The Center for Studying Health System Change has released results of a survey of about 4700 practicing American physicians. (Center Study) A plethora of interesting and useful facts are found in the report. For example, almost 40% of physicians practice in groups of five or fewer doctors. Other studies have suggested that these small practices tend to have little capital for health information technology, less time to work on practice transformations and in general may be slower to participate in programs which might improve quality and lower costs. Thirteen percent work in hospitals and a little less than half of those work in office or clinic settings. Hospital-based physicians may face pressure to increase utilization of hospital-related resources to maximize system revenue, which likely does not aid health cost reduction efforts.
Primary factors in physician compensation are productivity and overall practice performance. Fewer than ten percent of physicians say use of resources was an important factor in their compensation, about 13% said quality of care measures were important factors and 15% said patient satisfaction surveys were. In light of these numbers, it isn’t surprising that it has been difficult to see significant quality and cost improvement across the national system. Most physicians are at least somewhat satisfied with their careers. Thirty percent of physicians make more that $250,000 a year. As McKinsey and others have shown, American physicians are significantly better compensated than doctors in most developed nations, which accounts for a significant amount of our higher health costs.
The doctors said about half their revenue came from Medicare and Medicaid. Only about half of physicians are accepting most new Medicaid patients, about three-quarters were taking most new Medicare patients and almost 90% take new privately insured patients. At a time when Medicare and Medicaid are under substantial funding pressures, it would appear that those payers also need to figure out how to encourage physicians to see more of the patients which those programs cover, probably through payment increases, which conflicts with the need to reduce costs in those programs.