Compensation: Are Physicians Better Off Now Than 6 Years Ago?

Carol Peckham

Disclosures

April 01, 2016

In This Article

Impact on Practice of the Affordable Care Act?

As of February 2016, 12.7 million Americans selected plans through the health insurance marketplace—about 4% of the population.[14] There are few data to date on the number of physicians who are participating. Often they have no choice, and many may be locked out of networks.[15] According to the 2015 and 2016 Medscape Compensation Reports, last year 16% of physicians said they were participating in the exchanges and 84% were not. This year, 19% said they would be participating, 29% were not, and slightly over one half (52%) were uncertain.

In the current Medscape report, when physicians who participated in health insurance exchanges last year were asked whether their income was affected, 63% reported no change and 11% said it had increased. About one quarter (26%) experienced a decrease. There are still few national data, however, on the effects of the Affordable Care Act (ACA) on physician income. Many variables will play into the ultimate results.[16] One study from the Robert Wood Johnson Foundation reported a 3% increase in reimbursement in states that expanded Medicaid eligibility and 3.3% in nonexpansion states.[17]

Nearly one half of PCPs (49%) and 30% of specialists report having more patients because of the ACA. Of note, emergency medicine physicians have been particularly hard hit, with more than one half (55%) reporting seeing new patients because of the ACA. Orlee Panitch, MD, chair of the Emergency Medicine Action Fund, who commissioned a poll on this issue for emergency medicine physicians, said, "There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the [emergency department]."[18]

Of interest, a 2015 report analyzed how physicians viewed their ability to provide high-quality care 1 year after implementation of the ACA.[19] It found no association with lower- or higher-quality care, whether or not patient load had increased. Among those who said quality had worsened, 21% had a higher patient load and 18% saw no increase. Over three quarters (78%) of physicians whose number of patients increased said that quality had stayed the same or improved, and 82% who experienced no increase reported the same experience.

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