Survey finds veteran physicians generally dissatisfied

Approximately one-third of physicians practicing today are between the ages of 50 and 65, and according to the results of a recent survey, they’re not exactly pleased with the current state of their profession or the next generation of doctors. Three-fourths of the 436 physicians responding to Merritt, Hawkins & Associates’ 2004 Survey of Physicians 50 to 65 Years Old (available at http://www.merritthawkins.com/merritthawkins/surveys.jsp) said medicine has become less satisfying in the past five years, a 22-percent increase since the survey was last fielded in 2000. Sixty-four percent viewed physicians trained today as less dedicated and hardworking than past generations of physicians, and only 36 percent said they would encourage their children or other young people to choose medicine as a career.

Malpractice worries topped the list as the single greatest source of professional frustration for 28 percent of physicians, jumping from 6 percent in 2000. Citing a general dissatisfaction with medicine, 51 percent of physicians said they planned to make some change in their practice situation in the next few years, including retiring, closing their practices to new patients or significantly reducing their workloads.

Despite their declining satisfaction with the medical profession, almost half of the physicians surveyed agreed that the quality of patient care had generally improved over the past 20 years, and the majority still consider patient relationships to be their single greatest source of professional satisfaction.

Physicians support single-payer system, less paperwork, says survey

Nearly two-thirds of physicians believe a national single-payer health care system with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system, according to a survey of 904 Massachusetts physicians published in the Archives of Internal Medicine. Psychiatrists and primary care physicians indicated the most support for a single-payer system; surgeons indicated the least support. Only half of respondents thought that most of their colleagues would support a single-payer system.

Sixty-seven percent of respondents said they would accept a 10-percent reduction in fees in exchange for a substantial reduction in paperwork, and only a few respondents said they believe that the insurance industry should continue to play a major role in the delivery of health care. These findings suggest that "administration, billing, and referral paperwork is a substantial concern," according to the authors.

The authors acknowledged the possibility that support for a single-payer system might merely reflect physicians’ dissatisfaction with the status quo.

A growing problem

Forty-one million Americans have no health care insurance and, despite more than a decade of managed care, medical costs continue to increase rapidly. According to a new report from the Center for Medicare & Medicaid Services, U.S. health care spending in 2003 is projected to have increased to about $1.7 trillion (or $5,808 per resident), but the health care spending growth rate is expected to have decreased for the first time in six years to 7.8 percent (compared to 9.3 percent in 2002). Still, health care costs continue to outpace inflation, meaning more people will find that they simply cannot afford health care or insurance, say economists.

Practice Pearls

Creating a patient-centered culture in your practice

Demonstrate that your practice’s culture is focused on your patients by implementing a few of these steps in your office:

• Relate stories of exceptional patient service, especially those that went above and beyond the call of duty.

• Post any feedback from patients and display it in a public place.

• Work with your staff to map out on paper an ideal patient visit.

• Add a patient to each of your quality improvement teams.

- Clinical Microsystem Action Guide.http://www.clinicalmicrosystem.org/actionGuide.htm. Accessed Feb. 16, 2004.

Re-evaluate your meetings

Meetings can offer an effective forum for presenting information and discussing ideas, but in excess they can damage your group’s productivity. To prevent that, follow the lead of Joe Weller, CEO of Nestlé USA. "Meetings waste time and sap people’s energy," he says. "They slow us down." Weller has imposed a rule that prohibits employees from conducting meetings after 10 a.m. on Fridays so that they are free to strategize and set priorities for the week ahead.

- Breen B. Change is sweet. FastCompany. 2001;47:168.

MEDPAC recommends a 2.5-percent update for physicians in 2005

The Medicare Payment Advisory Commission (MedPAC) will be unanimously recommending a 2.5-percent increase in Medicare payments for physicians in 2005 in its March 2004 Report and Recommendations to Congress. The commission, which based the increase on the Center for Medicare & Medicaid Services’ projected inflation rate of 3.4 percent less 0.9 percent for projected productivity growth, made the same recommendation last year. Even if Congress doesn’t support MedPAC’s recommendation, the physician update for 2005 will be no less than 1.5 percent, according to the recently passed Medicare Prescription Drug, Improvement and Modernization Act.

“Understanding Your Medical Bills”: An FPM Patient Handout

This patient handout continues the Family Practice Management series designed to help you help your patients navigate the health care system. The handouts are designed to assist you in dealing with questions your patients may ask and with problems that arise when your patients misunderstand their insurance benefits and have unrealistic expectations of you.

This handout was written by Kent J. Moore, manager of health care financing and delivery systems for the AAFP. It explains in simple terms the elements of a billing statement and an explanation of benefits and the relationship between the two.

Charging access fees

Some physicians are beginning to charge access fees to patients to help defray the costs of soaring malpractice premiums, reports the Jan. 18 USA Today. Prevented from raising the price of their services by health plan contracts, these physicians are adding “office user charges” of $5 or $6 to their charges for every patient visit. While such charges can help alleviate malpractice premium increases, they may violate physicians’ health plan contracts, according to the article. Still, one physician quoted in the article says his patients have responded well to the fees: “Several times they’ve said, ‘Why don’t you make it more?’”

First steps in liability reform

Legislation introduced last month in the Senate could offer the first step toward medical liability reform for all physicians. The bill, S. 2061, would bring relief to the high-risk area of obstetrical services only. Noneconomic damages related to obstetrical services would be capped at $250,000, and lawyers’ contingency fees would also be limited.

Easy as 1-2-3

Thousands of physician claims that have been properly coded and documented are inappropriately denied, delayed or underpaid each year. Those claims should be appealed, says the AMA, and it has developed a tool to help. The Claims Management Resource Kit provides physicians and their office staff with step-by-step instructions for effectively submitting and appealing claims. AMA members can order a copy for free by calling 800-621-8335.

Universal health care by 2010?

The Institute of Medicine (IOM) has formally recommended that the United States work to establish a universal health care plan by 2010 and has called on the government to establish an explicit plan to reach this goal. Over 41 million Americans are uninsured, which results in poorer health, early deaths, lost productivity and greater burdens on health care institutions, according to the IOM. Health and Human Services Secretary Tommy Thompson responded that a universal health insurance system is not administratively or legislatively feasible.