A new American Medical Association survey says that the portion of U.S. physicians who provide some amount of care to patients without charge or at reduced fees rose to 67.7% in 1994 from 62.0% in 1988.
However, the survey, which was released late last month, also shows that despite widespread public attention to the issue of care for the poor, nearly one-third of U.S. physicians provided no charity care at all.
The survey said that physicians are spending more time each week giving free or reduced-fee service. In 1994 they gave 7.2 hours a week, or 12.4% of working hours, to charity care, vs. 6.5 hours, or 10.6% of their total practice time, in 1990.
Asked why charity care increased, survey author David W. Emmons, an AMA economist, said, "We know the numbers of uninsured have gone up. That's got to be a factor."
AMA President Robert McAfee, M.D., said, "For many patients charity care is their only means of obtaining necessary medical care. And, until significant reform is achieved, it remains a critical part of healthcare delivery." McAfee called his own charity care as a surgeon "a routine part of my ethical responsibility to the community."
The AMA doesn't have a policy on physician charity care. In June 1992 a proposal was made that would have called on physicians to devote 10% of their time or 50 hours a year to care for the indigent. The AMA's House of Delegates, however, rejected that ethical standard. In 1990 the AMA's Council on Ethical and Judicial Affairs included this statement in its Fundamental Elements of the Patient-Physician Relationship: "Physicians should continue their traditional assumption of a part of the responsibility for the medical care of those who cannot afford essential healthcare."
AMA representatives had no information about why 32.3% of physicians reported giving no charity care.
The data in the recent report were drawn from the AMA's 1994 Socioeconomic Monitoring System survey of 4,000 nonfederal, nonresident patient-care physicians. Because the information on hours of charity care is self-reported, there is no independent confirmation of the survey's findings.
Specialties varied in their level of charity care. Some 74% of radiologists gave charity care, the highest of any specialty, followed by surgeons. The lowest were pediatricians, of whom 60% provided charity care. In general, rural doctors are more likely to give charity care than big-city doctors.
The survey also broke the data down according to nine census regions. Analyzed against 1993 physician income data collected by the AMA, the survey reveals that doctors in the West North Central region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota), who had the second-highest mean incomes by region ($198,200 yearly), were the least likely to give charity care (61.7% of physicians).
Doctors in New England, who had the lowest mean incomes ($171,500), were most likely to perform charity care (72.9% of physicians).
Doctors in the East North Central region (Illinois, Indiana, Michigan, Ohio, Wisconsin), who had the highest mean incomes in the country ($199,200), had the third-lowest rate of charity care (64.4% of physicians). East North Central was also the only region where participation in charity care registered a decline since the 1990 survey, from 67.3% to 64.4%.