D Healthcare Daily

Texas physicians are more frustrated and more pessimistic than their colleagues are nationally, according to a Physicians Foundation survey.

Moreover, if they do what they say they’re going to do in the near future, Texas’ physician shortage may get significantly worse.

Among Texas physicians, the survey found:

• 56 percent said their income practice declined over the past three years—10 percentage points higher than the U.S. average.
• Nearly 75 percent said their practices either were at full capacity or overextended.
• More than half said they plan to cut back their workload, restrict the number of patients they see or retire. About two out of three said they would retire if they could afford to do so.
• More than three out of four say they are somewhat or very negative about the current state of the medical profession and its future.

On most survey questions, Texas physicians were more 5-10 percentage points more negative about health reform and the state of their profession. However, they were less concerned about medical liability, which reflects the state’s 2002 tort reforms.

Lou Goodman, vice president and CEO of the Texas Medical Association and president of the Physicians Foundation, said survey responses reflected the nature of the state’s physician workforce. About 60 percent of Texas physicians are independent practitioners, compared with less than half nationally.

Goodman described the state’s physicians as “fiercely independent.” He said healthcare industry changes tend to originate on both coasts and gradually fold onto the rest of the nation. They are also more hostile to health reform. Nearly three out of four Texas physicians said the passage of the Affordable Care Act made them more pessimistic about the future of U.S. healthcare, compared with less than 60 percent of U.S. physicians.

“There is a general sense in Texas that Big Brother is taking over. Doctors would have preferred a more bottom-up approach on health reform,” Goodman said.

More than 40 percent of the state’s physicians believed patient-centered medical homes would increase quality or decrease costs, and nearly half held those views toward accountable care organizations.

Goodman said physicians are having a hard time grasping exactly what those models are supposed to accomplish.

“The explanations are pretty esoteric. Every one is a little different. The government has done a terrible job of explaining them,” he said.

Travis Singleton, senior vice president at Irving-based Merritt Hawkins & Associates, said the survey results reflected the state’s “independent DNA. Texas is the last bastion of fee-for-service (because of independent practices).”

Singleton said he was struck by the responses to two questions: “If you had your career to do over, would you choose to be a physician?” and “Would you recommend medicine as a career to your children or other young people?” Fewer than 2 out of 3 said they would select the same career path, and only one out of three said they would recommend the profession. Texas physicians were about 5 percentage points more negative than U.S. physicians were.

He said, “The statistics back this up. They are making less money and seeing more patients. We’re in a bad situation. The math does not work on access (to healthcare). We are vastly increasing access and vastly decreasing reimbursement. I haven’t found a business where that works. All the signs point to doctors seeing fewer patients and working fewer hours. At a time when we’re selling the public greater access, the reality is we’re doing the opposite.”

Phil Miller, Merritt Hawkins vice president of communications, said Texas physicians worked 55 hours a week, compared with 53 hours nationally. He said if the state’s physician hours decreased by 6 percent as it did nationally, that would translate into 2,700 fewer full-time equivalent physicians and a loss of more than 6.7 million patient encounters.

Singleton called the gradual withdrawal of physician services “a silent exodus. It’s not in your face. But it’s happening. I almost would rather have them throw up picket signs and stop work. Then something might be done about it.”

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.