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The Future of Healthcare

Tags: | Comments: 0 | January 29th, 2014

The Doctors Company Releases Study Surveying Doctors on the Future of Healthcare: Uncertainty and Frustration with Healthcare Reform Clear Stand Outs

The Doctors Company, one of the nation’s largest medical malpractice insurers, has released the results of a survey they did in which they asked over 5,000 physicians from across all 50 states a series of questions about the future of healthcare in the United States. The survey represents surgical specialty, non-surgical specialty, and primary care doctors relatively evenly. Respondents were 80% male and 20% female, and the age distribution was under 40 – 6%, 41-50 – 17%, 51-60 – 34%, 61-70 – 31%, and over 70 – 12%. Survey respondents were, of course, unpaid. In addition to multiple choice questions, the doctors had the option of writing in personal comments, which over 3,500 of them did, providing the surveyors with a great deal of helpful information with which to get a good sense of the mood within the healthcare community. And the mood is not especially positive, particularly when it comes to healthcare reform and the other areas it touches on—doctor patient relationships, compensation, and regulatory issues to name a few. The twin themes seem to be uncertainty and frustration.

The survey results come down to three primary categories: changes being made (or not) by doctors, defensive medicine, and the expected impacts of healthcare reform.

When it comes to what changes doctors are making in the face of new regulations and a changing market it seems as though many feel paralyzed by uncertainty. 56% of those surveyed indicated that they are not likely to change their practice models within the next five years while only 20% said they were likely to do so, and 24% didn’t select a practice model at all when asked. Further, a majority of those that are making changes to their practice model are doing so in a predictable fashion: solo doctors are going to small groups, and small groups are going to larger groups and hospitals. The trend is clear, doctors are moving away from private practice. Sadly, the sample comments provided in the report indicate that doctors feel like they have no choice in the matter but are being pushed out.

Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), both of which are means of coordinating care through voluntary organizations intended to make healthcare more efficient, communicative, and cost effective, don’t get high marks from doctors either. While many view these types of practice models as the future of healthcare (ACOs are incentivized by the government) the reality is that only about 15% of those surveyed plan to participate in ACOs and only about 10% in PCMHs. On the other hand approximately 30% definitely intend not to participate in ACOs and 40% intend not to participate in PCMHs. Many of the rest indicated confusion or lack of information about exactly what these organizations will look like and how they will work.

Another change in day-to-day practice that the survey asked about was the implementation of Electronic Health Records (EHRs). Surprisingly only 30% had fully implemented a recognized EHR system at the time of the survey, while approximately another 15% indicated that they intend to do so within the next three years. However, even those who had implemented EHR systems expressed frustration at feeling forced to do so before they were prepared to as well as at the expense involved, and what they see as a tendency for the systems to be cumbersome and bury relevant data in a sea of repetition. 17% of those surveyed indicated that they neither have an EHR system in place nor do they intend to purchase one, regardless of potential costs or fees associated with not doing so.

Defensive medicine, which is a $200 billion a year industry, certainly triggered a strong reaction among the doctors. A full two-thirds of those surveyed indicated that they do not believe that healthcare reform will reduce defensive medicine. One doctor, a nonsurgical specialist from New Mexico said, “We all practice very expensive defensive medicine. I realize I order between 5-15 unnecessary MRIs, maybe 2-3 specialist consults, maybe some unnecessary lab test weekly to prevent lawsuits.” Indeed, tort reform remains the primary concern for addressing preventive medicine in the estimation of most physicians. Another New Mexico doctor, a surgeon, put it this way: “Healthcare reform without tort reform will not change defensive medicine.”

Finally, we come to the big one. What do doctors think will be the effects of healthcare reform? Well, in a word, failure. Not all of them of course. There are those who are optimistic, but on every major diagnostic asked the responses were overwhelmingly negative.

  • 60% of physicians surveyed think that healthcare reform will have a negative impact on patient care, while only about 20% think it will have a positive impact.
  • Over 50% think that healthcare reform will negatively affect the doctor/patient relationship, while only about 11% expect a positive impact.
  • 78% said they think that healthcare reform will hurt their earnings.
  • 43% of those surveyed said health care reform was likely to lead them to retire within five years.
  • Finally, only approximately 11%, or one out of ten, of those surveyed said they were likely to recommend the healthcare profession to their children or other family members.

There were positive comments cited, such as this from a California surgeon, “Despite all the bumps in health care, [I] still believe the practice of medicine is a great and rewarding work!!” But the surveyors indicated that negative responses far outweighed the positive when it came to healthcare reform, summarizing the consensus this way: “The majority of doctors feel that the pressure to reduce costs, increase volume, and improve quality will have a negative effect.” Doctors left comments like this from a nonsurgical specialist from Kentucky, “Physicians have no input/control in providing patient care,” or this from a Michigan surgeon, “We will be moving further away from humanity-based health care and more towards the patient as a commodity. This was not the way my father practiced—nor will I. Winding down to retire early.”

All in all, the survey is a bit of a bummer, and it is saddening to see how frustrated many of you are with the current situation. On the other hand, many of the results don’t come as a surprise and resources like this are invaluable both for helping physicians to see that they are not alone in their frustrations or confusion, and for helping those in positions to help know what doctors want and need. The Doctors Company has done us all a service by highlighting and quantifying both how doctors feel and where doctors’ advocates and partners like eQuoteMD can apply our resources and attention. Read the full report here, and enjoy this video highlighting some of the survey’s key findings.

This post was written by Justin Donathan.
Justin at Google+