2011 Great American Physician Survey

October 4, 2011

We surveyed hundreds of American physicians on everything from their views on politics and public policy to their sense of professional satisfaction to how well they’re taking care of themselves physically and emotionally. You’re juggling so many demands on your time. How are you holding up?

You're carving out a bit more time for your personal life this year, a trend that's likely to continue as younger doctors place a greater premium on work-life balance. Your retirement portfolios are on the mend, enabling more of you to retire on schedule, though you're still feeling the recessionary pinch. And stress continues to rank as the biggest drawback to your job, not surprising given that reimbursement cuts are forcing you to put in longer hours for less pay. Yet some 82 percent of you tell us that you like being a physician, down slightly from a year ago but still a high number.

All of it (and much more) is according to the results of the 2011 Great American Physician Survey. We ask dozens of questions to gauge your attitudes toward your careers, the state of your personal happiness and physical health, your views on politics and healthcare policy, even your family lives. The result is the clearest view into the state of the American physician community available anywhere. The 661 doctors who responded to this year's survey, our second, reflect a microcosm of the physician community at large, evenly divided between specialists and primary-care providers. Some 62 percent of the respondents are male, with a median age of 51. And a slim majority work in practices located in an urban setting with between two and five physicians.

To read the results of the 2011 Great American Physician Survey, view our slideshow here.

And despite the many frustrations of modern medicine, which you enumerated for us at length, you're mostly content, happy, and grateful for where you are in life. Given the chance to start your career over, nearly 60 percent of you say you'd do everything roughly the same. You're a happy lot, too. On a scale of 1 to 10 (with 10 being the happiest) your average rating is 7.35. And have you heard the old saw that most doctors urge their own kids to follow a different path? It's hogwash: The vast majority of you would either encourage your son or daughter to consider becoming a physician if they expressed an interest, or answer their questions honestly without influencing their decision.

You've evolved

That a majority of you tell us you're an employed physician of a hospital or other institution (as opposed to being a partner in your own practice) is no surprise, as the growing cost and administrative hassle associated with managing a private practice creates economic incentive for hospital-physician alignment. Over the next decade, in fact, more than a third of you believe most physicians will become hospital-employed. William Handelman, an internist with Nephrology Associates in Torrington, Conn., may be among them: "We are considering becoming employees of the hospital for a variety of reasons," he says. "It doesn't make sense from a business perspective for two physicians in their 60s to invest in information technology, like a new EMR, or deal with ongoing reimbursement challenges when that would be much easier done through the hospital."

You're also becoming more tech savvy by the day. You're fairly adept at using social media networks like Facebook, LinkedIn and Twitter, and reaching out to other medical professionals via similar online venues. But you're not much interested in using such networks to communicate with patients. Another 53 percent of you this year indicated you were using so-called "smartphones" for work, up from 42 percent in 2010. And many reported using iPads, laptops, and personal handheld devices in the exam room, in keeping with the trend toward high tech healthcare.

That more of you this year (66 percent vs. 59 percent) tell us that you accept Medicare and plan to continue is a surprise, perhaps, given what's happening with Medicare reimbursement levels. And you're open to opportunities that would render your practice more competitive: 43 percent say you'd consider switching to a fee-for-service-only practice that does not accept insurance if the numbers made sense. Going "boutique," or concierge, holds less appeal. In any case, most of you aren't making many significant changes just yet. Some 56 percent of you say you plan to continue practicing as you do now for at least the next five years, as opposed to merging, going solo, becoming hospital employed, or closing up shop. Beyond that five-year horizon, though, you're less certain - and somewhat pessimistic - about the future. For example, nearly half of you believe that primary-care physicians will be replaced by cheaper midlevels over the next decade, and about the same number say that reimbursement will evolve during the same time frame from fee-for-service to bundled payments or some newfangled reimbursement model.

You time

Despite some success in carving out more time for your families, you're still putting in long hours, with most of you working between 41 and 60 hours a week. Nearly two-thirds of you say you don't have as much time for yourselves as you'd like and 53 percent wish you worked fewer hours. But would you take a pay cut if it meant reduced hours? Two-thirds of you say no, though that number is down from 73 percent in 2010.

On a weekly basis, roughly half of you spend more than 10 waking hours a week with your families. You even manage to sit down together for dinner more often than not. But chances are good that you're putting in a few extra hours after everyone else goes to bed. "I don't call it a job. It's a lifestyle," says Dianna Tolen, a pediatrician with Kids First Pediatric Care in Canfield, Ohio. Tolen says medicine has been a bigger time commitment than she bargained for. "It's all encompassing. There is no clocking in or clocking out. You take home patient care in your head at night and you're always trying to research and read to stay updated. My family is constantly taking a back seat to my patients' needs."

That may explain why you still can't get to the gym often enough. Though more than half of you work out at least three times a week, if not more, nearly 30 percent of you say you don't get much exercise at all and the majority of you admit that you tip the scale at a larger number than you'd like. Yet you're no worse for the wear, it seems, with more than half of you saying that physically you either feel "great" or "better than most people your age." Your mental health is also generally good, with most of you categorizing yourselves as "happier and better adjusted than most people." And despite the verbal flogging that doctors regularly receive for not taking care of themselves, more than 80 percent of you say you eat right most of the time, and more than half of you get routine checkups and follow your own doctor's advice.

You vs. Washington

In the political front, you're not particularly active, with most of you calling yourselves "moderately involved," but you do stay abreast of the issues and nearly all of you plan to cast your vote in the presidential election next fall. Slightly more of you plan to vote for more Democrats than Republicans. If you could single-handedly change the U.S. healthcare system, you'd like to see tort reform to reduce the size of malpractice awards, financial incentives to encourage more people to enter medical school, and a public marketplace where individuals could compare insurance plans.

Like many Americans, you also believe that a lack of adequate insurance coverage is the biggest obstacle to good healthcare, but you don't necessarily think the 2010 Affordable Care Act goes the distance. While you generally support the initiative, with a few tweaks, more than 90 percent of you believe it will never be implemented as it currently stands - either due to funding issues or future Congressional action. As such, the majority of you won't be making any internal changes to prepare for reform, though a statistically significant 21 percent will be hiring more nurse practitioners and physician assistants. "I support basic medical care and preventive health care for everybody, but not the way the government is imposing it," says Francisco J. Sanchez, a solo practitioner with Chicago Family Wellness in the Windy City. "They're not doing anything to increase the number of primary-care doctors and there's already a shortage because it does not pay well and there is little professional regard for primary care among other physicians."

But reform is not your only concern on the public policy front. As with last year, the economy -more specifically unemployment, lackluster growth, and the growing threat of inflation - ranks even higher. Indeed, the recession continues to impact both your personal and professional lives. A good many of you, for example, have had to tighten your purse strings since the downturn began, canceling trips and other luxuries as you balance higher gas and grocery bills with reduced income, even as you support underemployed family members. A good number of you have also had to alter your retirement plans, though slightly more of you this year than last (30 percent vs. 27 percent) report that you'll still be able to retire on time.

As far as your practice is concerned, more than half of you say that many of your patients have lost their jobs and health insurance as a result of the economic crisis, that patients are waiting longer to come in, and are coming in less often.

"When it first hit we noticed that the biggest effect was the loss of insurance from those who lost their jobs, but now the issue is more underinsurance," says Tolen. "As a pediatrician, well visits are a mainstay of my practice, but patients don't come in for well visits now because their copays and deductibles are higher. They wait until their child is sick and then come in with 10 problems at a time." As a result, she notes, the visits are longer and more complicated, which wreaks havoc on her schedule. Patients are also requesting more write-offs than they ever have, insisting that tests and procedures be included in the cost of the visit.

While medical malpractice concerns continue to weigh heavily, the majority of you indicated you've never been sued or even threatened with a lawsuit, nor have you ever felt the need to meet with an attorney about a particular patient case. But you're taking no chances. Two-thirds of you say you've ordered procedures or tests that you thought were probably not necessary just to "cover all the bases" and avoid litigation. That's slightly less than the 73 percent who did so in 2010.

As the new paradigm of medicine unfolds, our latest physician survey finds you reasonably well prepared, but nervous about the three "R's" - reimbursement, reform, and regulation. You're redefining your business models to become more agile and better accommodate patient-centered care. And you're making it to more of your kids' soccer games. Perhaps most importantly, though, you're still content with your career of choice. "At the end of the day, physicians who are happy in medicine are happy because they enjoy being with patients and that hasn't changed," says Handelman, noting neither the economy nor policymakers on Capitol Hill can take that away.

To read the results of the 2011 Great American Physician Survey, view our slideshow here.

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.