Older physicians: "Looking for a ticket out"

Another driver of the physician shortage:

In the next one to three years, 48 percent of physicians between the ages of 50 and 65 are planning to retire, seek non-clinical jobs, work part-time, close their practices to new patients, and/or significantly reduce the number of patients they see, a new survey indicates . . .
. . . “When Baby Boom doctors entered medicine they had control over how they practiced and the fees they charged,” notes Mark Smith, executive vice president of Merritt Hawkins & Associates. “But the rules changed on them in mid-stream and now many are looking for a ticket out.”

Comments

Anonymous
Kevin, you say there is a physician shortage – what do you mean? Across the board, particular specialties, particular regions of the country?
How have you determined there is a shortage? Physicians per capita?
DDx:dx
It is worthwhile to read the actual Merrit Hawkins report which they will gladly send you. Interesting: demand for FAmMed is way up but compensation is not. I believe we have market forces affecting availability but not compensation. The prices(reimbursement) are set by medicare /HCFA rules. Compare recruiting offers for different specialties.
Anonymous
We have more physicians per capita than pretty much anywhere else in the world.
I would say that it appears we have a physician glut or else salaries would be rising at a tremendous rate.
Throckmorton
A crisis that is starting is the over “55 rule”. Many hospitals had this enacted with the idea that when a physician was over 55 years of age, they no longer had to cover unattached er call. The problem is that no other physicians will come in to cover this call. As the older physicians are forced to take call, many opt to retire.
Anonymous
There’s a shortage of doctors willing to work for free.
Over the years I’d seen so many physicians who sort of had to be pushed out because they were physically unable to keep up with the work. The ones I remember were mentally up to the work, but were getting angina attacks, TIA’s, dumping syndromes after surgery, and they were just physically not up to it, for themselves as well as the patients. Sad for all. Thing is, they wanted to keep on working, they had to be persuaded to retire. Aside from the extremes like that, many healthier docs wanted to keep working well into their 70′s or even early 80′s until they chose to retire.
Thing is, though, they were covering the free clinics, doing hospital administrative work, voluntary teaching of medical students……I had quite a few of those teachers myself. Doing medical work in Africa, I met an American volunteer from an upper Plains state who spent about six months a year operating in this African hospital when his home was freezing cold anyway, went back and put in his crop in the USA when it thawed out. Another doc I knew that just ran his office as sort of a nonprofit, took all the Medicaid no one else wanted. Everything was paid for, so what the heck…..
When it became “just a job”, the docs just retired in their 60′s like anyone else. It’s just, maybe 5% of the work that needs to be done, but I think we’ll have a hard time getting that work done by docs who still need to pay off their house and put their kids through college.
We’re about to see if there’s anything to this theory.
Anonymous
What does physicians per capita have to do with shortages?
Massachusetts has a high physician per capita rate, but they’re all in academics and research. When you want a family doc in Cape Cod or Lowell or Pittsfield, there’s none to be found. And that was before Mitt’s healthcare reforms, it’s even worse now.
Anonymous
I’m in the same boat myself. Just as soon as I’ve accumulated enough in my retirement, and my house has appreciated sufficiently, I’m outta here. I’m in my earlty 50′s.
If Hillarycare comes to pass, I’m outa here even sooner.
Anonymous
There is a physician shortage in primary care, neurosurgery, endocrinology, obstetrics and other fields. Factor in that 1/2 of all physicians are over 50. Factor in that now 1/2 of physicians are women who aren’t all working full-time. Factor in the issue that many of the new crop of docs are more interested in being home with their families, and are therefore unwilling to put in the long hours that many of us old farts have done. The absolute number of docs means nothing. There truly is a shortage. Wait till we get national health care.
Anonymous
OK, you say there is a shortage. How do you determine that? You just open the phone book and count?
Zelda
I am a medical student and growing more terrified by the day to enter this profession.
I am by now too far in debt to afford NOT to…
Maybe I have just been disabused of my idealism a few years earlier than my peers will be.
god help me, does anyone have some advice? it seems like there’s no specialty worth pursuing since it’s either do a million procedures and never see my family, or see patients and never get paid. And I may as well forget all the crap they’re teaching me now since I will apparently be practicing defensive mindless medicine anyways.
Depressing.
DDx:dx
I live in the rural part of the state that is 50th in per capita docs.And I don’t think there’s a shortage. All the little towns with two or three family docs twenty to fifty miles apart want 2 or 3 more partners. Why? Need? No, decause it will make the call schedule more convenient, less onerous. To go from q 3 call to q 5th. But there really aren’t all that many patients that need to be seen.
Especially if the docs would get efficient. They let these huge back logs of appointments build up(“I’m booked out for 3 months”) when they see 18/day with 5 no shows….Move to same day access, see todays problems today, finish your charts, answer your calls…But the perverse motivations/ incentives we have let us believe we are in demand….
http://poemd.blogspot.com/2007/03/demand-supply.html
Anonymous
I am not seeing that at all. In fact I think the opposit may be true. There are 70 year old orthopedic surgeons here. my PCP is 69 with no talk yet of retiring.
Anonymous
As a 50 year old physician who has witnessed all of the changes, I agree that the magic is gone in our line of work for all the reasons mentioned. What was once an honorable profession has become an assembly line job with the constant threat of bankrupcy due to lawsuits, government control/regulations and insurance company rip-offs. I aso am looking for my escape.
The Happy Hospitalist
The argument about whether there is a shortage or not of primary care physicians is not an argument. The shortage is here and it is massive. A multitude of forces are coming together NOW, not years from now, but NOW that will have destructive forces on access and cost in years to come.
These forces are coming at you from several angles. As stated the number of physicians expecting to retire in the next few years will far excede the number of primary care physicians chosing to enter the field now. In 10 short years the number of medical students who have chosen to dedicate their practice to primary care has fallen from 50% to 20%. That, my friend is a massive haircut.
But why you ask? It’s all about money, and it will always be about money. But we aren’t talking about rich greedy doctors who just want more money. We are talking about a class of doctors struggling to stay afloat with the flawed reimbursement scheme called medicare.
You see, medicare pays all physicians set fees for EVERY type of visit or procedure you can imagine. That fee is determined by something called the RVU (Relative Value Unit). It determines what the “value” of a service is. A heart cath carries an RVU value, a colonoscopy carries one, your sinus surgery or gallbladder surgery carries one. You primary care doctor visits carry one as well.
So what’s the problem you say? Well the committee that determines how many RVU’s (which means, how much money) each and every possible interaction the patient and doctor have is heavily controlled by specialists, who have a major vested interest in keeping the status quo.
There is one pot of money that must be distributed between all doctors. That pot of money is Medicare. The system in place places a much larger reimbursment for procedures than it does for cognitive/time based interactions. This is flawed on several fronts.
It encourages the proceduralization of the patient. That’s where the money is. Procedural physicians have increased their separation from primary care in the last 10 years by an amount that has incentivized medical students to avoid primary care at all costs.
This year, as every year, there is a 10% accross the board threat in reimbursment cuts to all physicians from medicare. This will cause a much larger percentage decrease in reimbursement for primary care than for procedural specialists. You see, what is a cognitive doc to do? They increase the number of patients, shorten visits and create more referrals to specialists for patients they do not have time to care for. What is a proceduralist to do? Increase the number of procedures which are heavily reimbursed. There is no money in cognition.
At some point, which is very soon, the primary care system will crack at the seems. Docs will retire in droves, no younger docs to replace them. We are already there in many places. Medicare is poised to cut reimbursment close to 40% in the next 5 years.
I see only one alternative way to avoid the looming crises. Primary care must remove themselves from this flawed reimbursment system. They must go to a cash only, fee for service system which pays them sustainable fees. There will be a access problem of insurmountable size in the next several years, in which no respectable primary care physician would allow themselves to be servitude to a system that highly devalues their work.
The patient will HAVE to pay, out of network, cash only, as there will be no primary care accepting any insurance. They system is flawed against them. Medical students aren’t stupid. Witness the mass exodus.
The clock is already ticking, and fast. These are my thoughts. I am a hospitalist, internal medicine trained. I have recently started a blog. I have a great deal of interest in hospital medicine, the economics and billing/coding and finances both medical and non medical.
http://thehappyhospitalist.blogspot.com/
Anonymous
Whine, whine, whine. I a officially tired of the endless pity party engaged in by some physicians.
What is needed is a new entrepreneurial spirit to be unleashed by physicians. Free market, (authentic) private practice, creative/novel practice models, and high tech alternatives exist to the atrocities of Medicare, Medicaid, ERISA theft of services, and brain-dead, oppressive government bureaucracy.
Patients and physicians will benefit big time.
Ed Sodaro MD
Anonymous
So what’s the magic number where the public doesn’t live under the constant physician propagated threat of too few of you?
How many does it take before we no longer have to listen to the breathless announcements of no more physicians if we don’t do X, Y, or Z?
Anonymous
“Medical students aren’t stupid.”
They are, however, oxymorons.
Anonymous
Zelda:
On the one hand, I say don’t worry. They were saying the same thing when I was in school. They were right in predicting the loss of independence but not the degree or rapidity. Medicine will still be fun and interesting and financially rewarding. But it is going to get less and less free. If you value your independence, chose your specialty carefully.
Anonymous
Docs used to not retire, they just faded away as forced by disability. No more. People look for an out. I didn’t mind not getting paid for a lot of stuff when I could set my fees and otherwise run my business as I see fit. It was part of the 2500 year convenant of Hippocratic medicine. I put my pateints interest over my own regarding sleep, sex, exercise, recreation, etc and don’t let business considerations contaminate my recommendations, and I could charge those who can pay whatever I decide without outside interference. With that, I didn’t mind not collecting about 1/3 of my charges. When the government started forcing me to treat the richest old fart in town at a discount, I started getting resentful.
You can’t handle the stress of this job and deal with resentment at the same time.
Should I be above that and not resent having my rights and freedom taken away from me, the same rights everybody else has to decide what they will work for? I make no apologies for that. I am an American and love freedom and OUGHT to get mad when it is taken away. The only way for a slave to fight back however, once made a slave, is to withhold his enthusiasm for his work. That stinks.
The Happy Hospitalist
“So what’s the magic number where the public doesn’t live under the constant physician propagated threat of too few of you?”
Look around, You can’t find a doc in my area that will accept new medicaid, unless you are mandated by a federally subsidized salary. You can’t find a lot of doctors that will accept NEW medicare patients. It’s not in the future. It’s now.
When it happens to you, you will know. It’s already happenening everywhere. If medicare passes their 10% cut, (and I hope they do), there will be a mass exodus of physicians. The only access to primary care will be those willing to establish a cash only basis on terms on par with reality.
If your dentist refuses to accept subpar reimbursment, why do you expect your primary care physician via medicare/medicaid/HMO/any insurance.
Anonymous
Part of the reason the number of physicians are declining is because of what you guys are doing to your own profession.
Every single day, you come here and discourage young medical students not to go into family practice. it seems you go out of your way to slit the throat of your own profession. Why would any young person want to become a doctor, after listening to you drone on and on about how horrible it is?
Anonymous
“When it happens to you, you will know. It’s already happenening everywhere. If medicare passes their 10% cut, (and I hope they do), there will be a mass exodus of physicians. The only access to primary care will be those willing to establish a cash only basis on terms on par with reality.”
That doesn’t answer my question, whether it’s true or not. The fact that none of you have answered it indicates that it’s just a throwaway line you use to scare the public. You really have no idea what the optimal number is or when you would stop threatening shortage.
Anonymous
“Every single day, you come here and discourage young medical students not to go into family practice.”
Ah, we should lie… That will get the numbers back up where they should be, no? Doctors leave because they’re not happy. Don’t you think it would better to address the reasons they leave, rather than lying to new doctors? Look, the new doctors are not stupid, they’re going to figure it out on their own, better to tell the truth. And the truth is that there are real problems that have to be addressed.
Anonymous
You don’t have to be older to retire from medicine, I retired at age 37. I now work as a medical manager in a pharma company research division. My life is infinitely better: no pager, no major liability, no begging for payment.
I earn about 20% less but work half as much. I don’t even miss that money, because half went to taxes anyway. Plus I get paid benefits, profit sharing, annual COL raise (imagine that!). Interestingly, I also get far more respect in my new job than I ever got in private practice.
To all unhappy docs I say: Get the hell out now!! Its only going to get worse. There is huge opportunity elswhere in the healthcare industry if you have the courage to re-invent yourself.
Get out now and let the lawyers eat whats left.
Anonymous
“You really have no idea what the optimal number is or when you would stop threatening shortage.”
The markey would determine the number without intervention or planning, if we would allow it.
The problem is, all of you socialists want to determine what the number is and then dictate what people should do, rather than allowing the market do it automatically.
What you fail to realize, is that asking the question “What is the optimal number of (picka commodity to be spupplied) and demanding an answer, reveals that you are a hard-core socialist.
Why do you not ask, what is the optimal number of cans of coca-cola – that is how many should be manufactured – no more, no less – and then dictate the price of coca-cola?
Anonymous
“You really have no idea what the optimal number is or when you would stop threatening shortage.”
You are not getting the idea. The absolute number of physicians is not what is being discussed. Imagine if 50% of all phyusicians were dermatologists. While the absolute number might not indicate a shortage, we’d be very short of many specialties, such as primary care, endocrinology and the like. Primary care is dying. The older docs, who make up 50% of the physician population, plan to retire early. Do you get it now?

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