Half of primary-care doctors in survey would leave medicine

Doctors cite red tape from insurance companies, government agencies
Med school students shy away from family medicine

Shortage of primary care physicians predicted to be 35,000 to 40,000
by 2025

By Val Willingham

(CNN) -- Nearly half the respondents in a survey of U.S. primary
care physicians said that they would seriously consider getting out
of the medical business within the next three years if they had an
alternative.

The survey, released this week by the Physicians' Foundation, which
promotes better doctor-patient relationships, sought to find the
reasons for an identified exodus among family doctors and
internists, widely known as the backbone of the health industry.

A U.S. shortage of 35,000 to 40,000 primary care physicians by 2025
was predicted at last week's American Medical Association annual
meeting.

In the survey, the foundation sent questionnaires to more than
270,000 primary care doctors and more than 50,000 specialists
nationwide.

Of the 12,000 respondents, 49 percent said they'd consider leaving
medicine. Many said they are overwhelmed with their practices, not
because they have too many patients, but because there's too much
red tape generated from insurance companies and government agencies.

And if that many physicians stopped practicing, that could be
devastating to the health care industry.

"We couldn't survive that," says Dr. Walker Ray, vice president of
the Physicians Foundation. "We are only producing in this country a
thousand to two thousand primary doctors to replace them. Medical
students are not choosing primary care."

Dr. Alan Pocinki has been practicing medicine for 17 years. He began
his career around the same time insurance companies were turning to
the PPO and HMO models. So he was a little shocked when he began
spending more time on paperwork than patients and found he was
running a small business, instead of a practice. He says it's
frustrating.

"I had no business training, as far as how to run a business, or how
to evaluate different plans," Pocinki says. "It was a whole brave
new world and I had to sort of learn on the fly."

To manage their daily work schedules, many survey respondents
reported making changes. With lower reimbursement from insurance
companies and the cost of malpractice insurance skyrocketing, these
health professionals say it's not worth running a practice and are
changing careers.

Others say they're going into so-called boutique medicine, in which
they charge patients a yearly fee up front and don't take insurance.

And some like Pocinki are limiting the type of insurance they'll
take and the number of patients on Medicare and Medicaid.

According to the foundation's report, over a third of those surveyed
have closed their practices to Medicaid patients and 12 percent have
closed their practices to Medicare patients. That can leave a lot of
patients looking for a doctor.

And as Ray mentioned, med school students are shying away from
family medicine. In a survey published in the Journal of the
American Medical Association in September, only 2 percent of current
medical students plan to take up primary care. That's because these
students are wary of the same complaints that are causing existing
doctors to flee primary care: hectic clinics, burdensome paperwork
and systems that do a poor job of managing patients with chronic
illness.

So what to do? Physicians don't have a lot of answers. But doctors
say it's time to make some changes, not only in the health care
field but also with the insurance industry. And they're looking to
the new administration for guidance.

One of President-elect Barack Obama's health care promises is to
provide a primary care physician for every American. But some health
experts, including Pocinki, are skeptical.

"People who have insurance can't find a doctor, so suddenly we are
going to give insurance to a whole bunch of people who haven't had
it, without increasing the number of physicians?" he says. "It's
going to be a problem."

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index
.html


The WSJ Health care blog reports the poll findings as follows:

Here are some of the bracing findings from 11,950 primary care docs
and specialists who responded to the survey:

- 94% said the time they've devote to non-clinical paperwork in the
past three years has increased.

- 63% said the paperwork has meant they spend less time per patient.

- 82% said their practices would be "unsustainable" if proposed
Medicare pay cuts were made.

- 78% believe there is a shortage of primary care docs in the U.S.

- 49% said that over the next three years they plan to reduce the
number of patients they see or stop practicing entirely.

- 60% would not recommend medicine as a career to young people.

- 42% said professional morale is either "poor" or "very low."

- 17% rated the financial position of their practices as "healthy
and profitable."

- 6% described morale of their colleagues as "positive."