%. Those looking to retire prior to retirement age jumps to 21%!


At the time of this writing there is already conversation that reconciliation will add the previously dumped “public option.” According to The New York Times, March 24, 2010, Democrats in both the Senate and House of Representatives are looking into ways to amend the recently passed bill to create a true socialist-style program.


Whether Congress adds the “public option,” physicians will be less likely to put up with the changes.


They will be reimbursed less. They will need to hire office help to process all the new paperwork demands that this plan will demand. They will need to work even more hours to make the same income and provide the same benefits to their employees. They will drop government subsidized patients as each office visit means dollars lost. As reimbursement dollars decrease and costs go up, it makes no economic sense for the practice to see these patients.


Physicians currently see many patients at little to no cost. They take trips to foreign countries to donate their time, expertise, money and medical supplies to take care of those that truly have little to no medical care.


Physicians are small business owners. They have to meet payroll. They have to pay for school loans. They have malpractice insurance to pay. They cannot afford to lose money.


If they can’t make it as independent small business owners due to overt governmental interference, what benefit is it to them to run a charity that loses money?


I don’t blame the large percentage of physicians for considering leaving the medical field prematurely. It makes too much sense.


God bless our medical community, they’ll need it.


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