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Report: Grim Future for U.S. Docs; Outlook Brighter in California

A national report released last week paints a grim picture of the future of practicing medicine in the U.S., but the sentiment is not universally echoed in California.

The white paper from The Physicians Foundation identifies many threats to the viability of U.S. medical practices and makes a number of policy recommendations to address them.

With comments about “dire challenges” and eroding physician morale, the authors of “The Future of Medical Practice: Creating Options for Practicing Physicians to Control Their Professional Destiny” say the problems physicians face have broad implications for the entire health care system.

In California, however, the outlook is not so dark.

A recent survey of Kaiser Permanente physicians shows the highest level of satisfaction ever among physicians in that organization, according to Kaiser officials.

Non-Kaiser family physicians in California acknowledge that the system is changing, but some of the changes are good, according to officials at the California Academy of Family Physicians.

“California’s experience is very different from the rest of the nation,” said Dustin Corcoran, CEO of the California Medical Association and a member of The Physicians Foundation.

“We’re so much further along towards the managed care model of care that many of the problems physicians face in other parts of the country are not the same as the problems we face here. That’s not to say we don’t have problems in California,” Corcoran added. “We do.”

Some California physicians are indeed facing the kinds of financial and professional challenges detailed in the report, Corcoran said.

Findings, Recommendations in Report

Lou Goodman – president of The Physicians Foundation and CEO of the Texas Medical Association – said the combination of retiring physicians and the aging baby boomer generation should serve as catalysts over the next several years to improve conditions and to make the profession more appealing to potential medical students.

“U.S. medical practices face dire challenges, which have significant implications for patients and the broader health care system,” Goodman said in a statement accompanying the report. “Given the expected retirement of as many as 100,000 older physicians in the next five years, and the impending influx of 36 million baby boomers into the Medicare program, our focus must be on creating more favorable practice conditions to attract the very best students to the practice of medicine.”

Walker Ray – vice president of the foundation and chair of its research committee – said health care reform is not helping.

“Physician morale continues to erode because of ongoing economic pressures and a failure of health system reform to address the needed improvement of the medical practice environment in any meaningful way,” Ray said. “Developing innovative practice models and adopting prudent policy measures will help to improve current medical practice conditions, which is a vital step toward sustaining patient access to health care.”

The report calls for the creation of a federal Commission for Administrative Simplification in Medicine to evaluate and reduce physician reporting requirements that do not result in cost savings or measurable reductions in patient risk.

The report’s other recommendations include:

  • Proposal for a new system of debt relief for young physicians to help them pay off education loans;
  • Development of new practice models such as patient-centered medical homes and direct-pay systems that could help diversify service offerings and improve physician productivity;
  • Elimination of a Medicare “site of service” differential that enables hospitals to charge more for physician services provided in a hospital setting than in a private practice; and
  • Reduction of hospital payments for outpatient imaging and surgical services versus the same services in lower-cost, private settings.

Kaiser’s Satisfied Docs

The Permanente Medical Group surveys its physicians each year on multiple aspects of their practice, including overall satisfaction. Results of the survey are not made public, but Robert Pearl, executive director and CEO of the Permanente Medical Group, said the most recent survey results show a high level of satisfaction among Kaiser physicians.

“The scores now are the highest they’ve ever been,” Pearl said. “On a scale of five, we’re getting an average of 4.75 across thousands of physicians. I think the reasons are pretty straightforward. Having the technology we need and being recognized on a national level for the work we’re doing is very gratifying.”

Pearl, who said the Permanente group is currently getting 10 applicants for each physician opening, said Kaiser’s integrated system gives physicians “autonomy to deliver the right care for patients every single time.”

Pearl and non-Kaiser physicians point to Kaiser’s early adoption and thorough implementation of electronic health records as a major reason the system gets high satisfaction ratings from patients, as well as physicians.

Kaiser officials suggest satisfaction levels also are high at similarly integrated systems with well-developed EHRs such as Geisinger and Mayo Clinic.

CMA’s Corcoran agrees.

“Kaiser is a good example of integration done right,” Corcoran said. “I would agree with the survey of Permanente physicians. We have quite a large presence of Kaiser docs in CMA, and from what we hear they are very satisfied with the way they’re practicing medicine.”

“In California we have a really good mixture of how to do integration right and how to do it wrong,” said Corcoran, who did not elaborate on the other side of the spectrum.

Things Looking Up for Family Physicians

Contrary to the eroding morale mentioned in the Physicians Foundation report, prospects for family physicians in California are looking up in some ways, said Steven Green, president of the California Academy of Family Physicians.

“We have not detected such a loss of morale among our members in California,” Green said.

“Medical practice is changing and thriving in many models. Physicians are a driving force behind non-governmentally supported accountable care organizations, for example, and family physicians very much support the patient-centered medical home model, which can be implemented in a variety of practice settings,” Green said.

Green said changes in how family physicians are reimbursed are attracting more medical students to primary care.

“We are seeing improvements in primary care physician pay, with a recent report by the Medical Group Management Association estimating the average income at about $212,000 a year,” Green said.

“We also are seeing a modest trend upward in students selecting family medicine as a career, both nationally and in our state.”

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