Fierce Q&A: Physicians feel powerless to change healthcare

We've reported on a number of physician surveys in recent months, but a just-released report from the Physicians Foundation is among the biggest. Conducted by physician staffing firm Merritt Hawkins, the Physicians Foundation's third biennial report on physician practice patterns and perspectives captured the attitudes of more than 13,500 U.S. physicians on 48 separate questions.

To gain further insight into what all these data points mean for your practices and physicians, FiercePracticeManagement spoke with Karl M. Altenburger (pictured), a board-certified allergist/immunologist who practiced medicine in Florida for more than 25 years and now serves on the Physicians Foundation's board of directors.

FiercePracticeManagement: As we look at these results, what do you view as the areas of biggest concern?

Altenburger: We're certainly interested in the idea of physician access and physician shortages. The big concern is that within the next decade, we'll have 100,000 physicians sharply curtail their practices or retire. And with all of the changes in the Medicare program, 52 percent of respondents to this survey indicated they already limited or are going to limit access to the Medicare population. It's going to create access problems; there's just no avoiding it.

Another big concern is physician morale because it affects physicians' willingness to fight the battles that have to be fought on behalf of their patients. When you say that 77 percent of physicians in this survey are pessimistic about the future of medicine, I don't think that's a good number. If I was a policymaker, that would be a red flag.

Also alarming is that 84 percent of physicians in this particular survey believe the medical profession is in decline. What a horrible number for a profession that's so important to the people of this country.

Worse yet in my mind is that 82 percent feel they have very little ability to change the healthcare system, and that's a sign that the forces at work here, most physicians feel are out of their reach.

In particular, I think it reflects a feeling that policymakers, especially those involved in forming the Affordable Care Act, really excluded physicians and didn't spend enough time talking to those of us on the front lines.

FPM: Like a lot of recent physician surveys, this report is pessimist news. Is there any good news here for physicians?

Altenburger: The good news is that we're still debating the issues nationally. I think this information will add to the national debate. Physicians are a pretty bright group, and if consulted I think they would be able to help policymakers come up with meaningful policy reforms that will be good for our patients and help the medical profession sustain itself and help the hospitals sustain themselves. We all have a stake. It's a huge problem. We can't hide from the effects.

FPM: What about the results did you found surprising?


Eighty-two percent of surveyed physicians feel they have very little ability to change the healthcare system.

Altenburger: What I did find fascinating is that, at the end of this fairly long survey, we offered respondents the ability to make comments. Out of the 13,500 who completed the survey, 8,000 also took the time to add a written comment; that's pretty remarkable. Some wrote a line and some wrote paragraphs. I think it's a reflection of the uncertainty facing the physician workforce, backing up the idea that so many physicians feel they have little ability to influence how changes are made.

Our intention is to go through those responses one by one to find the theme or themes we need to explore further. Among other things, a top focus of the Physicians Foundation is helping physicians deal with the impact of health reform and trying to give physicians the tools they need to deal with this challenging environment.

FPM: What should practice administrators take away from this data to help them run their practices and relate to their physicians?

Altenburger: Administrators should be aware of this data, realizing that their physicians may not exhibit all the signs of dissatisfaction. They're going to come in, go to work and do the best they can for their patients.

Practice administrators deserve a large thanks from physicians for helping them keep their heads above water and pay the bills, which is getting increasingly difficult. While there are some projections that private practices are going to go away and disappear, I don't think that's going to happen. There's going to be demand for physicians to remain as the chief advocate for their patients.

Editor's Note: This interview has been edited and condensed for clarity.