Physicians

The Numbers Tell The Story

Yesterday, athenahealth and Sermo released our Physician Sentiment Index℠ (PSI). With over 1,000 physicians polled, the national survey is thought to be the largest of its kind.  While many of the findings will come as no surprise to physicians in practice, the messages are nevertheless alarming.  Key findings include:

  • 64% cited the current healthcare climate as somewhat or very detrimental to their delivery of quality care
  • Only 22% are optimistic about the ability of the American physician to practice independently or in small groups
  • 59% are of the mind that the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve
  • The majority (54%) strongly disagree/disagree that more active government involvement in healthcare regulation can improve outcomes; less than a quarter feel otherwise
  • A shift from fee-for-service to pay-for-performance gives hope to almost half (49%) who think it will have a very/somewhat positive impact quality of care but;
    • 53 percent believe pay-for-performance will have a negative/very negative impact on the effort required to get paid

View full PSI survey results (PDF)

Working with athenahealth and THCB, Sermo plans to publicize these findings to help the general public understand what is really happening in our healthcare system today and establish a sentiment indicator that can generate longitudinal trend data in this area.  In the next phase of the athenahealth-Sermo relationship, we’ll be building off these findings to explore ways that physicians can run their practices more efficiently and level the playing field with insurers.

Daniel Palestrant, MD is the Founder & CEO of Sermo, Inc.  A frequent contributor to THCB, his work also appears on the FtF blog at Sermo.com, where this piece first appeared.

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12 replies »

  1. exhausted, I don’t see any Republicans refusing taxpayer paid cadillac plan health insurance so that their not be hypocritical.
    Also, would anything make you happy?

  2. rbar, I think you have it exactly right.
    I would also add the observation that a majority of physicians are politically conservative and the current circumstances are bound to adversely affect their “sentiments”.
    Not to mention that in this economy you would be hard pressed to find a sector with rosier sentiments about the immediate future.

  3. I cannot speak for my fellow colleagues, but of course I hear and read from them daily: the simple explanation for the pervasive unhappiness is the fact that things (working conditions, pay) go constantly downhill. In my opinion, they are still at a satisfactory level for most doctors incl. usually haredworking PCPs. They earn a decent living and usually can bring their kids through college. But of course, all this is RELATIVE, comparing current conditions/pay to the situation of stock brokers, realtors, physicians in the 70s and 80s, and most importantly, their colleagues doing procedures sours the mood. And the quite well off proceduralist docs think how rosy things were a few decades ago. That’s just human nature. I could observe exactly the same in my native country when private practice physician income came under pressure – docs where whining about any decline, while still being welll in the top percentiles (hospital docs were truly overworked and underpaid, and they had really good reason to complain, but that’s another story).
    Two things that definitely make US docs unhappy, and understandably so: the permanent threat of litigation and the extent of bureaucracy (preapprovals etc.). The latter would improve with a sincle payor system (of course not universally popular because it will likely decrease pay esp. for top earners), the former with real malpractice reform (i.e. not just capping damages, rather not allowing lawsuits that are on the grounds of a doctors fault of JUDGMENT in a complex situation, while litigation based on poor effort – negligence – is accepted as a necessity by most docs).

  4. this is the third time trying to comment here in the past 12 hours, so hope it works:
    Thanks for this post. It needs not just said, documented, and confirmed, but also accepted by the masses. A lot of physicians do NOT support this legislation. Accept it and figure it into future actions!
    By the way, to all you legislation supporters, explain to us reasonable and fair citizens, why does the President, his cabinet, and the major legislative leaders and formulators of this legislation NOT have to be covered by it? Go to Politico.com, a March 24 post, and read it for yourselves.
    This isn’t just hypocrisy people, this is downright fraud to the alleged importance of this act. And all you supporters should not only be ashamed, you should be outraged.
    But, party needs trump public needs, it is now floridly apparent.

  5. I am very suspect of a physician poll that indicates 59% of docs feel quality will deteriorate over the next 5 years. Specious at best.
    When 30-40% of health care providers cannot achieve appropriate levels of hand hygiene (not QI rocket science by any means), as they say, Houston, we have a a problem. That is just a drop in the bucket…
    Believe me, it can only go up from here. I live and breathe it every day–take my word.
    Brad

  6. I don’t think the survey has much insight as it lumps all physicians together in their opinions. But having lived in Canada for most of my life and having known more than a few docs there and here through my wife as a nurse, I’ve never met a doctor that was happy – with anything. How do you please this bunch?
    Tom, I guess you may be able to understand how non-docs struggle to get their kids into/through college. I’m for paying PCPs more but it’ll have to come at the expense of specialists and/or other parts of the system.
    Lawrence, there is good opinion that it’s the prices not the utilization. But if we did get the utilization down it would save the “system” but still incomes would suffer. Getting the taxman involved in the paying does draw everyone together as now we won’t have a system that dumps the uninsured off the books as someones else’s problem. I don’t have much hope at this time that costs will be brought under control anytime soon, so look for the next political fight to be for bigger premium subsidies as all players that can, will find a way to maintain cost increases and then boost premiums.
    Right now the things that make us sick are the things we create and push into the marketplace. Junk food and a junk food culture is a creation of subsidies for doing the wrong thing and corporate profits. I don’t think “encouraging” will do it. One item in the bill mandates the listing of calories on restaurant menus. That will help, but until we remove subsidies on corn and transfer them to fresh fruits and vegetables it will be hard to get people to turn away from the junk food industry.

  7. “Utilization is key. We have to shape up, or we have to ration.”
    There is a third option. Managing unit costs down.
    Since shaping up is unlikely to produce any immediate results, and since rationing is unlikely to be acceptable to the public, physicians are rightfully concerned that the fees for their services will have to go down.
    Call it P4P or call it bundling or call it global budgets or call it coordination of care, the net effect will be a reduction in physicians and hospitals income, and it will have to be driven by the Government through Medicare. It looks like it won’t be done blindly across the board, but targeted to empower primary care, which has fringe cost reduction benefits.
    This pretty much explains the unhappiness regarding Government intervention and the general “sentiment index”, whatever that may be.

  8. Gerber,
    Are you suggesting that the health care reform law was drafted by people who know nothing about health care (like lawyers trying to fix Toyota)?
    I thought a lot of health care experts put in their input/feedback into the law, and many of them believe this piece of legislation is (albeit not perfect) a good start.
    Who do you suggest should have drafted the law?
    Physicians or insurance company execs, since they have “in depth knowledge of insurance or the practice of medicine”?

  9. Doctors, specialists, anyway, have a reason to be concerned. The fact is that they cannot continue to make the money they make. The money isn’t there. I don’t mean that they can’t continue to charge what they charge. I mean that utilization will drop for the same reason that trees do not grow to the sky. Utilization will drop because utilization cannot not drop.
    The question is by what mechanism utilization will drop. Certainly, the least painful way for utilization to drop will be for people to get healthier. Socialized medicine (i.e.,any insured arrangement, whether through government or private carrier) gives all of its contributors a stake in each others’ lifestyles. Every smoker in my pool costs ME money. Every fat kid (not to mention every diabetic) in my pool who can’t pass up the next Twinky costs ME money. Every too-busy executive in my pool who can’t take time for an annual physical costs ME money. This might not be obvious after all of the political nonsense about how it costs “the insurance company” money when claims are paid, as if we hadn’t seen the enemy and he weren’t us, but it’s the case whether we admit it or not. So the best way for us to save money on health care is to need less of it. But how do we get there from here?
    First, tempting as Shakespearean malpractice reform may be, killing all the lawyers alone won’t get it done. No, I think we need to pay primary care docs a share of the savings realized by health plans for lowering utilization.
    The family doctor should have as a goal seeing to it that his patients do not need treatment. The doc who sees you before you get sick should bug you about getting an annual check-up, facilitate your gym membership, distribute information on your diet, etc. That doctor can be a real cost-reducer. All that’s needed is an economic incentive. Virtually all employer plans record a patient’s primary care physician. The plan administrator need only track the utilization of each doc’s patients, and reward the doctor accordingly.
    As a pension lawyer thirty-five years ago, I watched ERISA getting built. The whole complex law was created inexorably by falling logical dominoes. In order to bail out the rust belt, employers were required to guaranty vested benefits. For that to work, benefits had to vest. For that to happen, they had to accrue. For that to happen, employees had to be granted participation. And for employers not to speculate with a government backstop, plan assets had to be invested prudently. It all had to be. Just as mandatory coverage had to be if pre-existing conditions were to be covered. Just as utilization must drop for universal care to be affordable, and just as wellness must be incentivized if utilization is to drop.
    Paying PCPs for reduced utilization is one way to achieve it. Paying employees for specific good practices is another. For some reason, people tend to think of $0 as a magical number wholly unrelated to such amounts as $1 and -$1. Studies seem to bear this out. But from a health insurer’s perspective, the difference between 0 and any other number is just math. Why is “free” the right way to handle preventive care? What is an annual physical worth in reduced utilization? Why not pay the patient half of that for getting one? I can’t help but believe that merely waiving co-pays on preventive care is not wholly arbitrary in amount. But “free” don’t pay the rent. Maybe a small reward would generate big demand.
    Utilization is key. We have to shape up, or we have to ration. And, for reasons that are buried deep in the human condition, shaping up appears for too many people not to be its own reward. So let’s fire up the incentivizer and see if we can’t shorten the waiting line at the MRI center.

  10. I just got off the phone with one of my best friends. He was (until 1 month ago) a primary care physician – the type who took tamales for payment from time to time.
    He just joined a global pharma company as an executive because of the dismal prospect of putting his kids through college as a PCP in the current economic/health care environment.
    It is a real loss – and I think the high levels of uncertainty over the next several years will cause lots of capable, smart docs to make career changes.
    Tom O’Brien
    @tomob

  11. The current health care “system” is definetly in need of reform, though the new legislation just looks to make health care more difficult.
    We have a 2,000+ page bill that was constructed by persons who do not have an in depth knowledge of insurance or the practice of medicine. It would be similar to having your attorney fix your faulty Toyota; your attorney knows nothing of your Toyota and its recall and you wouldn’t expect him to fix that issue. I feel the same way about our legislators…they are tying to fix problems they know nothing about.
    It will be interesting to see how this all plays out…

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