Docs aren't happy, and if docs aren't happy ...

U.S. doctors seem to be fed up. Within the next three years, a new survey shows, almost half are considering cutting back on patients or simply halting their practice. Already, more than three-quarters say, there's a shortage of primary care doctors.

The responses from 12,000 U.S. physicians indicate they're spending more time on paperwork, which is  causing them to spend less time with patients. Frustration has ensued. Declining reimbursement rates are another problem, with some doctors saying they could eventually close their doors if proposed Medicare cuts become real.

The survey was released by the Physicians' Foundation, whose website says it seeks "to advance the work of practicing physicians and to improve the quality of health care for all Americans." Of course, disgruntled docs may be more likely to respond to such a survey than their more sanguine colleagues,  but the issues cited in the survey are well established.

The American Medical Assn. is now trying to combat the primary care physician shortage, for example.

Says the blog Kevin, M.D.:

"Those that think the mid-level providers like nurse practitioners and physician assistants can pick up the slack are sadly mistaken, since these providers see the writing on the wall and want no part of the primary care morass. They're not stupid."

Adds the blog GruntDoc, in reference to the 49% of physicians who are considering cutting back:

"Just half?"

Here's the full report. And the key findings.

-- Tami Dennis

Comments

[Greed Monsters]

It is a specious argument that insurance companies cause doctors to be short on time and care for patients.

Our doctors dropped insurance participation and demand (pricy) cash payments. This would at least be ok if it allowed for proper care and more time.

The fact is these doctors behave NO DIFFERENTLY than they did when they participated in insurance plans.

They are just as rushed and rude and, unfortunately, negligent. However, they should be commended for at least not being hypocrites. The participating doctors whine about insurance, but they don't have to take insurance. But they want their cake and to eat it too. They want the guarantee of steady income but whine about the terms.

Additionally, the doctors in lucrative cash fields like plastic surgery and fertility are also very rushed and very substandard in care.

Doctors need to stop hiding behind and blaming insurance companies.

THE PROBLEM IS DOCTORS, NOT INSURANCE COMPANIES.

Unfortunately, the Medical Board is going to allow even more neglient behavior than it already does using the argument that if it disciplines pcp's it will worsen the shortage.

The free market will not permit this shortage for long. There will be too many dermatologists and plastic surgeons and fertility doctors, and doctors will gravitate back to pc.

[Rob5289]

Unfortunately, in recent years physicians have isolated themselves from their patients by 1) reducing the time of an average visit to 10 minutes, and 2) putting layers of management between themselves and their patients. As a result, physicians have become focused on how much money they can make, and in the process lose contact with their patients and lose the idealism they had when they chose medicine as a career. It is very sad.

[Jose]

Oh boo hoo. I can't believe these whiny docs talking about how hard it is for them to practice. They obviously have never had to stood in an unemployment line. A recession proof field, and they still act like babies.

[Son of a doctor]

The funny thing is, a lot of people love to complain about how impersonal and greedy doctors are without ever once talking to a doctor. I've been around physicians all my life, and to say most of them don't care about patients or are in it just for the money is simply ludicrous. Your primary care physician in private practice is so greedy, right? Well, turns out he could make a whole lot more money working for a hospital, with even less personal contact with the patient and a lot less paperwork thanks to a dedicated, cost-shared staff. That goes double for specialists, who can usually get a much better compensated and much more cushy job by simply dropping out of private practice. The fact that any doctors remain in private practice is a little shocking, and really shows just how patient-centric most doctors are.

You can complain about short visit times and long lines, but when your doctor has to double the number of patients they see every 2 to 3 years to keep up with the rise in malpractice insurance costs and declining insurance payments, blaming them is more than ignorant.

And you, Mr Jose, perhaps if you could form a coherent and well-written thought, you wouldn't have to "stood" in unemployment lines either.

Final thought: Think doctors make too much money? You're welcome to stay home and tough it out. Most doctor visits aren't for life-threatening conditions, so feel free to not bother your already over-worked and under-appreciated physician. They and their staff thank you in advance.

[Thomas W LaGrelius MD FAAFP]

Many of the problems of high cost and poor access have to do with the virtual destruction of primary care over the past forty years. That resulted from well intentioned but misguided activities of government, employers and some insurance companies hoping to “fix” health care without ever asking doctors and patients in the trenches how that might be done. The beginning of a solution is the restoration of adequate primary care. The question is how to do this.

Most now agree that patient centered primary care medical homes for all Americans are indeed the solution, but how do we pay for them? Thousands of doctors have learned the way to do just that. By limiting our practice size to 1000 patients or less and charging a periodic fee around $100 per month to each of these patients directly (direct practice) the patient centered primary care medical home becomes a vibrant reality. I know. I run one and have the honor of heading a national organization of doctors who run such direct practices.

In these practices patients are seen immediately when ill, on time and at length. They stop going to emergency rooms because they can find their doctor and get care from him or her directly at any time 24/7/365. Our data demonstrates up to 80% reductions in hospitalizations, which if applied to all Americans would mean our hospitals would work again without having to build more ER rooms and inpatient beds. This results in huge savings

Most patients today with multiple medical problems have multiple doctors, one for each problem. Direct practice primary care medical homes take care of most of these problems in one place and all at once, eliminating the need for many of these consultants entirely and reducing the frequency of visits to many more, resulting again in more huge savings.

Students who see how cheerful, well paid and professionally fulfilled are such direct practice doctors gain hope that they too can have such a practice. We need 400,000 such practices in the if we are to care for our population properly. Currently the numbers of primary care doctors are rapidly dwindling and only eight percent of medical students elect any primary care pathway. Not long ago that figure was 50%. Short of coercion no system except direct practice primary care medical homes will draw the students we need.

My national organization SIMPD is having its annual meeting at the Marina Marriott Hotel in San Diego May 6-9 and I invite any of you who are interested in solutions to these problems to come to discuss these ideas. One of our board members Steven Knope, MD recently authored an excellent book titled "Concierge Medicine--The New System to Get the Best Healthcare" and I recommend it to you highly.

Sincerely,

Thomas W. LaGrelius, MD, FAAFP

President SIMPD, The Society for Innovative Medical Practice Design, http://www.simpd.org

Owner, Skypark Preferred Family Care, Torrance , CA http://www.skyparkpfc.com

[John Standish]

Doctors do make too much money, and we should cut their reimbursments drastically. Let them threaten to close up shop. We should call their bluff now. What are they going to go do to make as much money as they do now? I would like to hear the answer to that. They won't close their doors because they can't make half as much doing anything other than what they do now.