A Profile of Physicians' Practice Environments

By Sheri Sorrell and Keith Jennings

Each year, as we analyze the findings of our national physician survey and compare it to the data we've collected from prior years, we try to better understand the practice environments in which physicians work and identify related trends.

This article summarizes our findings from our 2014 national physician survey.

Practice Environments

Here is a breakdown of participants' employment and ownership status:

  • Hospital Employee (21 percent)
  • Solo Practice Owner (21 percent)
  • Ownership Stake in Single-Specialty Practice (17 percent)
  • Single or Multi-Specialty Practice Owned by Hospital/Health System (14 percent)
  • Employed by Privately Owned Single or Multi-Specialty Practice (14 percent)
  • Independent Contractor or Locums (9 percent)
  • Ownership Stake in Multi-Specialty Practice (4 percent)

Specialists most likely to own a solo practice include:

  • Dermatologists (55 percent)
  • Ophthalmologists (43 percent)
  • Behavioral Health (34 percent)
  • Women's Health (29 percent)
  • Primary Care (28 percent)
  • Musculoskeletal (27 percent)
  • Surgery Subspecialists (22 percent)

Two statistically significant changes that caught our attention occurred with primary care physicians. The number of hospital-employed primary care physicians increased from 10 percent in 2012 to 20 percent in 2014. And the number of primary care physicians with an ownership stake in a single-specialty practice decreased from 12 percent in 2012 to 7 percent in 2014.

When asked why they chose hospital employment over private practice, 37 percent of physicians said they did not want to deal with the administrative hassles of owning a practice. Thirty-three percent said they wanted to be a doctor, not a businessperson. Overall, the lifestyle that employment offers is the underlying factor driving physician preference.

For physicians who left private practice, the majority attributed their decision to high overhead costs. Reimbursement cuts, lack of resources to comply with ACA requirements and the administrative hassles of ownership were other significant reasons cited.

Practice Capacity & Workload

When asked if their medical practice was at capacity, half said yes and half said no. This has remained unchanged since 2012.

The medical practices of behavioral health and internal medicine subspecialists were more likely to be at full capacity. General surgeons, pediatricians and surgery subspecialists were least likely to be at full capacity.

The majority of physicians surveyed (61 percent) work between nine and twelve hours per day. Eighteen percent reported working eight-hour days.

The following are mean numbers from this year's survey:

  • Patients seen per day: 22
  • Minutes spent with each patient: 20
  • Patients seen/rounded on during hospital shift: 13
  • Surgeries on surgery day: 5

Overall, physicians (72 percent) reported no change in the amount of time spent with patients when compared to last year. However, 66 percent of hospital-based specialists said the amount of time they spend with patients has decreased since 2013.

Most physicians (65 percent) said the number of patients seen during a single hospital shift had remained the same since last year.

Call Rotation

There was a statistically significant decrease in the number of physicians taking call in 2014. The number of physicians taking call in 2012 (77 percent) dropped to 57 percent in 2014.

Primary care, dermatology, behavioral health and musculoskeletal physicians are least likely to take call. General surgeons, surgical subspecialists and anesthesiologists are most likely to take call.

The vast majority (88 percent) of physicians take unrestricted call (in which they must carry a pager, but not be on site). And most (64 percent) are not compensated an additional amount for call coverage, saying it is built into their salary. Only 23 percent reported being compensated over and above their reimbursement rate.

Patient Access

When asked the wait time for a new patient to get an appointment, physicians reported the following:

  • Less than one week: (28 percent)
  • Between one and two weeks: (25 percent)
  • No wait: (19 percent)
  • Between three and four weeks: (14 percent)
  • Longer than four weeks: (12 percent)
  • Not accepting new patients: (2 percent)

General surgeons and pediatricians are more likely to report no wait for new patients. Fifty-five percent of primary care physicians reported new patient wait times to be either no wait or less than one week.

Patient Mix

The patient mix for physician practices this year included:

  • Private insurance: (45 percent)
  • Medicare: (29 percent)
  • Medicaid: (15 percent)
  • Cash: (11 percent)

Eighty-five percent of physician practices reported accepting new Medicare patients. Far fewer (60 percent) are accepting new Medicaid patients.

The primary reason physicians cited for not accepting new Medicare or Medicaid patients were low and declining reimbursement rates.

General surgeons, internal medicine subspecialists and surgery subspecialists are more likely to be accepting new Medicare patients. Behavioral health and primary care physicians were least likely.

General surgeons, pediatricians and internal medicine subspecialists are more likely to be accepting new Medicaid patients, while dermatologists, primary care, surgery subspecialists and behavioral health physicians are not.

Final Thoughts

The shift from private practice to employment continues. And the ripple effects of this trend continue to impact physician satisfaction, compensation, practice environment, workload and patient access.

In a future article we will look at the impact the Affordable Care Act is having on physicians and their medical practices.

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Survey Methodology

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.

About the Authors

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