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