Physicians fret over future

A recent report of U.S. physicians by consulting company Deloitte shows that most are worried that the future of the medical profession may be in jeopardy and that the overall performance of the healthcare system in this country is "suboptimal."

According to the “Deloitte 2013 Survey of U.S. Physicians: Physician perspectives about health care reform and the future of the medical profession” doctors in this country see many of the changes that are occurring as threats to their profession, but also believe that the Affordable Care Act is a good start at addressing many of the problems.

Yet despite the pessimistic view, the survey also found that seven out of 10 physicians are satisfied with their jobs and of those that are satisfied nearly 40 percent cite the physician-patient relationship as the most important aspect leading to job satisfaction. In addition, physicians also believe that hospital-physician integration, already well under way, will continue to increase and that Medicare and Medicaid reimbursement issues will lead to physicians either limiting the number of public payer patients they treat or will eliminate seeing them altogether.

"Physicians recognize that 'the new normal' may necessitate major changes in the profession that require them to practice in a different setting as part of a larger organization that uses technologies and team-based models for patient care," explains Deloitte Center for Health Solutions Executive Director Paul Keckley, in a press release. “Affirming unique value of the profession, open communication and information sharing, structural features that actively engage physicians in leadership roles, and persistent sharing of credible data about safety, outcomes, costs, and patient experiences are requisite to health care organizations seeking a mutually satisfying, effective business relationship with physicians.”

The report also captured the shifting views of physicians regarding new care delivery and payment models including patient-centered medical homes (PCMHs) and accountable care organizations (ACOs).

Surprisingly, between 2011 and 2012 the number of physicians who were familiar
with ACOs, episode-based payments, patient-centered medical home pilot programs or demonstration projects decreased. In 2011, roughly half of all physicians said they were familiar these programs, while just one year later only one-in-three said they were familiar with the programs.

Familiarity with the PCMH model was highest among primary care physicians at 48 percent, while for non-surgical specialists (25 percent) and surgical specialists (15 percent) PCMH familiarity lagged significantly.

The views of doctors currently working in an ACO also showed some shifts between 2011 and 2012, mostly in a positive direction. While the survey showed an increase in the percentage of doctors believing capitation will replace fee-for-service in the next three years (57 percent in 2012, versus 44 percent in 2011), the percentage of doctors concerned that factors beyond their control could lead them to be penalized under an episode-based payment structure decreased to 77 percent in 2012, 11 points lower than 2011.

In addition, there is growing sentiment that Medicaid reimbursement rates will rise in the next one to three years to match those rates currently paid under Medicare, nearly doubling to 22 percent, up from 12 percent who believed this in 2011.

The research conducted by Deloitte is the second annual survey that polls a nationally representative sample of physicians to gain insight into their perspectives on the current state of healthcare in the U.S. For 2012, Delloite used a random sample of U.S. primary care and specialist physicians selected from the American Medical Association’s master file of physicians. Six hundred ninety-three physicians completed the survey. The margin of error is +/- 3.89 percent at the .95 confidence level.

A complete report of the findings can be found here.