Good news, bad news for physicians

Here are three pieces of good news and three pieces of bad news for physicians:

Bad news

1. Physician pay is declining 

CMS is floating a 3.34 percent conversion factor decrease in its proposed Medicare physician fee schedule for 2024 released July 13. 

The average physician compensation declined by 2.4 percent in 2022, according to Doximity's 2023 "Physician Compensation Report." 

"People wonder why our healthcare system is in such a turmoil. Poor access to doctors, and emergency rooms are so overcrowded with trivial problems," Sheldon Taub, MD, gastroenterologist at Jupiter (Fla.) Medical Center told Becker's. "Who wants to go into medicine when your reimbursement goes down every year? I pay more for my plumber or electrician than I make per hour… Our healthcare system is a travesty, and I have to blame much of it on the government. Big business is running medicine and that's a shame."

Additionally, more physicians and practices could be hit with a penalty with the Merit-Based Incentive Program based on the 2022 performance feedback. These penalties can reduce Medicare payments up to 9 percent, according to a Sept. 11 news release from the American Medical Association. 

2. Physician shortages are getting worse

The overall shortage of physicians in the U.S. could reach 124,000 by 2034, according to Physician Thrive's 2023 compensation report. Of those, up to 48,000 could be in primary care and 76,000 will be specialists, surgeons or hospitalists, according to the report. These shortages will burden already-burnt out physicians and further affect access to care. 

"The extraordinary rate of provider burnout is the most concerning healthcare disruptor to me. When combined with physician shortages, America's healthcare workforce is under enormous strain as the population ages and the demand for healthcare services increases," Luis Argueso, partner at InHealth Advisors, told Becker's. "There are no quick solutions to this problem given the time to train new practitioners, although increases to the number of resident slots are a good start. Provider shortages will lead to delays in care and increased costs, at a time when healthcare is already hard to find and difficult to afford. This concern doesn't just impact patients; given the way healthcare is financed (through taxes for government payers or forgone compensation for employees), we all bear the financial cost."

Areas with an aging population, such as Midwestern and Southern states, along with rural areas, will see exacerbated shortages in the next decade, according to the Physician Thrive report. 

3. Physicians are losing autonomy

Only 44 percent of physicians owned their practice in 2022, compared with 76 percent in the early 1980s, according to a report from the American Medical Association. Additionally, the number of physicians working in private practices decreased by 13 percent between 2012 and 2022. 

Some leaders feel that this is affecting physician autonomy. 

"Physicians remaining independent are going to be few and far between. They're either going to go with these large equity groups or hospitals or something like that," Dr. Taub told Becker's.  "You still have a quote, unquote, 'private practice,' but you have guidelines and rules that you have to conform to so it meets their criteria. So right away, you feel a little bit of your autonomy being compromised, and then the bigger the group gets, the more restrictions they have on what you can do to stay in the group and conform to what they want you to do. On top of that, the government throws in their regulations too. The private practitioner is a dying breed."

Good news

1. Payers, legislators are cutting prior authorizations

In 2022, 39 percent of physicians spent one to nine hours on prior authorizations weekly, according to Medical Economics' "94th Physician Report," but payers and legislators are making increasing efforts to cut down these requirements. 

In the last two months, Humana, Cigna and Blue Cross Blue Shield plans have cut prior authorization requirements. Additionally, UnitedHealthcare began a two-phased approach to eliminate prior authorization requirements for several procedure codes, aiming to cut prior authorization by 20 percent. 

"Many gastroenterologists are concerned about prior authorization and advanced notification processes causing delays in cancer diagnosis for patients with alarm symptoms and medical management in general," Benjamin Levy, MD, a gastroenterologist at University of Chicago Medicine, told Becker's. "As a physician community, we breathed a sigh of relief when the proposed new prior authorization requirements were changed to advanced notification."

States have also made efforts to limit prior authorizations. Last year, Texas passed a law where physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services. In June, Michigan launched new prior authorization rules that aim to make the process faster, more effective and more transparent.

2. CMS taking steps to address physician mental health

The Consolidated Appropriations Act of 2023 updated exceptions to Stark Law and Anti-Kickback law that will allow hospitals and healthcare providers to improve mental health services for physicians. The law issues a new exception for physician wellness programs offered by healthcare entities, including ASCs, hospitals and physician practices. 

"I don’t know of any hospital that was withholding those essential services for fear of violating Stark, but anything that removes any barriers to access mental health services for physicians is a huge step," Joseph Sewards, MD, the chair of orthopedic surgery and sports medicine at Philadelphia-based Temple University, told Becker's. "There already are enough barriers out there, and physician burnout and other signs of deteriorating mental health/wellness is getting to be a problem that is quickly getting out of control."

3. FTC, states are targeting noncompetes. 

Noncompetes, which affect between 37 and 45 percent of physicians, can limit career growth and restrict physicians' ability to provide care in economically or socially marginalized communities. But states are making increasing efforts to limit these contracts. 

This year, Connecticut passed a bill amending the state's physician noncompete statute and New York passed a bill aiming to stop employers from entering into noncompete agreements with their employees.

Additionally, the Federal Trade Commission proposed a rule in January that would keep employees free from noncompete contracts. 

"Noncompetes were more important when physician private practices were the norm. The purpose was to prevent a physician from opening another nearby practice to directly compete with the original practice," Marsha Haley, MD, clinical assistant professor of radiation oncology at the University of Pittsburgh, told Becker's. "Now that most physicians are employed by large health systems, we need to rethink the concept of noncompetes. Many large health systems have a footprint that expands several states. If a physician is let go or leaves the practice, this requires the physician to move a long distance to meet the noncompete clause."

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