The survey, which was conducted by the Merritt Hawkins physician search firm, also found that 39% of doctors are quickening their plans to retire and cited changes in the healthcare system as a reason.
A recent American Medical Group Association survey, conducted by the Cejka Search recruitment firm, noted that retirement was the cause for 18% of the 6.8% staff physician turnover rate in 2013. But that report linked turnover to improved housing and stock prices, and noted that home and investment values that had fallen during the recession had kept doctors from moving or retiring.
The Physicians Foundation survey found that Medicare and Medicaid patients make up 49.3% of the respondents' average patient volume, but 38% said they either do not see Medicaid patients or limit the number they see and 24% said the same for Medicare beneficiaries.
“These findings further confirm that the U.S. is experiencing a shortage of healthcare providers—a serious problem that hinders patient access and puts more pressure on available clinicians who are trying to meet this pressing need,” Ken Miller, American Association of Nurse Practitioners president, told Modern Healthcare. “To better serve patients, and help ensure physicians and other providers are not overextended, more states and government bodies, like the Department of Veterans Affairs, must grant all providers, including nurse practitioners, the ability to practice to the full extent of their education and clinical training.”
On average, respondents to the Physicians Foundation survey are almost 50 years old, work almost 53 hours a week, including 10.6 hours on paperwork, and see almost 20 patients a day. One-third of respondents were female, compared to 26.4% in 2012.
Physicians age 45 and younger reported working an average of 55.8 hours, compared with almost 51.2 hours reported by doctors older than 45. When breaking down the average number of daily patient visits, the largest percentage in both age groups reported seeing 11 to 20 patients. Forty-three percent of physicians 45 and younger were in that group, while only 31.8% of doctors 46 and older saw that number of patients on an average day.
One survey commenter noted that physicians had to see more patients because of forces beyond their control.
“Physicians are slowly being squeezed out of the ability to provide the care they think is best by reducing autonomy and reimbursements,” the survey respondent wrote. “Practices will become more and more a matter of how many patients can you run through the office in a day.”
Other commenters, however, lamented the loss of volume-based payments.
“Stop this silly talk about doing away with fee-for-service,” wrote one doctor. “It will only increase the movement of physicians becoming clock-watching salarymen.”
When asked to grade the Affordable Care Act, 46% of respondents gave the healthcare reform law a D or an F, though physicians 45 and younger were more likely to give it a higher grade. Sixty-three percent of the younger group gave the ACA an A, B or C, while only 49.2% of the 46-and-older group did so.
A generational divide also emerged with EHRs, with 41.7% of the younger physicians reporting that EHR use increased quality of care, compared with 26% of the older group. Only 36.3% of younger physicians thought EHRs posed a significant privacy risk, compared to 58.4% of the older group.
The survey also found that while optimistic physicians are in the minority, their numbers are increasing. In 2014, 44.4% of responding physicians said they felt somewhat or very positive about the current state of the medical profession, compared to only 31.8% in 2012.
Similarly, 48.9% were somewhat or very optimistic about the future of the profession, compared to only 22.6% in 2012.
Most telling perhaps was that 71.3% said that if they could start their careers over they'd still choose medicine. Only 66.5% said so in 2012. Also, 49.8% in 2014 said they would recommend medicine as a career to their children or other young people, compared to only 42.1% of respondents in 2012 and 40.2% in 2008.
“The state of the physician workforce, and medicine in general, is experiencing a period of massive transition,” Lou Goodman, Physicians Foundation president, said in a news release. “While I am troubled that a majority of physicians are pessimistic about the state of medicine, I am heartened by the fact that 71% of physicians would still choose to be a physician if they had to do it over.”
As in other surveys, an over-reaching government and a micromanaging insurance industry were common reasons cited for declining physician satisfaction.
“Physicians are over-regulated and constrained, especially by insurance companies,” one doctor commented. “Requirements for pre-authorization, preferred medication lists and similar intrusions into the doctor/patient relationship are killing us.”
Some also thought demanding patients had unrealistic expectations, and they needed to take more responsibility for their own health and for the nation's rising healthcare costs.
“People should have catastrophic insurance with high deductibles,” one physician wrote. “If people had to pay out of pocket they would no longer seek care for runny noses and rolled ankles. We have become a country of wimps, and the healthcare industry promotes this for its gain.”
On a similar note, one respondent said there should be consequences for people who make bad choices in their health. These included no liver transplants for drug and alcohol abusers and no lung transplants for smokers.
One commenter railed against the 80-hour weekly work limits for doctors in residency training and said it has “created physicians who don't understand that medicine requires sacrifice.”
Another, however, suggested that the pessimists should take a deep breath and think about why they originally chose medicine as a career.
“To my colleagues, in light of the many frustrations now faced within the profession, I suggest scheduling some personal time off for the purpose of reflection and rest,” this doctor commented. “If you have lost your concern for people, consider volunteering elsewhere in the world in order to regain perspective and your original sense of priorities.”
The survey was e-mailed to 650,000 physicians (and successfully delivered to 640,000) between March and June 2014.
Founded in 2003 with settlement funds from a class-action lawsuit by 22 medical societies against third-party payers, the Physicians Foundation has awarded $31 million in grants for physician leadership training, health information technology and other healthcare-related improvement issues.
Follow Andis Robeznieks on Twitter: @MHARobeznieks