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PHYSICIAN ENGAGEMENT & ALIGNMENT 2016 REPORT

 

The Engagement Gap reports 2016 survey data on physician alignment showing why doctors are not as aligned as hospital executives think.

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PHYSICIAN TRENDS 2016 REPORT

This report collects data, surveys and commentary on U.S. physicians. It includes data on supply & demand, regulatory impacts, compensation & reimbursement, outlook & satisfaction, practice environment and employment.

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2015 REPORT ON PHYSICIAN PRACTICE ACQUISITIONS

In 2012, Jackson Healthcare began surveying physicians and hospitals to track four trends:

  1. Which physician specialties were selling their practices
  2. What motives were driving these physicians to sell their practices
  3. Which physician specialties were hospitals acquiring
  4. What motives were driving hospitals to acquire these practices

We conducted our most recent survey of physicians and hospitals between May and June 2015. This survey encompassed telephone interviews with 23 hospital executives who acquired at least one physician practice within the past three years.

In addition to hospital executives, 69 physicians who had sold their medical practice were interviewed. These physicians were currently employed by the acquiring hospital.

What follows are this year’s findings.

 

Physicians Initiate the Majority of Acquisitions

Sixty-eight percent of the physicians interviewed reported approaching the hospital and initiating acquisition discussions.

This aligns with our findings in past surveys. In 2012, 70 percent of acquisitions were initiated by physicians. And in 2013, 60 percent of acquisitions were physician-initiated.

Hospital executives concurred. All but one reported that in at least one acquisition, the physician had initiated discussions.

 

Most Common Acquisition: Primary Care Practices

The majority of the acquisitions reported by the hospital executives were primary care. This includes general internal medicine and family medicine.

Other types of practices hospitals have acquired include (in order of quantity):

  • Cardiology
  • Orthopedics
  • General Surgery
  • Endocrinology
  • Gastrointestinal
  • Urology
  • Oncology

While no hospital executive reported acquiring surgery subspecialty practices during the past three years, four plan to acquire various surgical subspecialty practices during 2015.

 

Motives for Acquiring Medical Practices

Hospitals report both offensive and defensive reasons for acquiring medical practices. These included:

  • Expanding service capabilities
  • Meeting community need
  • Insurance-related purposes
  • Increased efficiency and alignment
  • Increased market share

Seventeen out of the 23 hospital executives interviewed for this study were seeking to increase their capabilities in certain specialty areas. Eleven of 23 said the private practice environment is conducive to acquisition at this time. Physicians who had sold their practices agreed, saying the cost of remaining independent in the current environment is too great.

 

Life After Acquisition

Hospitals are primarily looking at the cultural and organizational fit of each physician practice with the hospital.

Other characteristics hospitals look for in an acquisition target include:

  • Reputation of the practice
  • Strategic value of the practice
  • Location of the practice
  • Quality of physician(s) in practice
  • Referral patterns
  • Existing relationships between hospital and practice

Newly employed physicians accustomed to making their own decisions and having control over their own practices, face an environment in which they are no longer the primary decision-maker in the strategic direction of their practices.

Thirty-two percent of acquired physicians cited the inability to choose/influence/direct their own staffs as a disadvantage of employment. Twenty-eight percent said that hospital-driven productivity goals were preventing them from spending as much time as they would like with each patient. As one physician said, “I was used to cooperating with administration. Now I was expected to comply.”

 

Bottom Line: Acquisitions a Win for Hospitals & Physicians

Overall, the acquisition of physician practices by hospitals was a win/win for the respondents in this year’s surveys. Twenty-two out of 23 hospital executives said their expectations for the acquisition were either fully or partially met.

Although there are struggles in acclimating to employment, physicians said the advantages of employment outweighed the disadvantages. And for the majority of physicians who sold their practice, there are no regrets. Seventy-seven percent said that, knowing what they know now, if they had to go back and do it all over again they would.

Sixty-four percent of physicians said employment has met or exceeded their expectations. And 80 percent are satisfied with their current work environment.

Of the physicians who were hoping to decrease their administrative burden, 94 percent succeeded. Of those who were hoping to work less hours, 57 percent said they are. Seventy-two percent of physicians reported making the same or more money than they did in private practice.


Why Physicians Are Selling Their Medical Practices from Jackson Healthcare

NATIONAL PHYSICIAN SURVEY: ACA INCREASING HEALTHCARE COSTS

On June 25, 2015, the U.S. Supreme Court announced its decision to uphold the Affordable Care Act. Going forward, many physicians believe that the ACA is driving up the cost of healthcare.

In a national survey conducted by Jackson Healthcare in early June 2015, 59 percent of the doctors said the law’s positive effects did not outweigh its negative effects when it comes to their medical practice.

The following are additional findings from this survey:

  • Doctors believe the law aids patients by covering pre-existing conditions and providing routine medical screenings
  • 67 percent of physicians said they are accepting insurance plans sold in the exchange
  • 61 percent of physicians reported an increase in overhead costs for items such as electronic medical records and administrative costs to comply with the ACA
  • 60 percent of physicians reported more administrative work due to the law, resulting in less time with patients
  • 51 percent of patients are delaying routine screenings because of the cost of high-deductible plans associated with the ACA
  • 23 percent of physicians said they were either retiring, thinking of retiring or becoming part-time locum tenens/contract employee in 2015

Survey Methodology

A total of 1,352 doctors completed the Jackson survey. The error range for this survey was +/-1.3 percent at the 95 percent confidence level.

PHYSICIANS CONTINUE TO LEAVE PRIVATE PRACTICE FOR EMPLOYMENT

Across the nation, more and more physicians continue to trade the autonomy of private practice for the security of employment.

In a 2012 article in The Washington Post, Manoj Jain, MD, cited that reimbursement shifts, increased time handling billing and collections and the accelerating pace of hospitals purchasing physician practices were key drivers of this trend.

In a 2014 Wall Street Journal piece, Sandeep Jauhar, MD, wrote about the decline in physicians’ status and satisfaction during the last half of the 20th century. He cited declining compensation, increased administrative hassles, fear of lawsuits and the loss of professional autonomy as key drivers of this trend toward employment.

From March to April 2015, Jackson Healthcare surveyed a national pool of physicians who had been in private practice, but traded it for employment. The purpose of the survey was to rank the top factors driving physicians away from private practice.

 

Top 3 Reasons Physicians Left Private Practice

This year’s survey findings remained consistent with Jackson Healthcare’s 2014 and 2013 surveys. The top three reasons physicians cite for leaving private practice included:

  1. The overhead and cost of maintaining a medical practice was too high (33 percent)
  2. A desire to focus on the practice of medicine and patient care, rather than administrative hassles (27 percent)
  3. Reimbursement cuts (26 percent)

In addition to these three, there was a rise in physicians citing work-life balance (26 percent of those surveyed) as a key driver toward employment. For the first time, work-life balance entered the top three in a tie for third with reimbursement cuts.

 

Hospitals Are Actively Acquiring Medical Practices

In support of Dr. Jain’s claim in 2012, physicians reported that they had actively been approached by hospitals and health systems to sell their practice. In fact, the percentage of those saying they left private practice because a hospital or health system offered to buy their practice has increased steadily over the past three years.

 

More Employed Physicians Are Former Practice Owners

Of the employed physicians we surveyed in 2012, only 40 percent had previously been in private practice. In 2015, that number increased to 56 percent.

When asked if they are considering selling their medical practice, the majority of private practice physicians say they plan to remain where they are for the next twelve months. However, those who say they are considering leaving private practice cite high overhead and reimbursement cuts as their primary reasons.


 

To access all of Jackson Healthcare’s physician reports, visit our Physician Practice Trends Resource Center.

A PROFILE OF PHYSICIANS’ PRACTICE ENVIRONMENTS

By Sheri Sorrell and Keith Jennings

Each year, as we analyze the findings of our national physician survey and compare it to the data we’ve collected from prior years, we try to better understand the practice environments in which physicians work and identify related trends.

This article summarizes our findings from our 2014 national physician survey.

Practice Environments

Here is a breakdown of participants’ employment and ownership status:

  • Hospital Employee (21 percent)
  • Solo Practice Owner (21 percent)
  • Ownership Stake in Single-Specialty Practice (17 percent)
  • Single or Multi-Specialty Practice Owned by Hospital/Health System (14 percent)
  • Employed by Privately Owned Single or Multi-Specialty Practice (14 percent)
  • Independent Contractor or Locums (9 percent)
  • Ownership Stake in Multi-Specialty Practice (4 percent)

 

Specialists most likely to own a solo practice include:

  • Dermatologists (55 percent)
  • Ophthalmologists (43 percent)
  • Behavioral Health (34 percent)
  • Women’s Health (29 percent)
  • Primary Care (28 percent)
  • Musculoskeletal (27 percent)
  • Surgery Subspecialists (22 percent)

Two statistically significant changes that caught our attention occurred with primary care physicians. The number of hospital-employed primary care physicians increased from 10 percent in 2012 to 20 percent in 2014. And the number of primary care physicians with an ownership stake in a single-specialty practice decreased from 12 percent in 2012 to 7 percent in 2014.

When asked why they chose hospital employment over private practice, 37 percent of physicians said they did not want to deal with the administrative hassles of owning a practice. Thirty-three percent said they wanted to be a doctor, not a businessperson. Overall, the lifestyle that employment offers is the underlying factor driving physician preference.

For physicians who left private practice, the majority attributed their decision to high overhead costs. Reimbursement cuts, lack of resources to comply with ACA requirements and the administrative hassles of ownership were other significant reasons cited.

 

Practice Capacity & Workload

When asked if their medical practice was at capacity, half said yes and half said no. This has remained unchanged since 2012.

The medical practices of behavioral health and internal medicine subspecialists were more likely to be at full capacity. General surgeons, pediatricians and surgery subspecialists were least likely to be at full capacity.

The majority of physicians surveyed (61 percent) work between nine and twelve hours per day. Eighteen percent reported working eight-hour days.

The following are mean numbers from this year’s survey:

  • Patients seen per day: 22
  • Minutes spent with each patient: 20
  • Patients seen/rounded on during hospital shift: 13
  • Surgeries on surgery day: 5

Overall, physicians (72 percent) reported no change in the amount of time spent with patients when compared to last year. However, 66 percent of hospital-based specialists said the amount of time they spend with patients has decreased since 2013.

Most physicians (65 percent) said the number of patients seen during a single hospital shift had remained the same since last year.

 

Call Rotation

There was a statistically significant decrease in the number of physicians taking call in 2014. The number of physicians taking call in 2012 (77 percent) dropped to 57 percent in 2014.

Primary care, dermatology, behavioral health and musculoskeletal physicians are least likely to take call. General surgeons, surgical subspecialists and anesthesiologists are most likely to take call.

The vast majority (88 percent) of physicians take unrestricted call (in which they must carry a pager, but not be on site). And most (64 percent) are not compensated an additional amount for call coverage, saying it is built into their salary. Only 23 percent reported being compensated over and above their reimbursement rate.

 

Patient Access

When asked the wait time for a new patient to get an appointment, physicians reported the following:

  • Less than one week: (28 percent)
  • Between one and two weeks: (25 percent)
  • No wait: (19 percent)
  • Between three and four weeks: (14 percent)
  • Longer than four weeks: (12 percent)
  • Not accepting new patients: (2 percent)

General surgeons and pediatricians are more likely to report no wait for new patients. Fifty-five percent of primary care physicians reported new patient wait times to be either no wait or less than one week.

 

Patient Mix

The patient mix for physician practices this year included:

  • Private insurance: (45 percent)
  • Medicare: (29 percent)
  • Medicaid: (15 percent)
  • Cash: (11 percent)

Eighty-five percent of physician practices reported accepting new Medicare patients. Far fewer (60 percent) are accepting new Medicaid patients.

The primary reason physicians cited for not accepting new Medicare or Medicaid patients were low and declining reimbursement rates.

General surgeons, internal medicine subspecialists and surgery subspecialists are more likely to be accepting new Medicare patients. Behavioral health and primary care physicians were least likely.

General surgeons, pediatricians and internal medicine subspecialists are more likely to be accepting new Medicaid patients, while dermatologists, primary care, surgery subspecialists and behavioral health physicians are not.

 

Final Thoughts

The shift from private practice to employment continues. And the ripple effects of this trend continue to impact physician satisfaction, compensation, practice environment, workload and patient access.

In a future article we will look at the impact the Affordable Care Act is having on physicians and their medical practices.

 

You may also enjoy reading:

51 Statistics On How Income Impacts Physicians in 2014

51 Statistics On Satisfied Versus Dissatisfied Physicians

Advanced Practice Trends 2012 – 2013


Survey Methodology

A total of 1,527 physicians completed this survey, which was conducted between April 18 and June 5, 2014. The error range for this survey was +/- 2.5 percent at a 95 percent confidence level.

Invitations for Jackson Healthcare’s surveys are emailed to subsets of a database, which include physicians who have been placed by Jackson Healthcare’s staffing companies and those who have not.

Respondents to all surveys were self-selected and spanned all 50 states and medical/surgical specialties.

About the Authors

Sheri Sorrell leads Jackson Healthcare’s market research efforts. Keith Jennings is the company’s marketing and content strategy director.

IMPACTS OF THE ACA ON PHYSICIANS AND THEIR PRACTICES

By Sheri Sorrell and Keith Jennings

Each year, we survey physicians throughout the U.S. to identify trends impacting their career and medical practice. One of the areas we’ve tracked since 2012 is how the Affordable Care Act (ACA) is affecting physicians.

In this year’s survey, physicians reported both positive and negative impacts on their practices as a result of the continued rollout of the ACA.

Some physicians are pleased to be able to offer care to patients who haven’t seen a doctor in years — especially patients with conditions in need of treatment. Other physicians have increased or maintained their patient panels, but are seeing patients less often as a result of high deductibles.

When asked what the most prevalent effect the rollout of the ACA has had on their practices, physicians’ responses were as follows:

  • Too early to tell / no changes so far (25 percent)
  • High deductibles for patients (12 percent)
  • Loss of patients (8 percent)
  • More patients with coverage (8 percent)
  • Confusion on the part of physicians and patients (7 percent)
  • Decline in reimbursements / more denials (7 percent)
  • More bureaucracy / paperwork (6 percent)
  • New patients (5 percent)
  • Degradation of payer mix / more patients with Medicaid (5 percent)

The majority of physicians we surveyed experienced no changes in their patient panels or practices as a result of the ACA. That said, 23 percent lost patients due to insurance policy cancellations and another 15 percent lost patients because their practice could no longer accept their insurance plans. Nineteen percent have added patients who have obtained insurance in the exchanges.

 

ACO Participation on the Rise

The number of physicians participating in ACOs has grown significantly since we began surveying them in 2012. Hospitals and health systems are the leading sponsors of ACOs. And hospital-based medicine specialists and pediatricians are the most likely to participate in ACOs.

Physicians who participate in ACOs work longer days and are more likely to take call. Yet, they are more likely to say their income has not changed, more likely to recommend a career in medicine to a young person and more likely to say the outlook for a career in medicine in 2014 is generally favorable. They are also more likely to have help from nurse practitioners, physician assistants and foreign medical graduates.

In accordance with the ACA’s goals, primary care physicians and pediatricians are more focused on prevention and population health. However, only 49 percent of primary care and internal medicine generalists plan to participate as a provider in the exchanges.

 

Physicians involved in an ACO are more likely than those who are not to:

  • Practice in the Midwest (23 percent vs. 18 percent)
  • Practice in New England (9 percent vs. 4 percent)
  • Practice in Urban areas (42 percent vs. 37 percent)
  • Be younger than 54 years of age (54 percent vs. 46 percent)
  • Say their income has not changed since 2013 (48 percent vs. 41 percent)
  • Be on call rotation (67 percent vs. 53 percent)
  • Work more than 10 hours per day (65 percent vs. 53 percent)
  • Utilize nurse practitioners (46 percent vs. 30 percent)
  • Utilize physician assistants (38 percent vs. 27 percent)
  • Say their use of advanced practice professionals is increasing (34 percent vs. 28 percent)
  • See patients in a hospital (non-emergency, non-surgical) (51 percent vs. 41 percent)
  • See patients in the emergency department (31 percent vs. 25 percent)
  • Be likely to encourage a young person to enter the field of medicine (60 percent vs. 53 percent)
  • Say the outlook for a career in medicine in 2014 is generally favorable (31 percent vs. 25 percent)
  • Describe their practice as hospital employment (33 percent vs. 16 percent)
  • Describe their practice as a single or multi-specialty practice that is owned by a hospital or health system (23 percent vs. 11 percent)
  • Retain an ownership stake in a multi-specialty practice (7 percent vs. 3 percent)
  • Have never worked in private practice if they are currently employed by a hospital (50 percent vs. 42 percent)
  • Specialize in hospital-based medicine (9 percent vs. 5 percent) or pediatrics (15 percent vs. 10 percent)

 

Physicians not involved in ACOs are more likely than those who are to:

  • Practice in the Southeast (33 percent vs. 26 percent)
  • Practice in the Mountain region (7 percent vs. 4 percent)
  • Be older than 55 years of age (54 percent vs. 46 percent)
  • Say their income has decreased over the past year (48 percent vs. 38 percent)
  • Not take call (47 percent vs. 33 percent)
  • Say their practice is not at full capacity (53 percent vs. 44 percent)
  • Not utilize advanced practice professionals (50 percent vs. 32 percent)
  • Say the outlook for a career as a physician in 2014 is generally negative (28 percent vs. 21 percent)
  • Describe their practice as a solo practice (27 percent vs. 7 percent)
  • Own / retain an ownership stake in a single-specialty practice (18 percent vs. 12 percent)

 

Uncertainty Prevails

There is no doubt that the ACA is influencing patient and physician behavior. A new group of patients have access care, but the sicker ones are requiring more hands-on treatment, which is decreasing physician productivity.

Insured patients are delaying care. Physicians report patients putting off routine care and procedures because their high deductible plans are tantamount to self-pay. “In reality,” one physician wrote, “patients do not have insurance until they have met their deductibles.”

Physician practices are also experiencing reimbursement and collection challenges. All of these factors are creating uncertainties that are making it tough for physicians to make strategic decisions with regard to their practices.

With only half of primary care physicians planning to participate in the ACA exchanges and many not part of an ACO, how will this impact patients and physicians in the coming years? And what’s to become of the solo physician in the era of ACA?

These are trends we will continue to watch.

You may also enjoy reading:

51 Statistics On How Income Impacts Physicians in 2014

51 Statistics On Satisfied Versus Dissatisfied Physicians


Survey Methodology

A total of 1,527 physicians completed this survey, which was conducted between April 18 and June 5, 2014. The error range for this survey was +/- 2.5 percent at a 95 percent confidence level.

Invitations for Jackson Healthcare’s surveys are emailed to subsets of a database, which include physicians who have been placed by Jackson Healthcare’s staffing companies and those who have not.

Respondents to all surveys were self-selected and spanned all 50 states and medical/surgical specialties.

About the Authors

Sheri Sorrell leads Jackson Healthcare’s market research efforts. Keith Jennings is the company’s marketing and content strategy director.

ADVANCED PRACTICE PROFESSIONALS IN TODAY’S MEDICAL PRACTICE

by Sheri Sorrell and Keith Jennings, July 8, 2014
It’s a good time to be an advanced practice professional.

Job satisfaction is high. Demand is strong. And physicians, especially those who use them, are satisfied with the productivity and skillset advanced practitioners bring to their medical practice.

A key trend we’ve tracked since 2012 is how physicians are using nurse practitioners, physician assistants and other advanced practice professionals (APPs) in their medical practice. And how these choices are impacting physicians’ attitudes and productivity.

In this article, we will share our key findings related to APPs from this year’s national physician survey.

 

Use of Physician Assistants on the Rise

When asked about their use of APPs, physicians reported the following:

  • 44 percent do not use APPs
  • 35 percent use nurse practitioners (NPs)
  • 30 percent use physician assistants (PAs)
  • 10 percent use certified registered nurse anesthetists (CRNAs)

When asked how their use of APPs has changed in the last year, 66 percent reported it has remained unchanged. However, 30 percent said their use of APPs had increased. Only four percent said it had decreased.

Although use of NPs has remained steady between 2012 and 2014, the use of PAs has shown a statistically significant increase. Twenty-five percent of survey respondents in 2012 reported using PAs. This rose to 30 percent in 2014.

Hospital-based specialties like critical care medicine, emergency medicine and hospitalists, as well as surgical subspecialists are most likely to use physician assistants. Hospital-based specialties and pediatricians are most likely to use nurse practitioners. And behavioral health specialists are most likely not to use advanced practice professionals.

 

Physician Preference Split Between NPs and PAs

When asked which APP they would rather work with, if they had a choice, physicians were split between PAs (31 percent) and NPs (30 percent).

Pediatricians and women’s health specialists were most likely to prefer working with NPs. Surgical subspecialists, general surgeons and hospital-based specialists were most likely to prefer working with PAs.

 

APPs Positively Impact Medical Practices

Seventy-six percent of physicians said APPs contribute to the productivity of physicians and their medical practice. They said more patients receive care when APPs are part of their practice team. Only twenty-four percent reported no change in the number of patients treated.

Sixty-one percent of physicians reported that duties formerly performed by physicians being taking on by APPs. And 60 percent affirmed that this is a positive trend, especially surgery subspecialists, general surgeons and internal medicine subspecialists. Anesthesiologists were more likely to view this as a negative trend.

 

The Attitudes & Outlook of APPs

In 2012, 74 percent of the NPs and Pas we surveyed were satisfied or very satisfied with their current work environment.

At the time of that survey, both NPs and PAs reported seeing an average of 16 to 18 patients per day, but said that number was increasing as they were asked to take on more responsibility.

Forty-seven percent of respondents foresaw risks to the NP role and 32 percent anticipated risks to the PA role. That said, APPs saw the NP role evolving to assume more responsibility in patient care, especially primary care. And PAs will continue to specialize with demand for their services expected to increase.

 

You may also enjoy reading:

51 Statistics On How Income Impacts Physicians in 2014

51 Statistics On Satisfied Versus Dissatisfied Physicians

Advanced Practice Trends 2012 – 2013


Survey Methodology

A total of 1,527 physicians completed this survey, which was conducted between April 18 and June 5, 2014. The error range for this survey was +/- 2.5 percent at a 95 percent confidence level.

Invitations for Jackson Healthcare’s surveys are emailed to subsets of a database, which include physicians who have been placed by Jackson Healthcare’s staffing companies and those who have not.

Respondents to all surveys were self-selected and spanned all 50 states and medical/surgical specialties.

About the Authors

Sheri Sorrell leads Jackson Healthcare’s market research efforts. Keith Jennings is the company’s marketing and content strategy director.

51 STATISTICS ON SATISFIED AND DISSATISFIED PHYSICIANS

By Sheri Sorrell and Keith Jennings, June 25, 2014

Participants in this year’s national survey by Jackson Healthcare were notably more satisfied than in 2013. Seventy-two percent of respondents reported being either satisfied or very satisfied with their career in medicine at this point in time. Only nine percent reported being very dissatisfied.

However, this year’s survey participants were also younger. There has been a clear correlation between age and satisfaction in our surveys since we began studying physician practice trends in 2012.

In this piece, we highlight 51 statistically significant data points that emerged from comparing the attitudes and outlook of satisfied versus dissatisfied physicians.

In a future piece, we will share data on satisfied and dissatisfied physicians by specialty.

 

Satisfied Physicians are more likely to:

1. Say there has been no change in the amount of time they spend with each patient since last year (76 percent of those who are satisfied vs. 64 percent of those who are dissatisfied)

2. Encourage a young person to enter the field of medicine as a physician (70 percent vs. 19 percent)

3. Say there has been no change to the number of surgical procedures they schedule per day this year than last (69 percent vs. 45 percent)

4. Say that it is a positive trend that nurse practitioners and physician assistants are taking on more duties historically performed by physicians (68 percent vs. 40 percent)

5. Say that as the ACA rolls out, they have had no shifts in their patient panel as a result of healthcare reform (56 percent vs. 50 percent)

6. Say there has been no change in the number of patients they see during an office day since last year (53 percent vs. 41 percent)

7. Say the outlook for a career as a physician in 2014 is generally favorable (35 percent vs. 4 percent) or cautionary (52 percent vs. 40 percent)

8. Be employed and have never worked in private practice (49 percent vs. 37 percent)

9. Have a greater percentage of patients with private insurance in their practice make-up (46 percent vs. 42 percent)

10. Say patients are more knowledgeable about their health, conditions, etc. this year than they were last year (41 percent vs. 31 percent)

11. Say they have partnerships in place with insurers, hospitals, and local companies to provide care to their patients and the community (39 percent vs. 28 percent)

12. Be leaving medicine in 2014 because they are 65 years of age or older (39 percent vs. 19 percent)

13. Say their practice is more focused on preventative care and population health this year vs. last year (32 percent vs. 21 percent)

14. Say they’d rather work with nurse practitioners than physician assistants (32 percent vs. 26 percent)

15. Have chosen hospital employment for lifestyle reasons – they did not want to work the long hours that private practitioners must (27 percent vs. 12 percent)

16. Be foreign medical graduates (22 percent vs. 15 percent)

17. Say that as the ACA rolls out, they have added patients who have obtained insurance through the healthcare exchange (21 percent vs. 14 percent)

18. Be between the ages of 25 and 44 (21 percent vs. 15 percent) or 65+ (19 percent vs. 12 percent)

19. Work eight hours a day (20 percent vs. 13 percent)

20. Say their income has increased (15 percent vs. 5 percent) or not changed (49 percent vs. 27 percent) since last year

21. Be pediatricians (14 percent vs. 7 percent)

 

Dissatisfied physicians are more likely to:

22. Not accept new Medicaid patients because of low / declining reimbursements – cannot afford to do so (88 percent of those who are dissatisfied vs. 79 percent of those who are satisfied)

23. Not to encourage a young person to enter the field of medicine as a physician (81 percent vs. 30 percent)

24. Work more than 8 hours per day (75 percent vs. 68 percent)

25. To be between the ages of 45 and 64 (73 percent vs. 61 percent)

26. Say that nurse practitioners and physician assistants performing more duties that used to be performed by physicians is a negative trend (60 percent vs. 32 percent)

27. Say that patients are delaying services, procedures, electives, etc. (71 percent vs. 61 percent)

28. Say their income has decreased since last year (68 percent vs. 36 percent)

29. Say billing and collections from insurance companies in 2014 vs. 2013 was more difficult (59 percent vs. 44 percent)

30. Say billing and collections from patients in 2014 vs. 2013 was more difficult (58 percent vs. 43 percent)

31. Say there are no plans for their practice to join an ACO in 2014 (58 percent vs. 51 percent)

32. Say the outlook for a career as a physician in 2014 is generally negative (56 percent vs. 13 percent)

33. Not accept new Medicaid patients because of a high no-show rate (51 percent vs. 36 percent)

34. Not accept new Medicaid patients because of refusals to pay / denials (50 percent vs. 38 percent)

35. Say billing and collections from Medicare in 2014 vs. 2013 was more difficult (51 percent vs. 36 percent)

36. Say billing and collections from Medicaid in 2014 vs. 2013 was more difficult (48 percent vs. 35 percent)

37. Discontinue accepting new Medicaid patients because of increased litigation risk (44 percent vs. 6 percent)

38. To say they schedule less surgical procedures on a surgery day this year than last (40 percent vs. 19 percent)

39. Not accept new Medicare patients because these are sicker patients whose treatment is too time intensive (39 percent vs. 16 percent)

40. To practice in the Southeast (35 percent vs. 30 percent)

41. Say the number of patients they see during an office day has decreased since last year (33 percent vs. 21 percent)

42. Have a higher percentage of Medicare patients in their practice make-up (32 percent vs. 29 percent)

43. Say they have lost patients as the ACA has been implemented because those patients have lost their insurance or have had their insurance canceled because it did not comply (32 percent vs. 19 percent)

44. See patients in the Emergency Department (31 percent vs. 26 percent)

45. Not work with either nurse practitioners or physician assistants (28 percent vs. 21 percent)

46. Say the amount of time they spend with each patient has decreased since last year (28 percent vs. 16 percent)

47. Own a solo practices (26 percent vs. 20 percent)

48. Have chosen hospital employment because they did not have the money to invest in a practice (26 percent vs. 14 percent)

49. Strongly consider retiring or leaving the practice of medicine in 2014 (20 percent vs. 4 percent)

50. Be independent contractors or LT physicians (12 percent vs. 8 percent)

51. To be in hospital-based specialties (Emergency Med, Critical Care, Hospitalist) (8 percent vs. 5 percent)

 

Final Thoughts

It is obvious dissatisfied physicians see the glass half empty, while satisfied physicians see it as half full. And, in our research, there continues to be a correlation between satisfaction and employment vs. private practice.

The growing number of employed and female physicians in the workforce is changing physicians’ political alignment, as well. According to a recent study published in JAMA Internal Medicine, physicians are more likely to contribute to Democrats’ political campaigns and favor Democratic candidates than they were twenty years ago.

Not only are we in the midst of the most significant regulatory overhaul of the U.S. healthcare system since 1965, we’re seeing the physician workforce transform itself.

You May Also Enjoy Reading:

51 Statistics On How Income Impacts Physicians in 2014


Survey Methodology

A total of 1,527 physicians completed this survey, which was conducted between April 18 and June 5, 2014. The error range for this survey was +/- 2.5 percent at a 95 percent confidence level.

Invitations for Jackson Healthcare’s surveys are emailed to subsets of a database, which include physicians who have been placed by Jackson Healthcare’s staffing companies and those who have not.

Respondents to all surveys were self-selected and spanned all 50 states and medical/surgical specialties.

 

About the Authors

Sheri Sorrell leads Jackson Healthcare’s market research efforts. Keith Jennings is the company’s marketing and content strategy director.

Click here to email the authors your questions, feedback and requests.

51 STATISTICS ON HOW INCOME IMPACTS PHYSICIANS IN 2014

by Sheri Sorrell and Keith Jennings, June 17, 2014

Each year, Jackson Healthcare studies trends impacting physicians’ careers and medical practices.

We hope this information helps physicians make more informed, strategic decisions in their career and practice. And we hope these statistics help healthcare executives, industry thought leaders and media professionals better understand the attitudes, challenges and opportunities physicians face.

There were a number of statistically significant (and interesting) findings in our 2014 study.

In this piece, we highlight 51 statistics that emerged from our look at physicians reporting compensation increases (12 percent of participants) versus those reporting a decrease in compensation (45 percent of participants) from 2013 to 2014.

We will not look at trends related to the 43 percent who reported no change in income.

 

Physicians whose INCOME DECREASED in the past year are more likely than those whose income increased to:

Demographics

1. Be age 45+ (85 percent of those whose income has decreased vs. 72 percent of those whose income has increased)

2. Own / retain an ownership stake in a single specialty practice (23 percent vs. 11 percent)

3. Internal medicine subspecialists (21 percent vs. 12 percent)

4. Anesthesiologists (8 percent vs. 1 percent)

 

Billing & Collections

5. Say billing and collections from insurance companies over the last year has been more difficult (62 percent vs. 38 percent)

6. Say billing and collections from patients over the last year has been more difficult (61 percent vs. 34 percent)

7. Say billing and collections from Medicare over the last year has been more difficult (50 percent vs. 30 percent)

8. Say billing and collections from Medicaid over the last year has been more difficult (47 percent vs. 29 percent)

 

Patients

9. Say their patients are delaying services, procedures, electives, etc. (77 percent vs. 49 percent)

10. Say their patients have become more cost-conscious over the last year (73 percent vs. 59 percent)

11. Say their patients are doing more cost-comparative shopping for medical services (54 percent vs. 39 percent)

 

Workload & Career Outlook

12. Say they will not remain in private practice because the overhead costs are too high (76 percent vs. 0 percent)

13. Say they do not have partnerships with insurers, hospitals and local companies to provide care to their patients and the community (69 percent vs. 59 percent)

14. Say they are unlikely to encourage a young person to enter the field (61 percent vs. 31 percent)

15. Say they do not use Advanced Practice Professionals (48 percent vs. 37 percent)

16. Say they are dissatisfied with the practice of medicine (43 percent vs. 12 percent)

17. Say they schedule less surgical procedures on a surgery day this year vs. last (40 percent vs. 10 percent)

18. Say the outlook for a career in medicine in 2014 is generally negative (40 percent vs. 14 percent)

19. Say the number of patients they see in an office day has decreased (39 percent)

20. Say they are strongly considering leaving the practice of medicine or retiring (14 percent vs. 4 percent)

21. Say they have made the decision to practice medicine part-time or on assignment. Slowing down, not completely leaving (11 percent vs. 4 percent)

 

Payor Mix

22. Say they are not accepting new Medicare patients because of low / declining reimbursements (73 percent vs. 31 percent)

23. Have a higher percentage of Medicare patients in their practice (31 percent of their practice make-up vs. 25 percent)

 

Affordable Care Act

24. Say they have lost patients who have lost their insurance or had their policies canceled as the ACA has been implemented (35 percent vs. 13 percent)

25. Say they are not planning to participate as providers on the health insurance exchanges (27 percent vs. 19 percent)

26. Say they’ve lost patients as the ACA has been implemented because they no longer accept their insurance (21 percent vs. 9 percent)

 

Physicians whose INCOME INCREASED in the past year are more likely than those whose income decreased to:

Demographics

27. Be younger than 45 (28 percent of those who say their income has increased vs. 15 percent of those who say it has decreased)

28. Specialize in behavioral health (13 percent vs. 4 percent)

29. Specialize in hospital based medicine (10 percent vs. 5 percent)

 

Billing & Collections

30. Say billing and collections from Medicaid does not apply to their practice (40 percent vs. 29 percent)

31. Say billing and collections from Medicare does not apply to their practice (39 percent vs. 21 percent)

32. Say billing and collections from insurance companies does not apply to their practice (28 percent vs. 12 percent)

33. Say billing and collections from patients does not apply to their practice (26 percent vs. 12 percent)

 

Patients

34. Say their patients have not been doing more cost-comparative shopping (62 percent vs. 46 percent)

35. Say their patients have not been delaying services, procedures, electives (51 percent vs. 24 percent)

36. Say their patients have not become more cost-conscious over the past year (41 percent vs. 27 percent)

 

Workload & Career Outlook

37. Say they will definitely be practicing medicine in 2014 (91 percent vs. 74 percent)

38. Say the outlook for a career in medicine in 2014 is generally favorable (45 percent vs. 14 percent)

39. Say they are very satisfied with their careers in medicine (45 percent vs. 16 percent)

40. Say the number of patients they see in an office visit during the past year has increased (43 percent vs. 20 percent)

41. Say they chose hospital employment over private practice because they wanted to be doctors, not business people (41 percent vs. 17 percent)

42. Say they use nurse practitioners (41 percent vs. 31 percent)

43. Say they have partnerships in place with insurers, hospitals and local companies to provide care to their patients (41 percent vs. 32 percent)

44. Say they use physician assistants (40 percent vs. 28 percent)

45. Say they are very likely to recommend a career in the field to a young person (35 percent vs. 11 percent)

46. Say they see/care for/round on more patients in a single hospital shift (33 percent vs. 17 percent)

47. Say they work 8 hours a day (26 percent vs. 16 percent)

48. Be a hospital employee (26 percent vs. 12 percent)

49. Say they use foreign medical graduates (16 percent vs. 6 percent)

 

Affordable Care Act

50. Say they are planning to participate as a provider in the health insurance exchanges (59 percent vs. 49 percent)

51. Say that as the ACA has been implemented that they have added patients who have obtained insurance through the exchanges (26 percent vs. 16 percent) or to say they have had had no changes to their patient panels (59 percent vs. 45 percent)

 

Final Thoughts

While this list contains some obvious statistics (naturally physicians with increasing income are more likely to be satisfied with their careers than those whose income is decreasing) it also contains statistics that align with broader trends seen in other Jackson Healthcare and industry research.

With the shift from private practice ownership to employment continuing throughout the U.S., the impacts of decreasing reimbursements, billing & collection hassles and lifestyle choices are apparent throughout these 51 statistics.

 

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51 Statistics on Satisfied and Dissatisfied Physicians


Survey Methodology

A total of 1,527 physicians completed this survey, which was conducted between April 18 and June 5, 2014. The error range for this survey was +/- 2.5 percent at a 95 percent confidence level.

Invitations for Jackson Healthcare’s surveys are emailed to subsets of a database, which include physicians who have been placed by Jackson Healthcare’s staffing companies and those who have not.

Respondents to all surveys were self-selected and spanned all 50 states and medical/surgical specialties.

About the Authors

Sheri Sorrell leads Jackson Healthcare’s market research efforts. Keith Jennings is the company’s marketing and content strategy director.

Click here to email the authors your questions, feedback and requests.