BY LESLIE CHAMPLIN
Recent national surveys point to better days for family physicians. The surveys indicate family doctors work fewer hours than their counterparts, their liability insurance costs haven't risen as fast, and their incomes are improving (see related story).
The survey results drew mixed reviews from FPs across the country. Many saw no change in long days, erratic schedules and stagnant reimbursement.
"I average approximately 60 hours a week, and the stress and hassle level of dealing with the hospital and patient expectations have increased 100 percent plus," said Gary Bevill, M.D., of El Dorado, Ark. "In our community, the specialists work less hours than those of us in primary care and definitely make more money."
Others found the survey results to be on target. Pennie Marchetti, M.D., of Stow, Ohio, said she worked an average of 50 hours a week while her peers in surgery, cardiology and obstetrics logged more hours. She noted, however, that subspecialists handled more emergency and higher-risk cases and were compensated "a lot more than we are. But if you compare us to other primary care physicians, we probably all work about the same."
Practice setting plays role
Others said the work hours, liability costs and income derive from individuals' choices, not the nature of the specialty itself.
"Several studies have indicated family medicine is not considered one of those specialties that's controllable," said Doug Campos-Outcalt, M.D., of Phoenix, a member of the AAFP Commission on Clinical Policies and Research. "I've always disagreed. Controlling your practice does limit where you go and the type of setting where you practice, but that's true of any specialty. A neurosurgeon in a large geographic area will also have less control over his time.
"How controllable family medicine is depends on where you practice. If you practice in a rural area, you may have less control. But it's not necessarily a rural versus urban issue, because you can work in a (rural) community health center with an agreement that stipulates when you work."
That's just what Keith Davis, M.D., of Shoshone, Idaho, did. He changed his practice to a rural health clinic and saw an improved financial return for his time.
Acknowledging his aversion to "feeding at the government trough in what is essentially a subsidized program to keep rural health care available," Davis said, "I probably should have just done it years ago. The program exists for a reason!"
Business decisions have influence
Location isn't alone in determining demand on a physician's time. Other business decisions, such as office size and structure, professional obligations beyond clinical practice, and relationships with medical peers can influence the workweek.
Physicians can lighten the load by sharing, said Dennis Perry, M.D., of Okemos, Mich. "Doing family practice involves controlling the uncontrollable. There are certainly ways to make it more tenable. Group practices, call sharing, job sharing are all ways to ease the burden of a 60-hour workweek."
Service mix affects hours, insurance rates
Moreover, many FPs have changed their clinical mix.
"It is my surmise -- read educated guess -- that a significant number of family physicians are fleeing inpatient medicine, and decreased hours are due to this," said Arthur Freeland, M.D., of Kirksville, Mo. "All of medicine is intrusive to physicians' private lives. Family medicine is less so than most. In fact, the only real reason that my practice is not controllable is that I still do -- and love -- maternity care."
Unlike some specialists, family physicians can tailor clinical services. That flexibility could contribute to the relatively mild increases in liability premiums.
In fact, family physicians across the country have dropped obstetrical or hospital care in response to malpractice premium spikes. Such a decision, though made under duress, isn't available to many other specialists. OB-Gyns who drop obstetrics or cardiologists who drop hospital care can dramatically cut into their patient loads.
"Our blessing and our curse"
Much of family medicine's angst probably stems from the perceived lack of respect by other specialties, despite FPs' dedication to high-quality care, several observed.
"I believe that those who choose family practice genuinely care for their patients and strive to make a difference in their lives," said Perry. "Not that the subspecialists don't do so, but unlike the subspecialists, we become ingrained in the lives of our practice families. That is our blessing and our curse.
"Those of us that love what we do are secure in the sense that we will always have a job. Sometimes we have to remind ourselves that even though we are one of the lowest-paid specialties, in the eyes of those we care for, we are the highest. I never -- in reflection -- regret the hours I spend or the decisions I made."
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Copyright © 2004 by
American Academy of Family Physicians.