Decline of the Independent Practice: Why the Work Environment for Physicians Continues to Change
In the last several years, there has been a sharp decline in the number of physicians who identify themselves as “independent”. Twenty years ago, about 81% of physicians worked in independently-owned practices. Now that number is down to around 30%, with no evidence it will plateau. Solo private practitioners currently make up about 15% of independent practice physicians, which is down from roughly 25% just five years ago.
The Physicians Foundation, a non-profit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare in America, recently conducted a survey of over 20,000 doctors, which demonstrated how the working environment for physicians continues to change.
The study showed that practicing physicians are younger than ever before, which indicates an increase in the rate of retirement. The most common reason for early retirement among older physicians was increased workload. The average age of respondents was 50 (down from 54 two years earlier).
Not surprisingly, 81% of physicians describe themselves as either over-extended or at full capacity, while only 19% claim they have time to see more patients. Nearly half of physicians are actively taking steps to reduce patient access to their practice. These steps include cutting back on the number of patients, retiring, moving to part-time work, closing their practice to new patients or seeking non-clinical healthcare jobs. The end result has been an overall decline in physician availability to patients.
Unfortunately, this decline of physician availability comes at the same time there is an explosion of patients seeking healthcare. Between 2011 and 2021, more than 75 million baby boomers will reach age 65 and qualify for Medicare. Couple this with the approximately 10 million Americans who have signed up for health insurance through the Affordable Care Act —and simple access to a physician is becoming limited, at best.
The fallout is reflected in physician morale. Physicians under the age of 45 tend to have a more favorable opinion of medicine, but physicians over age 45 have a 70% unfavorable outlook towards the current and future states of medicine.
Younger physicians are usually starting their career as an employee of a hospital or large group, whereas older physicians mostly started their career in a private practice. Thus, most younger physicians haven’t experienced a private practice setting with a fee-for-service payment system and complete autonomy in regards to patient care.
Still, when employed physicians were asked about the levels of clinical autonomy, and the ability to make the best decisions for patients, 69% indicated that their decisions are often compromised, demonstrating a strong potential negative affect on the quality of patient care.
Despite all of this, 71% of physicians would still choose a career in medicine if they could do it all over again. Almost all stated the relationship they have with patients was unquestionably the most satisfying aspect of their career.
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