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Uncertainty prompts doctors to rethink private practice, according to survey

Many physicians who responded say they are ready to seek options outside the traditional office.

By Victoria Stagg Elliott — Posted Dec. 13, 2010

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Robert Lauer, MD, PhD, never thought he would leave private practice to become a hospital employee. But after 28 years as a partner in a four-physician cardiology group in New Jersey, he became an attending physician -- and the first-ever cardiologist -- at Artesia General Hospital in New Mexico.

A recent survey shows that many doctors worried about financial pressures and the effects of health system reform are ready to switch out of private practice.

"The practice was beginning to feel the strain," said Dr. Lauer, 64. "We were working harder to see more patients and trying to do more procedures, but I was getting older. I wasn't sure I could do that kind of pace for 10 or 12 more years."

Concern about how health system reform will roll out in the next few years and continuing instability in Medicare pay have an increasing number of physicians pondering changes in how they practice. Many are considering cutting back on hours, switching to concierge medicine, taking locum tenens positions or selling their practices to accept hospital jobs, according to a survey released Nov. 19 by The Physicians Foundation. The organization was formed in 2003 after health plans settled lawsuits by physicians and medical associations over payment issues.

The survey was completed by 2,379 family physicians, internists, pediatricians, obstetrician-gynecologists, cardiologists, orthopedic surgeons, radiologists, anesthesiologists, general surgeons and hospitalists in June, July and August. About 59% were part of physician-owned practices; 41% were employed by a hospital or other large entity -- below the overall 52% employed physician rate reported by the Medical Group Management Assn.

Only 26% of respondents planned to continue practicing as they have been for the next three years. A total of 14% planned to switch to locum tenens work, and 11% said they will take hospital jobs. About 16% intended to switch to concierge or cash practices, and 16% planned to retire.

"It's the tremendous uncertainty of what is going to happen in the future," said Lou Goodman, PhD, the foundation's president and executive vice president and CEO of the Texas Medical Assn. "And hospitals are saying, 'Come work for us.' "

The last time the foundation asked doctors about their plans was in 2008. In that survey of 11,950 responding physicians, including family physicians, general internists, pediatricians and obstetrician-gynecologists, just over 51% planned to continue practicing as they had been and only 11% said they would retire. Slightly more than 7% talked about changing to concierge medicine, and nearly 8% planned to switch to locum tenens.

The question about hospital employment was not asked in the 2008 survey but was added in 2010. That's because of increased hospital interest in hiring physicians, particularly in the wake of the Patient Protection and Affordable Care Act.

The 2010 Physicians Foundation survey found significant dissatisfaction with the new health reform law. The major goal of the survey, "Health Reform and the Decline of the Private Practice," was to assess physicians' views of the legislation.

According to the survey, 67% felt "somewhat" or "very negative" about it when it was enacted in March. An additional 27% were "somewhat" or "very positive." After the initial reaction subsided, 10% felt more positive but 39% were more negative.

Of the respondents, 54% believe patient volume would increase because of reform, but 69% said they did not have the time or resources to treat additional patients while maintaining quality of care. A total of 68% believe that reform would diminish the financial viability of their practice.

"There's general anxiety about big government, and it is shared by physicians," said Tim Norbeck, the foundation's executive director.

This anxiety was compounded by numerous short-term Medicare pay patches in 2010.

According to the foundation's survey, physicians place reform of the sustainable growth rate formula (36%) above health reform (34%) as the policy that could have the greatest effect on their practices. An additional 30% said they were unsure which of the two would be the bigger issue.

Although the Physicians Foundation's survey documented a malaise among some physicians, experts cautioned about generalizing based on the results. Foundation representatives said the survey was mailed to 40,000 physicians and e-mailed to 60,000, with 2,379 completing them for a response rate of only 2.4%.

Even those conducting the surveys don't expect that every physician who says he or she will make a change will do so. However, "a certain percent are going to make a change, and this will have a significant impact on the delivery of health care," said Mark Smith, president of Merritt Hawkins & Associates, a physician placement firm in Irving, Texas, that conducted the survey for the foundation. "We are going to see a migration away from private practice to employment."

For example, the foundation noted that many of the options physicians might choose would involve treating fewer patients, which could exacerbate doctor shortages.

Dr. Lauer, who hopes to retire in five years, said he has no regrets about moving 2,000 miles from central New Jersey to southeastern New Mexico to leave private practice for hospital employment.

He said he still works hard, but it's eight to 10 hours a day rather than up to 14. He said he gets to spend more time with patients, because appointments are longer than they were at his medical group.

At first, Dr. Lauer said he wasn't sure whether his new job would be the right fit. "But I'm now quite happily employed at this small community hospital," he said. "The cardiology clinic keeps getting busier, and we're doing testing that they could never do before. To me, it's very satisfying."

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External links

"Health Reform and the Decline of Physician Private Practice," The Physicians Foundation, November (link)

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