Every year the Deloitte Center for Health Solutions, which is the health services research arm of business consulting firm, Deloitte LLP., surveys more than 20, 000 U.S. physicians about their attitudes and opinions.
Since this survey was last conducted in 2011, the Supreme Court affirmed the Affordable Care Act (ACA) which put into place sweeping changes including new restrictions on health insurance companies and prospective expansion of health insurance coverage for 33 million Americans.
How have opinions changed since the last survey? We have the answers.
By and large, most U.S. physicians are increasingly pessimistic about the future of their profession and about the many changes they see in the market and U.S. healthcare generally.
Here are a dozen of the key conclusions from this year’s physician survey.
1. The performance of the U.S. health care system is suboptimal, but the Affordable Care Act (ACA) is a good start to addressing issues of access and cost.
Physicians are highly critical of the performance of the U.S. health care system. Only 31% give a favorable grade of “A or B”—which is down from 35% in 2011.
Defensive medicine is still a problem, but a declining one. In this year’s survey 71% said that defensive medicine was a major influence on overall health care system costs. In 2011 that percentage was a whopping 91%.
Less than half of all physicians (44%) think that the ACA is a good start. But the percentage of physicians who believe that the ACA is step in the wrong direction declined (38% in this survey and 44% in 2011)
Seven in 10 physicians are satisfied with practicing medicine. But, primary care providers (59% satisfied) are the least satisfied when compared with their specialist colleagues (63% of surgical specialists, 67% of non-surgical specialists).
Younger physicians were more satisfied than older ones (aged 25-39, 80%) and less experienced physicians were more satisfied than their more experienced colleagues (10 years or less, 73%).
Four in 10 physicians rank patient relationships as the most important element of job satisfaction followed by protecting and promoting the health of individuals (3 in 10) and intellectual stimulation (2 in 10).
Interestingly enough solo physicians are happier (61%) than those who practice with between 2 and 9 colleagues (36%) or 10+ physicians (31%).
2. Compensation is falling and clinical autonomy is evaporating.
Half (51%) of all physicians think that physician incomes will fall dramatically in the next one to three years. Significantly more solo physicians (68%) believe that their incomes will fall than those in practices of 2 to 9 physicians (51%) or 10+ physicians (44%).
Nearly half (49%) of all physicians think that capitation will replace FFS (fee for service) payments in the next one to three years.
About a fourth (26%) of all physicians believe that the sustainable growth rate (SGR) mechanism will be repealed in the next one to three years.
Six in 10 physicians say that it is likely that many of their colleagues will retire earlier than planned in the next one to three years.
Four in 10 physicians report that their take-home pay decreased from 2011 to 2012. Over half of the physicians surveyed reported having a decrease of 10%. Among those physicians whose take home pay decreased by any amount in 2012, 4 in 10 believe that it was a result of the ACA. In 2011, the last time this survey was conducted, about half (48%) of all physicians believed that their income would decrease in 2012 as a result of the ACA.
Physicians identify the trade-offs between larger (e.g., large medical groups, health systems, hospitals, and health insurance plans) versus solo practices: Larger practices are perceived to be better placed to secure superior third-party payer contracts and offer the greatest financial success potential, whereas solo practices are perceived to offer greater clinical autonomy and, therefore, personal satisfaction.
Nine in 10 physicians report that their greatest concerns about financial viability is under an episode-based (bundled) payment structure. Physicians are worried that they will not receive adequate payment for their services and that they will be penalized for factors out of their control.
Surgical specialists are significantly more concerned about inadequate payments than primary care physicians (90% versus 79%).
3. For physicians, the key to job satisfaction is patient relationships.
The greatest single element of job dissatisfaction among physicians is less time for each patient. Among primary care physicians the percentage identifying that element was 26% and among non-surgical specialists it was 21%
Surgical specialists mentioned long hours and long work weeks as being a key element of job dissatisfaction (20%).
And rounding out the top three causes of job dissatisfaction is dealing with Medicare/Medicaid/government regulations – 22%.
4. Medical liability (malpractice) reform is a major concern to physicians.
Few (1 in 10) physicians believe that liability (tort) reform will pass in Congress in the next one to three years.
More physicians who are younger (aged 25-39, 16% and aged 40-49, 15%) versus older (aged 50, 59% and aged 60 and up, 11%) believe that such reform will pass. Among those significantly more likely to believe reform will occur are physicians who work in an Accountable Care Organization (ACO) (19%) versus those who do not (9%).
5. Health insurance exchanges (HIXs) are unlikely to be ready for enrollment by the 2013 deadline.
Only 2 in 10 physicians believe that health insurance exchanges (HIXs) will be implemented by the 2013 deadline for receiving enrollment applications or that HIXs will force insurance companies out of business in the next one to three years.
6. Physicians are likely to increasingly compete with mid-level professionals in primary care.
A large majority (8 in 10) of physicians believe that mid-level professionals will play a bigger role in direct primary care delivery and that insurers will aggressively negotiate to preserve margins. Not surprisingly, 6 in 10 say that many physicians will retire earlier than planned.
7. Medicaid and Medicare reimbursements may be problematic, prompting many physicians to limit or close their practices to these enrollees.
Most (9 in 10) physicians believe that Medicaid reimbursements will not increase to match Medicare rates for primary care services in the next one to three years. If Medicare lowered payments or switched to vouchers, physicians would react. What would they do? A quarter of physicians would place new or additional limits on the acceptance of Medicare patients if there were potential payment changes to the Medicare program, such as lower payments or a switch to vouchers.
8. Physician-hospital integration expected to increase.
Although most physicians have not consolidated or considered it, 31% of the surveyed physicians report having done so in the past one to two years.
The primary reason physicians consolidated in the past one to two years was in order to gain or retain income security (29%) or leverage negotiation power with payers (21%). About two-thirds of all physicians believe that physicians and hospitals will become more integrated in the next one to three years.
9. Clinical decision-support information technologies that reduce unnecessary services and increase clinician adherence to evidence-based practices are of interest to physicians.
Nearly half of all physicians believe that when operating under a bundled payment structure the most important evidence needed when purchasing medical technology beyond safety and efficacy is the potential reduction in instances of needed care.
Seven in 10 physicians believe that physician-led, peer review of new medical technologies (covering both efficacy and value) followed by use of evidence-based guidelines (six in 10 physicians) are the leading best practices in the selection and purchase of medical technologies.
10. Electronic Health Record (EHR) adoption by physicians expected to increase.
Two-thirds of physicians say they use EHRs that meet meaningful use stage one requirements. Three in five physicians (fairly uniform among physicians by medical specialty) are satisfied with their EHR system. The majority of physicians report numerous benefits to using an EHR system including:
- Faster and more accurate billing for services (74%)
- Time saving through e-prescribing (67%)
- Communication improvement and care coordination capabilities due to interoperability (67%)
Seven in 10 (72%) of all physicians believe that in the next one to three years the majority (80% or more) of physicians will adopt EHRs.
11. Connectivity with consumers (patients) using online or mobile technologies and personal health records expected to become increasingly important to physicians.
One-third of all physicians report that they can communicate with their patients using email or texts. Just over a fourth (26%) say that consumers can be directed to trusted health care web sites. Just under a fourth of the surveyed docs (24%) say that their patients can schedule visits or access test results through a web site and 19% say that their patients can request prescription refills through a web site.
12. Incentives to address consumers’ unhealthy lifestyles can help.
The vast majority of physicians (71%) believe that if consumer incentives were widely introduced, financial ones (e.g., direct payments, reduced insurance premiums or reduced co-pays) might work best with consumers in an attempt to motivate them to engage in healthy behaviors.
Seven in 10 (70%) of the surveyed physicians agree that consumer incentives could be very helpful to achieve better treatment compliance, but fewer (55%) physicians agree that incentives are sufficiently powerful to motivate consumers to address lifestyle issues and positively change behavior.
Seven in 10 (69%) of surveyed physicians agree that consumer incentives based upon cost-sharing could be counterproductive, leading consumers to avoid or delay seeking necessary treatment.
To read the full survey; http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_chs_2013SurveyofUSPhysicians_031813.pdf
In conclusion, this year’s Deloitte survey could not be more clear. Physicians, who are the engine that runs the U.S. healthcare system, are increasingly pessimistic about their future and the future of healthcare. With declining incomes and reduced clinical autonomy, who can blame them? So, what does this mean for orthopedic clinicians and the companies who support them? That is the billion dollar question.
