"Physicians think of themselves as being autonomous in making decisions in the patient's best interest, but employed physicians have to have one ear open to what their employer is saying. Otherwise they put their jobs in jeopardy," he says.
Most physicians just want out.
"We found that 60% said they would retire today if given the opportunity. What was worrisome is that this is up from 45% in 2008," Walker says. "We also know from the survey that we disaggregated it into certain categories, 47% of physicians under 40 said they would retire today if given the opportunity."
Walker acknowledges that some physicians could be speaking out of frustration and that they do not intend to leave practice. "But even if only a small percentage follow through on any of that it could be worrisome to the workforce," he says.
"We have 75 million Baby Boomers transitioning to Medicare starting last year over the next 12 or so years. We have a growing population. We have 32 million people who may be gaining health insurance and yet we have the same number of doctors. We have a bottle neck for training. We are training 25,000 or so doctors a year and the fact that we are finally building some new medical schools is not going to increase the doctor supply because the residency level is fixed at 25,000 or 26,000 positions."
The online survey was conducted from late March to early June by Merritt Hawkins with an overall margin of error of less than 1%. Phil Miller, vice president of communications at Merritt Hawkins, says physicians are caught amid crosscurrents in healthcare delivery and it's proven challenging to find incentives that work for everyone.
"We have a doctor shortage, so we want doctors to stay busy and be productive and see a lot of patients. But you are rewarding them with a salary which they know they are going to get regardless of how many patients they see. So you try to build in incentives that will keep them focused on volume," Miller says.
"At the same time, you have this crosscurrent that says 'let's not reward them for volume. Let's reward them for quality and patient satisfaction and these subjective metrics.' So we have two trends working at cross purposes and at the end of the day the doctors are going to take the salary. They may achieve some of their production bonuses, but it is going to be more of a nine-to-five, do-your-job-and-go-home-type of profession," Miller says.
Walker says the issues that zap physicians' enthusiasm run deep. "We have to improve the medical practice environment and the things physicians are most concerned about are autonomy, regulatory issues, liability issues, and reimbursements," he says. "We've got to fix some of those things to keep the workforce together because we not only want to train more physicians, we want to retain more in their practices and that is not happening now."