Judging by the pulse of the industry, there's a growing "silent exodus" of physicians from the profession, according to the results of a recently released survey. And if the trend continues, 44,250 full-time-equivalent doctors could be lost in the next four years, amounting to 91 million fewer patient encounters annually.
Those were some of the dire results of a new survey by The Physicians Foundation, a nine-year-old nonprofit advocacy group based in Boston. With the help of the consulting firm Merritt Hawkins, the foundation polled some 13,575 physicians by email earlier this year, and found a workforce that's largely jaded, pessimistic and feeling powerless.
Walker Ray — vice president of the nonprofit, chairman of its research committee and a retired pediatrician — believes this isn't just the usual grousing.
"This survey is about more than professional grumbling," he told me by phone recently. "Physicians are just as concerned about this as any patient, even more so. Remember that physicians are patients also. Physicians have families. I've got seven grandchildren, and I won't be able to have the best medical care, like has been given in the past."
According to the results, doctors are working fewer hours than the past, and seeing fewer patients. More than half of respondents said they plan to work less in the next few years, cutting back on appointments, dropping to part time, exploring concierge medicine, retiring or taking on nonclinical positions at hospitals.
Unable to brave it alone, many physicians are shacking up at hospitals to gain the comforts of being employed. But Ray said that isn't necessarily a good thing for patients. Doctors are more likely to stay late for an extra patient or two, he believes, than a physician who works for a hospital (their studies show about three or four fewer visits a week). If 100,000 docs transition to an employed setting in the next four years, that could amount to 91 million fewer patient visits, because of those lost encounters, the foundation estimates.
"They're more productive. They work for themselves, they work a little bit harder, they work a little bit longer, and they see more patients," Ray said, later adding, "it's just human nature that, when you are in that type of a model, you may not be quite as productive as if you were self-employed."
Those with public insurance are seeing additional roadblocks to maintaining their doctor-patient relationship, according to the survey. Some 52 percent of physicians have or are planning to limit access to their practice by Medicare patients. And 26 percent aren't accepting Medicaid, both for reasons including time constraints, dipping reimbursements and escalating practice costs. "It costs more to see the patient than you're receiving in reimbursements," Ray said. Defensive medicine and an aging population were cited as the two top factors, respectively, driving up expenses.
Doctors are increasingly getting pulled away from their patient relationships, despite the fact that they're the most satisfying part of the profession, said 80 percent of those surveyed. Blogger and physician Rob Lamberts wrote a provocative piece earlier this month, titled "The Doctor-Patient Relationship is Over," about his decision to move to a direct-care practice, stop taking insurance, and only see 1,000 patients.
Overall, a cloud of gloominess seems to be hanging over the PCP field, judging by the report. Some 77 percent of those polled are pessimistic about their profession's future. Eighty-two percent feel powerless in changing health care. More than 84 percent feel their line of work is in decline, and almost 58 percent would be hesitant to recommend working as a doctor to their kids.
"The level of pessimism among America's physicians is very troubling," Lou Goodman, president of the foundation and CEO of the Texas Medical Association, said in a press release, later adding, "we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine."