This is especially true for the medical profession. Change is everywhere. Some changes are good for the field of medicine, others are not. Regardless, these changes will ultimately affect many basic elements of the patient physician relationships.
For example, between 1983 and 1994 there was a considerable rise in the number of doctors who practiced medicine as employees. In 1983, only 24% of doctors were employees while in 1994 that figure had risen to 42%. During this time the percentage of doctors who were in solo or group practice fell from approximately 40% to 30%. Most of these changes were brought about by young physicians choosing to become employees rather than going into solo or group practices.
In a review of over 1,300 young doctors completing their training in 1995 and 1996, it was noted that for the first time in history over 50% being recruited chose a salary as the primary form of compensation. What was interesting about this fact was that this form of payment was the preferred method by graduating doctors.
The authors of the report noted that the dramatic increase in salary acceptance was due to the fact that employment of physicians is common in managed care settings, as well as the fact that young doctors do not want to have to put up with hassles of government regulations. Salaries are now a regulation friendly form of physician compensation.
With large debts hanging over them from their medical education, these graduating physicians want the security of a six-figure salary rather than having to worry about starting from scratch in solo or group practice. However, this change may have a sudden affect in patient-physician relationships since these employee doctors may be subject to increased bureaucratic oversight, less independence in making medical decisions and increased pressure to make a profit.
Another change occurring is that for the first time since the American Medical Association has kept records on income, physician net income fell. A survey by the AMA found that median 1994 net income fell from $156,000 to $150,000. This drop was noted in most specialties, with the largest drops noted by cardiovascular specialists (down 12%), otolaryngologists (down 11%) and pathologists (down 10%). 1995 and 1996 data is expected to reveal continued reduction in physicianВ’s net income. The report also noted that one in four doctors now make less than $105,000.
The factors responsible for this first time ever decrease in net income were increasing overhead, decrease compensation for managed care plans, and stagnant reimbursement for Medicare. In addition to this change in income, doctors are working harder. Surveys show that specialist productivity since 1991 increased over 20% while primary care physicians worked 15% more.
Finally, a change in the number of available doctors in this country is being noted. If something is not done to reduce the number of doctors in the United States, especially specialists, many may find themselves under or unemployed. According to Dr. Marc Rivo of PCA Health Plans of Florida and Dr. David Kinding of the University of Wisconsin School of Medicine, the supply of doctors is growing fastest than the general population.
To meet medical needs of this country it is estimated that there needs to be 145 to 185 doctors for every 100,000 citizens. Currently, however, there are 200 doctors per 100,000 and that number is increasing. In a mere fourteen years it is estimated that there will be approximately 219 doctors per 100,000 Americans. Rivo and Kinding state that В“Most analysts of the work force agree that under or unemployment of specialist physicians in the early 21st century is a distinct possibility in the United States.В”
Hopefully all these changes will have little impact on the desire of our best and brightest to become physicians or the willingness of physicians to practice the same high quality and compassionate medical care that they are now practicing. But I worry because I know that the only thing that doesnВ’t change is change itself!
(Frank H. Boehm, MD is a professor of OB/GYN and Director of OB at Vanderbilt Medical Center in Nashville, TN. He can be reached at his web site http://dr-boehm.com. Dr. Boehm resides in Boca).