Here we go with another view into the minds of doctors, this one reflecting almost 8800 physician respondents for a survey by the Physicians Foundation. (PF Survey) The shift away from independent, owned practices is very stark in the responses; only 31% of doctors say they are an owner in their medical practice, down from 48.5% in 2012. 19% are employed by a hospital, 17% by a hospital-owned medical group, and 13% by a physician-owned medical group. 18% are in a solo practice, 38% in one that is 2-10 doctors; 28% in one that is 11-100; and 16% are in groups with more than 100 physicians. 55% say they have somewhat or very negative feelings about the state of the medical profession, but this is actually down substantially from 2012. A strong economy likely helps. And while 62% say they are somewhat or very pessimistic about the future of the profession, that also is down from 2012. 73% say if they could choose again, they would still select medicine as a profession, up slightly from prior years. And 48% said they would not recommend medicine as a profession to their children or others, which to me is a key indicator of how doctor feel. Patient relationships, at 79% of doctors, and intellectual stimulation, at 55%, are given as the leading factors for job satisfaction. EHRs are listed by 39% of physicians as the least satisfying aspect of the job, alongs with regulatory and insurance requirements, by 38% and loss of clinical autonomy by 37%. 9% say they always feel symptoms of burnout, 31% say they often do and 31% say they sometimes do. Feelings of powerlessness in regard to the health system are common; with 32% of doctors saying the profession has very little influence on the system and 31% saying it has little effect.
About 54% of physicians plan to maintain their work circumstance as it is for the next 1-3 years; 22% plan to cut back the hours they work, 17% to retire and 12% to find a non-clinical job. 58% of physicians think that hospital employment of doctors does not improve quality or cut costs, and only 13% think it does improve them. Those number perceiving hospital employment as having negative effects has grown significantly, likely reflecting more actual experience with that setting. Most doctors work more than 50 hours a week and they spend 23% of their time on non-clinical paperwork on average. They see an average of 20 patients per day. 79% say they are either at full capacity or over-extended. 22% limit or do not see Medicare patients and 32% do the same for Medicaid. These numbers have trended downward for several surveys, suggesting that the spread of Medicare Advantage and ACOs for the Medicare population, and Medicaid managed care, are keeping doctors seeing these groups. Many more doctors think that EHRs have worsened quality, cost and patient interaction than think EHRs have improved those areas; and the trend is getting more negative. Clearly an opportunity for better systems. 47% say at least some of their compensation is “value” based, but it is typically a small percent of the total. 57% of physicians say such compensation methods will do nothing to improve quality or lower costs. More tomorrow.