To make up for less than desirable incomes, physicians are trying a lot of things: 26 percent of respondents said they added ancillary services, 36 percent of physicians increased the number of patients seen per day, and 27 percent took on work outside of their practice, for example. Others have started in-house dispensaries, started making fee-based house calls, and taken other measures.
Still, rising overhead costs continue to erode their pocketbooks.
Forty-two percent of all physicians said overhead costs are greater than they were last year, and only 7 percent said they are less than they were in 2012.
"The costs of running a practice are increasing, and that's the same for both those who are employed by hospitals or those who are running their own practice," says Bohannon. "Certainly those running their own practice feel that pinch more."
The Affordable Care Act's Medicaid expansion provision, which calls for Medicaid coverage for those whose income is up to 133 percent of the federal poverty level, or $29,700 for a family of four, according to the most recent CMS data available, isn't making things easier for doctors — even though states that adopt the provision will see Medicaid reimbursement rates rise in 2014. Because of the reform law, 10 percent of physicians say they're considering not taking new Medicaid patients, and 5 percent may stop seeing Medicaid patients altogether.
Looming Medicare cuts have also kept physicians up at night, wondering whether they can continue participating in the program. Eighteen percent of physicians said the uncertainty of Medicare may cause them to stop accepting any new Medicare patients, 6 percent are considering dropping the program altogether, and 7 percent are exploring direct-pay practice models.
With all these income-based challenges, physicians are looking for new ways to maximize revenue. But seeing more patients can only go so far.
"The biggest thing we hear from practices is, 'If I want to make as much as I did in the past, I have to see more patients,'" says Bohannon. "The challenge, though, is in a private-practice environment, that has a finite limit. You can only see so many more patients."
Here are some other ways practices can improve compensation:
• Focus on referring physicians. Harkey says Texas Retina also goes to great lengths to keep referring physicians happy, so its own physicians have a full schedule. And the results pay off. "We always take same-day, new-patient referrals even if the schedule is full, which can help our referring physicians if and when they have an urgent case that needs to be seen immediately," he says.
• Utilize nonphysician providers (NPPs). With primary-care physician shortages looming, not to mention an influx of new patients under the reform law, nonphysician providers such as physician assistants (PAs) and nurse practitioners (NPs) are going to become even more important as practices shift to team-based care models. Relying on NPPs can help physicians focus on their complex patients, and in turn, help practices accommodate more patients. Also, compensation for NPPs is typically half that of a physician, thus they are a lower-cost resource that can focus on less-intensive office visits or patient follow up that is reimbursed at lower levels, says Jim Lord, a principal with healthcare consulting firm ECG Management Consultants. ECG's most recent "Provider Compensation, Production, and Benefits Survey" revealed that an NP's median compensation is $97,676, versus $210,531, the median for a family-practice physician.
"We're moving into a model now where many of the physicians are just learning how to use that nonphysician provider as an extension of themselves and that's going to be a very important skill for them to master," says Lord.