A well-intended objective of the Affordable Care Act (ACA) is to improve patient access to doctors. Sometimes this objective is artfully stated as “better” access to care, rather than “increased” access to care, perhaps to acknowledge the reality that as more patients become insured via the ACA, there may actually be less access to physicians. “Better” access may therefore be an argument that, even as an existing physician shortage worsens, new alternatives under the ACA nonetheless improve access to care for the population as a whole. For sure, millions of Americans have enrolled in new insurance coverage via the ACA health insurance exchanges. In any event, whether it will be easier for most Americans to actually see a doctor remains to be seen according to a recent national survey.
The survey, by The Physicians Foundation, concluded that patients are likely to face increased difficulties in finding true access to care if current health care reform trends continue. More than 20,000 doctors nationwide were surveyed by the Foundation, and its findings are detailed and compelling. Among other things, the survey indicates that: 81 percent of doctors believe they are over-extended or at full capacity; only 19 percent of doctors think they have time to see additional patients; and 44 percent of doctors are now planning steps that would reduce patient access to their services (e.g., cutting back on patients seen, retiring, going part-time, closing their practice).
According to the survey, the factor that doctors, particularly primary care physicians, find most satisfying about medical practice is patient relationships. Survey, p. 48. Unfortunately, health care reform and overbearing regulation of health care providers have stifled and eroded the quality of doctor-patient relationships “through lack of clinical autonomy, liability concerns, a continuing struggle for reimbursement, lack of patient face-time, and other factors.” Consequently, physicians have been less satisfied with medical practice. The survey shows that physician disenchantment with medical practice continues to be a very serious problem for all of us. According to the survey:
In 2012, survey results painted a picture of a medical profession on the verge of crisis and potential implosion, while the 2014 survey shows physicians walking back from the brink to some extent. This contrast appears to be the result of a changing of the guard in medicine, in which younger physicians, female physicians, employed physicians and primary care physicians are coming to the fore and bringing with them different viewpoints on medicine and the healthcare system.
Survey at 49.
An Emerging Pattern: Increasing Opportunities for Concierge and Direct Pay Medical Practice
The survey indicates that doctors are showing an increased interest in concierge or direct pay medical practice as a viable professional opportunity. Seventeen percent of doctors 45 years old or younger plan to change practice models to some variation of a direct pay or concierge model to enhance professional satisfaction. Survey at 53. While doctors who do so may increase their professional opportunities and find greater satisfaction in medical practice, this emerging trend could also exacerbate the shortage of physicians to serve patients wedded to insurance plans.
Source: The Physicians Foundation Survey
*Disclaimer: Thoughts shared here do not constitute legal advice.