How declining physician pay will alter the healthcare industry

CMS has proposed another physician pay cut in its Medicare physician fee schedule proposed for 2023. Seven physicians leaders were asked what the healthcare industry will look like if physician reimbursement continues to drop. This is how they responded:

Editor's note: These responses were edited lightly for clarity and length. 

Cory Calendine, MD. Orthopedic surgeon at the Bone and Joint Institute of Tennessee (Franklin): The outcome of this continued declining reimbursement combined with rising costs will be additional physician employment by larger health systems (seeking shelter from the financial storm) and a reduction in the physician workforce over time. Presumably, a portion of the care can be provided by [advanced practice providers]; however, there will likely be declining quality and availability of physician services. The physician spend represents a small portion of the total Medicare spend, making this approach seem shortsighted, if not entirely inappropriate. More to the point, this path is unsustainable and will lead to system collapse if unchecked. 

Matt Mazurek, MD. Assistant professor of clinical anesthesiology at Yale School of Medicine (New Haven, Conn.): A continued decline in payments will accelerate the current trends for physicians to become employed. Seventy percent of physicians are now employed. By the end of this decade, I predict all physicians will either be employed or remain in academic practices. Even without payment cuts, increases are not keeping pace with inflation and overhead costs. To provide care with fewer physicians and increased demand, healthcare teams composed of APPs, including nurse practitioners and physician assistants, will help fill the gaps in care. If these teams perform efficiently, the administrative burden for physicians will hopefully decrease. My concern is we are not addressing burnout, and systems are layering administrative responsibilities on physicians. It is well known that 60 percent of a physicians' time is spent doing menial, administrative tasks and data entry. The big three EMR companies have not changed their user interface to increase patient care flow and efficiency — they remain primarily billing tools with fragmented information not geared toward bedside care. As payments decline, physicians will demand some accountability for the lack of progress on key drivers of burnout. 

Bradley Shapiro, MD. Gastroenterology physician at Duly Health and Care (Hoffman Estates, Ill.): The proposed 4.42 percent pay cut for physicians is appalling and shows lack of appreciation for our profession. Soaring inflation results in increased overhead, including labor and supplies, vital to running a medical practice. I anticipate this will lead to closures of smaller medical practices, as they will not be able to absorb the increasing costs due to decreasing revenues. Some internal medicine physicians will likely turn to concierge medicine in order to enhance revenue. As Medicare puts the squeeze on physicians, many will retire earlier than expected, decreasing availability for patients. More than 43 percent of the physician workforce is 55 and older. These changes will result in physician shortages and decreased access to care for our patients, especially in the primary care setting. I can only hope our medical societies can adequately express these concerns to Congress and amend these proposed changes.

Gerald Hayken, MD. Orthopedic surgery specialist in Mount Laurel, N.J.: I believe that the healthcare industry has to be reformed. We need a system that will ensure that all people have access to care. I also believe that physicians should be freed from the burdens of unnecessary bureaucracy, i.e. unnecessary documentation and interference by insurance companies, that challenge physician decisions such as ordering of diagnostic tests and treatments, such as surgery, thereby enabling them to spend time seeing patients.

Shamsideen Musa, MD. Pain management physician in Anchorage, Alaska: If physician payments continue to decline, we will continue to see the consolidation and corporatization of medical practices. As a result, patients will likely continue to experience the depersonalization and corporate feel of medical treatment offered by large groups. Physicians will increasingly seek employment at hospitals and private equity-backed corporations for stable income while the number of solo practitioners declines.

Scott Huitink, MD. Pediatrician and owner of Compass Pediatrics (Nashville, Tenn.): Physicians will figure out how to take insurance out of the equation. This devaluing of insurance will shift the patient-physician relationship from the patient-payer-physician to the patient-physician relationship. Arbitrary pay cuts to physicians highlight the reality that politicians don't have to do much to get paid tax money for their wages. They just need to be in charge. Since physicians aren't in charge of pay, we will continue to be marginalized.

Jonathan Phillips, MD. Former orthopedic surgeon at Orlando (Fla.) Health: Until our government realizes that they have created a hugely toxic environment, which healthcare workers increasingly decide not to tolerate, the standard of medicine in this country will continue to decline. The disempowerment, disrespect and interference in clinical practice at all levels in this country is depressing. I trained in the National Health Service in the U.K. and came to the U.S. a long time ago to escape the government's stupidity in that land. Sadly, we are going in the same direction in my adopted nation.

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