Physicians More Stretched, but More Positive, Says Survey

September 16, 2014

Physicians in 2014 rate their morale higher than they did 2 years ago, and look at the future of their profession more optimistically, largely due to a "changing of the guard" to a younger generation of mostly employed physicians, according to The Physicians Foundation.

Released today, the latest survey by the nonprofit group shows that 44.4% of physicians this year describe their professional mood as positive compared with 31.8% in 2012. However, physicians aged 45 years or younger (54.2%) were more prone to say that than their elders (38.9%). Likewise, the jump in optimism about the profession's future over that 2-year span (22.6% to 48.9%) was powered more by younger physicians (56%) than older ones (45.8%).

For one gold standard of physician morale, age hardly made any difference in the results. In 2014, 49.8% of all physicians said they would recommend medicine as a career to their children, up from 42.1% in 2012. Nearly as many physicians aged 46 years or older (49.2%) thought that a white coat for their sons and daughters was a good idea as younger ones (51.1%).

Physicians of all ages take a dim view of healthcare reform, according to the poll of 20,000 physicians. Only 29.9% of younger physicians and 22.9% of their older colleagues graded the Affordable Care Act (ACA) as an A or B, and less than 15% in either group predicted that accountable care organizations — a prime vehicle for carrying out the ACA — would improve quality and lower costs.

More Physicians Work for Somebody Else

The survey by The Physicians Foundation provides further proof that Big Box medicine is the wave of the future. The percentage of physicians who said they were an employee of a hospital or medical group rose from 43.7% in 2012 to 52.9% in 2014. Physicians aged 45 years or younger (65.7%) were far more likely to be somebody's employee than their older counterparts (45.7%).

Physicians of both generations are not sold on working for hospitals. Only 47.4% of younger physicians agreed that hospital employment is a positive trend that probably will improve the quality of care and bend the cost curve. Hospital employment had even fewer fans among older physicians (31.5%).

Older physicians (41.5%) are almost twice as likely to be self-employed as younger ones (22.4%). In one respect, however, the younger set is just as entrepreneurial when it comes to operating concierge or direct-pay practices that remove the insurance middleman to varying degrees. Almost 7% of younger physicians and almost 8% of older ones said they were in such a practice. Significantly, more younger physicians (17%) than older ones (11.3%) said they planned to adopt this model in some fashion.

Trends That Threaten Patient Access

Physician morale is a bit stronger despite more physicians having jam-packed schedules. In 2014, 81.1% said they were either at full capacity or overextended, compared with 75.5% in 2012. At a time when healthcare reform is making a trip to the doctor's office more affordable, fewer physicians (18.9%) have time to see new patients than 2 years ago (24.5%).

In another ominous note for patient access, 44% of surveyed physicians reported having plans to make career moves in the next 3 years that would reduce their case load. Under consideration were retiring, working part-time, seeing fewer patients or not accepting any new ones at all, or taking a nonclinical job within healthcare. Retirement and nonclinical jobs, said The Physician Foundation, would remove some 152,000 physicians from the patient-care workforce.

The survey is available at the Web site of The Physicians Foundation.

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