Policy

Doctors Don't Have To Quit To Become Less Accessible

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I wrote a week ago about a survey revealing declining morale among physicians and a desire by a majority of them to scale back their practices or even leave medicine entirely. I received some very thoughtful, well-considered responses, which essentially boiled down to: "Those rich bastards should suck it up and treat our boo-boos for whatever we choose to pay 'em. They can't afford to quit, anyway!" This is, of course, a compelling argument. It's also unlikely that a large percentage of physicians, no matter how demoralized, will abandon medicine en masse, both because of economic concerns, and because it's hard to abandon a career in which you've invested many years of life. But even if none of those unhappy physicians abandon ship, it's undeniable that the healthcare industry is moving in a direction that will leave patients scrambling for access to doctors.

Most people agree that demand for physicians already outstrips supply in many areas, and that the problem is likely to get worse. The Association of American Medical Colleges says there was a national doctor shortage of 13,700 in 2010, predicted to grow to 130,600 (PDF) by 2025. Even allowing that the AAMC has an interest in recruiting eager new students to its pricey campuses, there seems to be  too few doctors to go around, with demand likely to grow for that limited supply. But even if the numbers of doctors don't fall as short as predicted, the number of patients they see very likely will. That's because doctors are pulling down their shingles and taking salaried jobs with hospitals and other employers, and as they do so, they see fewer patients in any given day.

According to American Medical News:

Hospitals directly employ about 20% of practicing physicians, according to the American Hospital Assn. Many other physicians are employed in group practices owned by health systems. The proportion of doctors in independent practice is now a minority, says the MGMA-ACMPE, the entity formed by the merger of the Medical Group Management Assn. and the American College of Medical Practice Executives. That matters because hospital-employed physicians work fewer hours and see fewer patients than do independent doctors, the foundation's survey showed.

Employed physicians averaged 53.1 hours a week, compared with 54.1 for doctors in private practice. Employed physicians saw 17% fewer patients — 18.1 a day­ — compared with 21.9 a day seen by practice-owning doctors. Slightly more than 20% of employed doctors worked fewer than 40 hours a week, compared with 18.4% of physicians with an ownership stake in their practice. More than 60% of physicians younger than 40 are employed by a hospital, physician group or other entity.

"We know that an employed physician is less productive than a practice owner," said Smith of Merritt Hawkins. "Physicians are looking for a safe harbor [in hospital employment], for someone to say, 'I think I see what's coming, and I can mitigate this risk for you.' "

That makes sense. Few people work as hard for other people as they do for themselves. And that temptation to slack off, just a little bit, represents patients unseen. The migration of physicians from independent, private practices to employed positions has been continuous as the challenges of dealing with red tape and both public and private insurance have risen. There are no signs of those difficulties easing in the near future, so the trend of employee-doctors will likely continue.

And, yes, that means it will be harder to get in to see your doctor.