Physicians are the central fulcrum of the health care system–they are the part most trusted by patients and they control the treatment levers. They are the central actors in attempts to limit costs and improve quality. Jackson Healthcare routinely surveys physicians about issues and recently asked questions of over 2,000 physicians on each of three separate surveys. (Jackson Survey) Among some of the key findings are that many physicians are leaving private practice; some to retire but most to be employed in another setting. Reimbursement pressure and regulatory and payer hassles are the main reasons. Just over half of physicians are still in a private practice setting. A significant proportion, 34%, plan to leave practice in the next ten years, with 14% saying they will do so in five years. That is a lot of doctors to replace, at a time when demand is expected to increase.
While 82% of practices currently treat Medicare patients and 74% Medicaid ones, and most practices said they have more capacity, many are unwilling to take new patients, especially Medicaid beneficiaries, where only 64% said they will accept more. Primary care doctors were most unlikely to take new Medicare patients and more than half of many specialists said they would not see new Medicaid members. Almost two-thirds of practices don’t use nurse practitioners or physician assistants, indicating ample opportunity to raise capacity at a lower cost. Only a small percentage of physicians are participating in either ACOs or medical homes. There is a fair amount of variation in this by region and by specialty. Physicians are very negative on the federal reform law, with those saying they were very knowledgeable being the most negative. Doctors, correctly, believe the act will neither lower costs nor improve quality.