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Survey: Healthcare Reform, IT Burdens Play Key Role in Reduced Physician Morale

September 27, 2016
by Rajiv Leventhal
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Docs are burnt out and don't feel supported as healthcare looks to transform its ecosystem
Across the U.S., physician morale is down, with leading contributors including regulatory/paperwork burden, dissatisfaction with electronic health records (EHRs), and doubts about the future of healthcare reform, according to a survey of 17,000 doctors commissioned by the Physicians Foundation. 
 
Overall, U.S. physicians continue to struggle to maintain morale levels, adapt to changing delivery and payment models, and provide patients with reasonable access to care. The combination of these factors leaves a majority of physicians feeling that they lack time to provide the highest level of care, according to the biennial survey from the Physicians Foundation, an organization that aims to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients, and by Merritt Hawkins, a physician search and consulting firm. The survey was sent to every physician in the country who is in the American Medical Association's (AMA) Physician Master File. 
 
The survey data indicates that the majority of physicians are not convinced to sufficiently engage or support the mechanisms of healthcare reform to achieve its stated aim of transforming healthcare from a system driven by the volume of services to one focused on the value. Indeed, only 43 percent of physicians surveyed said their compensation is tied to value. Of these, the majority, (77 percent) have 20 percent or less of their compensation tied to value. Additionally, only 20 percent of physicians surveyed are familiar with the Medicare Access and CHIP Reauthorization Act (MACRA) which will greatly accelerate value-based payments to physicians. These results are similar to a Deloitte Center for Health Solutions survey from this summer which found that half of surveyed physicians have never heard of MACRA, while 32 percent only recognize the name "MACRA." 
 
Another perceived barrier is the new ICD-10 system, which last October added thousands of new codes intended to allow physicians to be more efficient, bill more precisely and improve patient care. However, the majority of physicians have not yet realized these benefits. Most surveyed indicated that ICD-10 has had little to no impact in practice efficiency, revenue or patient care.  
 
Similarly, physician's opinions of EHRs have not improved, with even more physicians stating that it detracts from patient interaction compared to findings of the 2014 survey. Only 11 percent of respondents indicated EHR has improved patient interaction, while the remaining 89 percent say it has had little or no impact or has detracted from patient interaction.
 
What's more, physician assessments of accountable care organizations (ACO), which covers 15 percent to 17 percent of the U.S. population, have not changed appreciably since the earlier 2012 biennial survey. The percent of physicians that agree ACOs are likely to enhance quality and lower costs decreased, while there was an increase in physicians who feel ACOs are unlikely to increase quality or decrease cost.
 
All of these things and more are leading to doctors feeling overburdened, per the survey results. According to the research, titled "2016 Survey of America's Physicians: Practice Patterns and Perspectives," 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains steady with the findings reported in the 2014 survey from the Foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative, with 49 percent saying they are either often or always feeling burnt out.
 
In response to these and other challenges, 48 percent of surveyed physicians plan to cut back on hours, retire, take a non-clinical job, switch to "concierge" medicine or take other steps that will further limit patient access—an increase from those who answered similarly in the 2014 survey. These patterns are likely to reduce the physician workforce by tens of thousands of full-time equivalents (FTEs) at the time that a growing, aging and more widely-insured population is increasing overall demand for physicians.
 
"Many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles," Walker Ray, M.D., president of the Physicians Foundation, said in a statement. "By retiring, taking non-clinical roles or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce. This trend is to the detriment of patient access. It is imperative that all healthcare stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment."
 
And, regarding the impact of physician morale on patient access, this survey (conducted biennially since 2008) has consistently demonstrated that the professional morale of physicians is declining. In addition to challenges in morale, 63 percent of those surveyed are pessimistic about the future of the medical profession. About half of survey respondents would not recommend medicine as a career to their children. Close to one-third would not choose to be physicians if they had their careers to do over. This sentiment has larger implications outside of the profession itself, given that physicians manage larger clinical teams comprised of nurse practitioners, physician assistants and more who also play a pivotal role in healthcare economics.
 
Physicians identified regulatory/paperwork burdens and loss of clinical autonomy as their primary sources of dissatisfaction. Respondents indicated that they spend 21 percent of their time on non-clinical paper work duties, while about two-thirds (72 percent) said third-party intrusions detract from the quality of care they can provide.
 
The data also revealed that again, the physicians' primary source of professional satisfaction is the patient relationship. In the 2016 survey, 74 percent of respondents listed this as the most satisfying aspect of their jobs, followed by "intellectual stimulation" at 59 percent. Similarly, in a patient survey commissioned by the Physicians Foundation earlier this year, 95 percent of patient respondents reported they were satisfied or very satisfied with their primary care physician's ability to explain information in a manner they understand, while 96 percent feel their physicians are respectful of them. Physicians noted that issues such as a lack of clinical autonomy, liability concerns, struggle for reimbursement and decreased patient face-time can all negatively impact the patient-physician relationship—thereby undermining physician satisfaction.  
 

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