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Physicians Are Pessimistic About Future of Healthcare, Highlight Extent of Social Determinants

Laura Joszt
A majority of US physicians have a pessimistic view about the future of medicine, believe value-based payments won't improve quality of care or reduce costs, and treat patients with social conditions that impact their health.
A majority of US physicians have a pessimistic view about the future of medicine, according to a survey that took the pulse of the nation’s doctors. The Physicians Foundation’s 2018 survey examined the impact of several factors that are causing physicians to reassess their careers, including regulator and insurer requirements, quality payments, and the impact of poverty on healthcare outcomes. Nearly 9000 physicians responded to the survey.

While 55.3% said their feelings about the current state of the medical profession is somewhat or very negative and 61.6% said they are very or somewhat pessimistic about the future of the profession, both of these are slight improvements over responses in 2012, when 68.2% felt somewhat or very negative about the current state and the same share felt very or somewhat pessimistic about the future.

Physician views varied greatly by age with only 42.6% of physicians age 45 or younger having a negative morale compared with 61% of physicians age 46 or older. However, younger and older physicians are in agreement about whether or not they would recommend medicine as a career—48.2% of younger physicians and 48.9% of older physicians said they would not.

The number of physicians reporting burnout has increased from 74% in 2016 to 77.8% in 2018. Younger physicians were slightly more likely to say they had feelings of burnout (81% vs 76.3%), and women were more likely than men to report burnout (84.8% vs 74.1%).
The 2 factors that physicians identified as contributing the most to them feeling dissatisfied were electronic health record design and interoperability, and the patient–physician relationship. In addition, 62.5% said they have little ability to significantly influence the healthcare system, which has also contributed to low morale and feelings of burnout.

While close to half (47.1%) of all physicians said that any of their compensation is tied to value-based metrics (up from 42.8% in 2016), they largely remain skeptical about the worth of value-based payments. Only 18% said value-based payments would improve quality of care and reduce costs. Older physicians (59.7%), independent practice owners (66.6%), and specialists (68.8%) were the most likely to say they did not believe value-based payment would improve quality and reduce costs.

The survey also found that physician ownership of practices is down. Only 31% of physicians said they were practice owners or partners compared with 48.5% in 2012. While physicians in general reported working fewer hours, employed physicians said they worked more hours. However, employed physicians reported seeing fewer patients than practice owners.

In 2018, the survey added a new question about how many patients doctors see who are affected by social issues that impact their health. The majority (87.9%) said at least some of their patients are affected by a social issue that presents a serious impediment to their health. More than half (56.43%) said many or all of their patients are faced with such social conditions. Only 1.06% said none of their patients are impacted by a social condition that affects their health.

“It is distressing that such a high number of patients are dealing with one or more social situations that are detrimental to their health,” Walker Ray, MD, chair of the Foundation’s Research Committee, said in a statement. “These challenges directly impact a physician’s ability to deliver effective care, and the cost implication of these issues is enormous. Such social determinants as they relate to healthcare have been a critical focus of the Foundation for years, and we have made concerted efforts to address these vital issues with partners across the US.”

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