Physicians are in the midst of dramatic change, affecting practice patterns, care delivery models, payment methods, performance expectations, patient relations, business relationships, incomes, careers, retirement plans – and particularly morale. Physician perceptions of changes in their profession and the U.S. health system are the focus of a recent 84-page report – 2016 Survey of America’s Physicians: Practice Patterns and Perspectives – by The Physicians Foundation.
Background on Physician Survey and Data Analysis
The survey emailed to 630,000 physicians that forms the basis for this report is conducted by Merritt Hawkins every two years. The surveyed doctors represent 79 percent of all physicians in the U.S. actively performing patient care. Not only are findings for 2016 presented in this report, but also a comparison to those of the past surveys conducted in 2012 and 2014. Survey responses for 2016 were obtained from 17,236 physicians across all 50 states.
Scope of Findings
Analysis of the survey responses—plus 10,170 written comments—enabled findings within a variety of areas, including:
- Current state of physician morale
- Physician practice plans (e.g., plans for retirement)
- Physician practice models and patterns
- Physician payment models
- Patient access to physicians
Demographics of Physician Survey Respondents in 2016
The highest percentage of respondent physicians—50.7 percent—were between 46-65 years old, and only 36.2 percent were age 45 or younger. The gender breakdown was 64.2 percent males and 35.8 percent females. Physicians who were medical practice owners, or partners/associates in a practice, accounted for 32.7 percent of survey respondents.
Meanwhile, 34.6 percent were employed by a hospital, and 23.3 percent by a medical group. Analysis of aggregated data showed the following medical practice distribution:
- Solo practice: 16.8 percent
- 2-5 physicians: 21.4 percent
- 6-10 physicians: 13.5 percent
- 11-30 physicians: 16 percent
- 31-100 physicians: 12.4 percent
- 101 or more physicians: 19.9 percent
While 35.8 percent of all surveyed physicians were female, 45 percent were age 45 or younger. In contrast—although 62 percent of surveyed physicians were male—55 percent were age 45 or younger, but 69.5 percent were age 46 or older. This distribution suggests that female physicians are not as represented among older physicians.
Medical Specialty of Physician Survey Respondents
The distribution among surveyed physicians who work in primary care was:
- Family Practice: 14 percent
- General Internal Medicine: 11.1 percent
- Pediatrics: 10 percent
Among surveyed physicians not working in primary care, the percentages associated with the top four categories were:
- Medical specialty (42.4 percent)
- Surgical sub-specialties (5.9 percent)
- Surgical specialty (5.5 percent)
- Ob-Gyn (5.1 percent – 4 percent for physicians age 45 or younger, but 5.7 percent for those age 46 and older)
Growth Value / Quality Reporting Systems and Practice Models
Question Number 18 in the survey in 2016 was, “Do you participate in any of the following value/quality reporting systems or practice models?” Analysis of aggregated responses revealed the following affirmative percentages:
- Patient Satisfaction Surveys: 74.7 percent
- Meaningful Use: 63.5 percent
- Physician Quality Reporting System (PQRS): 55.3 percent
- Accountable Care Organization (ACO): 36.4 percent
- Patient-Centered Medical Home (PCMH): 27.5 percent
Emerging Trends in Physician Practice Styles
The authors of this report perceive that physician practice styles are evolving. “Though physicians continue to practice traditional, full-time, inpatient and outpatient medicine, many doctors are choosing alternative practice styles, such as part-time practice, inpatient only positions, administrative-only positions, and temporary (locum tenens work),” according to this report.
48.5 percent of physician respondents identified as independent practice owners or partners/associates in 2012, as compared to only 32.7 percent in 2016. The overall trend found was “the evolution of medical practice away from the traditional private, independent practice model and toward the employed model.”
Citing Merritt Hawkins’ earlier Survey of Final-Year Medical Residents, the authors also note that, “70 percent of newly trained physicians expressed a preference for an employed setting in their first practice situation.” Furthermore, the authors feel that “Some physician group practices now have reached the scale and scope of hospital systems.”
Morale and Professional Satisfaction of Physicians
The main patient-focused finding presented in this report is that physician practice patterns are limiting patient access to healthcare. Overall, 54 percent of physicians in 2016 rated morale as somewhat or very negative. As the authors of this report state, “employed physicians are considerably more optimistic about the future of medicine than are practice owners.”
Physician Self-Perceptions Reflect Increased Stress
Key findings regarding physician professional self-perceptions were as follows:
- 80 percent responded that they are over-extended, with no time to see additional patients.
- 72 percent responded that external factors (e.g., third-party authorizations) significantly detracted from their capacity to deliver desired quality of care to their patients.
- 49 percent responded that they often or always experience feelings of “burn-out”.
- 49 percent responded that they would not recommend medicine as a career for their own children.
Physician Hours for Non-Clinical Duties
Among the offered response options, most survey respondents selected 6-10 hours as their time duration spent on non-clinical duties only (at 30.6 percent). However, for physicians aged 46 and older, the second-most frequent choice was 0-5 hours (at 25.9 percent). Indeed, the tabular findings suggested that younger physicians spent more time on non-clinical duties than their older counterparts.
Physicians and Least Satisfying Aspects of Work-Life
The leading responses to the survey question, “What two factors do you find least satisfying about medical practice?” were: (1) regulatory/paperwork burdens (58.3 percent of respondents), and (2) erosion of clinical autonomy (31.8 percent). Notably, the report states that “physicians spend 21 percent of their time engaged in non-clinical paperwork.”
Impact on Medicare and Medicaid Patients
“Almost one in four primary care physicians have eliminated or reduced access to Medicare patients,” according to this report. Moreover, 33.1 percent of physicians as practice owners responded that they either do not see or limit Medicare patients, in comparison to 23.2 percent of employed physicians. From 2014-2016, the percent of surveyed physicians limiting the number of Medicare patients has increased.
Only 63.7 percent of surveyed physicians in 2016 responded—in regard to Medicaid patients—that they “see all of these patients”, and 20.3 percent responded that they “limit number of these patients.” These findings showed that Medicaid patients were even more likely to experience healthcare access barriers than Medicare patients.
Value-Based Reimbursement and Physician Practices
Analysis of the survey results showed that—among physicians who are practice owners or partners—35.9 percent received compensation tied to value/quality as compared to 49.8 percent of employed physicians. However, the report’s authors note that “Even for those physicians who do receive value-based compensation, the great majority (77.2 percent) have 20 percent or less of their compensation tied to value.”
Familiarity with MACRA by Physician Type
There was a lack of familiarity with the Medicare Access and CHIP Reauthorization Act (MACRA) among surveyed physicians, with 55 percent of primary care physicians (PCPs) specifying that they were very or somewhat unfamiliar with MACRA. Meanwhile, only 20.6 of surveyed PCPs responded that they were very or somewhat familiar.
A noticeable disparity in MACRA familiarity was found between physicians self-identifying as practice owners/partners and those self-identifying as employees. While 57.5 percent of practice owners responded that they were “very/somewhat unfamiliar”, the percentage increased to 62 among employed physicians.
Electronic Health Records and ICD-10 Coding
The report found that “physicians have not bought-in” to electronic health records (EHR) and the shift to ICD-10 codes. The key finding from survey results in 2016 was that “Only 28.9 percent of physicians indicate EHR has improved quality of care in their practices.”
Moreover, “Physician opinions of EHR have not improved appreciably since the survey was conducted in 2012.” However, the authors also note that “There is a clear generational difference in the way physicians rate the effect of EHR.”
While only 3.7 percent of surveyed physicians aged 46 and older felt the shift to ICD-10 codes had increased or improved efficiency, 9.7 percent of those under age 45 felt efficiency had been increased/improved—revealing a gap between the perceptions of this shift between younger and older physicians.
Health Reform and Delivery Models
The viewpoint of the report’s authors is that “the majority of physicians remain in a fee-for-service world and are not sufficiently engaged in or supportive of the mechanisms of healthcare reform to achieve its stated aims.”
Differences Between Perceptions by Physician Age
The report authors found that “Younger physicians appear less apt to be society ‘joiners’ than do older physicians, a trend that may be tied to the fact that a higher percentage of younger physicians are employees than older physicians.”
One of the conclusions expressed in this report is that “The primary public policy and healthcare concern attached to low physician morale is the prospect of physicians modifying their practice styles in ways that reduce patient access.”
While the authors note that a physician shortage by 2025 of up to 90,400 physicians has been predicted by the Association of American Medical Colleges (AAMC), an increasing percentage of respondents from 2012-2016 said that they would seek a non-clinical job within healthcare. Additionally, 21.2 percent of surveyed physicians in 2016 responded that they would “cut back hours” in the next three years.
This complete report is available for free download here (PDF).