ANNUAL PHYSICIAN SURVEY

In the current issue of Medical Economics magazine, the editors present their “95th” annual “Physicians Report.” Every year, they conduct an extensive survey that contains “exclusive data collected from our physician audience on salaries, productivity, malpractice rates, the state of the profession, and much more.” I always find the report interesting because it allows me to compare their findings to my own thoughts and experiences. It provides me with information I hope readers find interesting. The usual conclusion I reach from these surveys is that many physicians were a lot more unhappy with their career choice than I and didn’t work as hard or as many hours. 

Topics addressed by this year’s survey are:

     The Financial State of your practice: better, worse, same and why

     The Top Ten Issues facing physicians

     Physician Practice Ownership: Yes or No

     Time spent weekly on Prior Authorizations—insurance company paperwork

     The Financial Impact of COVID-19 on your practice: better, worse, same, telemedicine

     Physician Salary: by specialty, gender, location of community, practice ownership, type, size

     Productivity—How many hours per week do physicians work

     Malpractice Insurance Rates:

     Does your practice provide ancillary services:

     Did you earn income from employment outside of your practice?

The FINANCIAL STATE of your practice in 2023:

      Compared to 2022 was your practice: Better 13%

                                                                    The Same 48%

                                                                    Worse 39%

      Improvement occurred because: The doctor saw more patients

                                                           The practice added ancillary services increasing revenue

                                                           The practice received performance incentives

                                                           Telemedicine generated increased revenue

                                                           The practice renegotiated payer contracts

                                                           Better CPT coding, effective collections, reduced

                                                             overhead

     Practice got worse because: Higher practice overhead (rent, salaries, supplies, utilities, etc)

                                                    Lower reimbursement—abysmal actually

                                                    Technology costs—electronic health record (EHR/EMR)

                                                    Poor collection efforts 

                                                    The doctor saw fewer patients

                                                    Competition from large groups of physicians

                                                    Loss of payer contracts

     Comments: 5 in 10 said seeing more patients was the top reason for financial improvement.

                         7 in 10 said overhead/staffing costs was the reason finances were worse.

Dr. G’s Opinion: Medicare and private insurance reimbursements continually get lower while practice costs continually go higher for a net negative financial impact on a practice.

TOP TEN ISSUES FACING PHYSICIANS:

     Listed in my order of importance. ( ) = Med Econ order

1. Inadequate reimbursement (2)
2. Third party interference (3)
3. Burden of paperwork/quality metrics (1)
4. Electronic health records (5)
5. Burnout, work/life balance (4)
6. Malpractice insurance costs (10)
7. Non-physician providers gaining practice and prescribing independence (7)
8. Lack of staffing (6)
9. Lack of trust in health care institutions/medical knowledge (8)
10. Recruiting young physicians (9)   

Dr. G’s Opinion: Keeping a practice afloat financially becomes harder every year. Costs go up while payments from Medicare and insurance companies go down. Red tape thrown at physicians requires a lot of unreimbursed time. A practice must cut costs and figure out how to increase revenues.

PHYSICIAN PRACTICE OWNERSHIP:

     Does the physician own an interest in the practice?

          In 2021–YES 45%

                        NO 55%

          In 2023–YES 50%

                        NO 50%

TIME SPENT ON PRIOR AUTHORIZATIONS: 

     39% spent 1-9 hours/week

     26% spent 10-15 hours/week

     19% spent 20 hours/week or more

     10% spent 16-20 hours/week

       6% spent no time on prior authorizations

THE FINANCIAL IMPACT OF COVID-19:

     Was your practice…..

     Better off: 18%

     Worse off: 44%

     The Same:  38%

PHYSICIAN SALARIES:

     By specialty: Average pretax income increased $11,000 in ‘23 compared to ‘22

     By gender: Gap in average pay between male and female physicians is $55,000.

     By community: Urban physicians earn most, rural earn least—$45,000 difference

     By practice ownership: Owners earn $12,000 more on avg.

     By practice type: Concierge earn most, privately-owned earned least

     By practice size: Solo practitioners earned least, Docs in groups of 3-10 most.

     Pay gap between practice owners and employed physicians is $12,000

PHYSICIAN PRODUCTIVITY:

     Average hours worked per week: 44 for all physicians

                                                           45 Family physicians

                                                           44 Internal medicine

                                                           45 men, 40 women 

                                                           46 practice owners, 41 non-owners

                                                           45 docs in practice 0-20 years, 43 for 21-40 yrs. 38, 41+

Dr. G’s Opinion: Not sure how these hours are figured, but they are very low. In my busiest years, I made hospital rounds from 6:30-7:00 am to 9:30 am. seven days a week (21 hrs). Office hours on Monday, Tuesday,  Wednesday, and Fri. were 10:00 am to 6:00 or 7:00 pm. (36 hrs) and Wed and Sat from 8 am to 12:00 noon (8). My arithmetic adds those up to be 65. That doesn’t count being on call from 7 pm to 7 am at least twice a week, and visits to patients in nursing homes. So it could be as much as 75-80 hours/week. In later years (the last 7), my hours were definitely less because I worked just 3 days a week. I had stopped rounding, had no nursing home patients, and was on call only 2-3 times a month. I averaged 27-30 hours a week. Today’s PCP’s are office-based only. Their hours will be less as a result. 

MALPRACTICE RATES:

     45% of physicians saw their malpractice rates INCREASE in the last year up from 39% the preceding year. 

     31% paid $10,000 to $20,000

     14% paid $20,000 to $30,000

     11% paid $30,000 plus

     16% didn’t know how much they paid—that’s crazy!

ANCILLARY SERVICES:

     80% of practices provide ancillary services to augment revenues.

         Most popular services were:

           EKG—49%

           Lab services—46%

           Weight loss counseling—26%

           Spirometry—26%

           X-ray services—25%

           Pain management—18%

           Holter monitoring—15%

           Pharmacy services—15%

           Other: Botox, Sleep studies, Stress Tests, Sports Medicine, lactation support, etc.

INCOME EARNED FROM OUTSIDE EMPLOYMENT SOURCE:

     36% of physicians earned secondary, non-practice income

     64% did not

     Secondary income sources:

        Consulting

        Medical administrator, hospital medical director

        Clinic work

        Teaching

        Expert Witness

        Hospice

        Clinical trials/research

        Speaking 

        Medical writer, Chart reviews, locus tenens 

        Many non-medical income pursuits

CONCLUSION: Today’s doctors don’t work as hard as doctors of 35-45 years ago. They don’t have to. Emergency rooms and urgent care centers have taken away the disruption to the office and free time caused by needing to attend to a medical emergency. Doctors don’t see patients for acute illnesses the same day anymore because urgent care centers are open 24/7 to take care of those situations. Family doctors don’t earn patients’ trust and friendship any more because the doctor is not involved in family medical crises. They are dealt with by specialty clinics. And doctors no longer invest themselves in a business, their practice, because Medicare and insurance companies control what revenues the “business” earns, and those amounts are not enough to sustain the financial status quo.

This survey is misleading. It reports that doctors’ salaries have increased, on average, $11,000. I’m not sure I believe that number. If doctors are making more, why are they quitting practice in droves? Why do 80% of practices have ancillary income sources? Why do over a third of doctors earn income from outside employment? Why do so many doctors become employees of a hospital or group practice? It’s because they are told what they will be paid for services, and have no choice but to take it. They are made to navigate through numerous webs of red tape to gain approval and justification for patients to have procedures only the physician is trained to know are necessary. The healthcare system is a perfect example of how government regulation and control eventually squeeze the life out of entities that were previously efficient, respected, and personal. People respond to incentives, and physicians are no exception. Take them away, make them difficult to obtain, or devalue them, and individuals give up and look for success elsewhere. This survey identifies these problems and physicians’ solutions. It would all be much different if reimbursement levels were realistic and were enough to sustain a business, but they aren’t.

Reference: Physicians Report Medical Economics 2024 July/August:8-21.