Over-Extended Physicians a Detriment to Practice Financials

For any major automobile manufacturer, having a large volume of customers lined up outside your dealerships waiting to grab the new models as soon as they hit the showroom floor would be a good thing. Not so in healthcare.

A national survey of more than 20,000 physicians by The Physicians Foundation reveals that 80% of doctors say they are currently over-extended or working at full capacity.

For any major automobile manufacturer, having a large volume of customers lined up outside your dealerships waiting to grab the new models as soon as they hit the showroom floor would be a good thing. Not so in healthcare.

“The wait times to see a primary care physician are substantially high in a number of the normal markets throughout the US, particularly in Boston, where it’s 66 days to see a primary care physician for a physical,” says Walker Ray, MD, vice president of The Physicians Foundation. “And yet Boston is an area where there are probably more doctors per square foot than any place you can think of. [Physicians being over-extended] is a major concern.”

The negative trend

The survey also found that 44% of responding physicians plan to take steps to reduce patient access to the healthcare services they provide. This includes closing their practices to new patients, working part-time, or seeking non-clinical jobs—all of which, according to Ray, means a reduction in the physician workforce at a time when there is great demand for services.

“There’s a problem,” Ray says. “And I think this is exemplified by the [US Department of Veterans Affairs (VA)] scandal where patients were not able to be seen in a timely fashion, and that became an embarrassment throughout the country to the VA. And yet, people were saying that the way to solve that is to just turn to the private sector. Well, the capacity is not there in the private sector.”

And the potential negative financial impact to a practice where physicians are over-extended is considerable. Ray explains that when he was a practicing primary care pediatrician, come wintertime he was unable to keep up with the demand for healthcare services.

“I was working at 110, 120% of my capacity,” he says. “It was telling upon me. And money was not important. What was important was a little time off. Time to see my family. Time to go to my girls’ soccer games. The stress of being over-extended is just as bad as the stress of not having enough patients.”

Silver linings

An interesting outcome of the survey is that while the majority (56%) of physicians still describe their morale as somewhat to very negative, a greater percentage of physicians—44% in 2014 compared with 32% in 2012—describe themselves as somewhat to very positive about the current state of the medical profession.

“We were pleased to see that, because 2 years ago it was as if the physicians had walked to the brink of the abyss and stared into it, and then walked back a little bit,” Ray says. “But on the other hand, we are a little reluctant to say that there’s a trend one way or another until we get a little more data.”

Want more reason for optimism? Ray draws an analogy to the law of chemical reactions. When a reaction tends to move solidly in one direction, eventually equilibrium occurs and the reaction tends back in the opposite direction. That could be the case with respect to the percentage of physicians who describe themselves as employees of a hospital or medical group—up to 53% from 44% 2 years ago.

“We have some internal information from focus groups and from smaller surveys that the physician employment model is not meeting expectations of what physicians thought they were going to get when they went into that,” Ray explains. “They thought they would have less paperwork and less business issues, and more time to see patients, and that’s not necessarily happening.”

Ray also points out that physicians in hospital practices see all sorts of patients, whether Medicaid or Medicare, and if reimbursements continue to be cut, hospitals can’t continue to employ these physicians at the same financial package that they initially offered.

“After a 2-year contract, they’re calling them in, and I know this from many anecdotal cases, and saying we’re sorry, but your salary is going to have to be cut by X percentage, and you’re going to have to see more patients.”

That, combined with physicians’ frustration with diminishing levels of clinical autonomy and the ability to make the best decisions for their patients, could be an equilibrium shift in the near future.

For now, Ray encourages physicians to “stay the course, hang in as long as they can, and reduce overhead as much as possible without affecting quality of care.”