Top physician concerns beyond COVID-19

By John Murphy, MDLinx
Published March 31, 2020

Key Takeaways

The most concerning thing on physicians’ minds right now is the coronavirus pandemic. Unfortunately, worrying about this new and deadly virus doesn’t eliminate all the other major concerns on doctors’ minds. Those problems—from prior authorizations and certification requirements to declining reimbursements and increasing workloads—haven’t gone anywhere. 

Just before the COVID-19 outbreak became a global calamity, MDLinx surveyed our readers to find out what concerns them the most this year. In short, what are the biggest issues that medicine is now facing?

Not surprisingly, we found that, as physicians have a lot on their plate, they have a considerable number of concerns. Here, we’ll enumerate and characterize these many concerns, which include patient satisfaction scores, online reviews, malpractice, board certification, and non-physician providers.

We’ll begin with the biggest concern occupying the minds of many doctors this year: healthcare legislation.

Legislation

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Two-thirds (66%) of physicians are concerned about legislation that affects medicine. This includes more than 26% who describe themselves as “moderately concerned” and about 40% who say they are “very concerned.” 

A lot of physicians over age 65 years—nearly three-quarters (73%) of them—report having these concerns. But, that doesn’t mean the younger generation isn’t thinking about healthcare legislation, because as many as 64% of doctors under age 45 years said they’re concerned about it. 

“Healthcare is at a pivotal point and any legislation passed now will have a significant impact on the future of healthcare,” said a gastroenterologist in private practice. 

But, what kind of healthcare legislation are physicians concerned about? You name it—anything from declining reimbursement and insurance company interference to the rise in non-physician providers and the possibility of universal healthcare. 

The matter that weighs most heavily on doctors’ minds appears to be the upcoming 2020 presidential election, and what healthcare will look like under that president’s administration. 

On one end, some physicians worry that Obamacare will be fully dismantled if President Trump retains the Oval Office. On the other end, some physicians foresee disaster if Medicare For All is instituted under Sen. Bernie Sanders. Somewhere in between, physicians have mixed feelings about former Vice President Joe Biden’s plan to not only maintain Obamacare but expand on it. 

“The Affordable Care Act led to families being insured with plans that provided reasonable benefits. Prior to the [Affordable Care Act], some insurance plans were terrible. I think the current administration will go backward on this progress if they can,” said a professor of oncology. 

Is Medicare for All the answer? Some doctors think so, but others are decidedly against it. An internal medicine physician who’s a health-plan administrator said, “Single-payer medicine appears to be the wave of the future, and I am in favor of it.”

“Medicare for All could be a great change for the country,” agreed an internal medicine physician in private practice. 

Not everyone agrees, however. “Ideologues creating healthcare policy is very dangerous. If we move to healthcare for all, I would need to seriously think about moving out of the country. This next election is VERY important,” warned a family physician in a university setting.

A neurologist in solo practice predicted: “Socialized medicine will end my medical career,” because of minimized reimbursements. 

One young hospitalist (self identified as between 31 and 45 years old) takes a pragmatic, middle-of-the-road approach: “I am concerned about the impact the current president has on the market, as well as the trend towards Medicare for all. I don't believe the extremes on either side are the answer,” she wrote. “We need to look at fixing our healthcare system in a step-wise approach, not jump to a single-payer system because the current system has flaws. There are ways to improve things without completely changing our current system.”

But, the presidential healthcare agenda isn’t the only legislation on respondents’ minds: 

  • Reimbursement: “Reimbursement has already dropped to barely tolerable levels, and private practice is barely sustainable, let alone profitable,” said a family physician in solo practice. 

  • Insurance company influence: “Our system is quite broken, and continues to be run by the bottom line for insurance companies,” noted a psychiatrist in solo practice. 

  • Prior authorization: “We need an overhaul of our broken system! Prior authorizations are just one example of how care is dictated from the top down,” said a family physician in a multispecialty practice. 

  • Non-physician providers: “There are significant decisions being made regarding nurse practitioners practicing without supervision,” said an emergency medicine physician. An internal medicine physician in a multi-specialty group said, “[Nurse practitioners] are lobbying for independent practice rights, which will oversaturate the market and devalue MDs/DOs.”

For this survey, MDLinx contacted physicians by email, asking them to rank their level of concern regarding these topical issues. Nearly 600 physicians responded—about half are primary care physicians (family and internal medicine doctors) and the other half are specialists of all stripes (oncologists, emergency medicine physicians, psychiatrists, hospitalists, neurologists, and many others). 

Patient satisfaction scores

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About half of all physicians in our survey report that they are either moderately concerned (29%) or very concerned (20%) about patient satisfaction scores. 

By age group, the greatest number of physicians concerned about patient satisfaction scores are those under age 45 years (59%). The age group with the fewest concerned physicians are those age 65 years and older (25%). 

By practice setting, a significantly higher number of physicians who work in hospitals said they’re concerned about patient satisfaction scores (57%) compared with those who work in private practice (44%) or other settings (45%). 

Interestingly, physicians are concerned about patient satisfaction scores for different reasons. Some physicians appreciate them as a bellwether of their bedside manner. Others consider them a necessary evil; these physicians concede that it’s important to gauge patient satisfaction, but don’t like that scores may be tied to physician compensation. And then there are those physicians who dismiss patient satisfaction scores entirely. 

“If I do my job well, patients will usually be satisfied,” said a neurologist in a hospital setting.

“Patient satisfaction scores may help me discover if I am becoming less empathetic,” said a family physician in a hospital-owned practice. 

“My bonus is contingent on patient satisfaction scores, although I don’t place much weight in them per se because I think they are skewed or bogus,” noted a hospital internist. 

Patient satisfaction scores are “[n]ot designed to evaluate individual physicians, but hospitals and employers are using them for that purpose,” said a hospitalist. 

“[W]e are expected to treat [patients] as “clients” but the motto “the client is always right” CANNOT be applied to medicine,” said a palliative medicine physician. 

Said a neurologist in a hospital-owned practice: “These scores seem to equate medical care with other services like auto repair.”

Online patient reviews

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More than 46% of physicians say they are either moderately concerned (29%) or very concerned (17%) about online patient reviews on Google, Yelp, social media, etc, and how these impact their reputation. These concerns were voiced more commonly by younger physicians (age 45 years and under) and those in private practice. 

“I’m still young and building my practice, so reviews are very important in continuing to build it,” said a family physician in a hospital-owned practice. 

“Only the disgruntled ones write anything. The satisfied patients don’t bother,” observed an internist in a private group practice. 

“Responses are not vetted and people can write anything, even if it is false,” said a family physician in a multispecialty practice. 

“I personally use reviews to assess if I want to utilize a product in general, so I suspect patients will look at reviews when they determine if they want to see me as well,” reasoned a rheumatologist in a multispecialty practice. 

“I pay no attention to this,” said a psychiatrist in a hospital setting. “It is all part of the ‘dumbing down’ of the medical profession.”

Malpractice

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Nearly 37% of physicians are moderately concerned (19%) or very concerned (18%) about medical malpractice. The physicians with the greatest concern are those aged 46-54. Among specialties, hospitalists and internal medicine physicians are some of the most concerned about malpractice, according to our survey. 

“This concern requires me to excessively document patient encounters and over order clinical tests in order to be in a position to properly defend my clinical judgment, if it is questioned,” said an internist in solo practice. 

“I strive to practice within the standard of care. I think being sued is, unfortunately, a fact of life for physicians, no matter how good or caring they are,” observed a nephrologist in an academic teaching hospital. 

“Malpractice cost is rising because of frivolous lawsuits, and there is no way to countersue them,” bemoaned a psychiatrist in solo practice. 

“The better you know your patients, the less likely you are to be sued,” observed another internist in solo practice. “Patients will sue over abandonment and poor communication!” 

Said an internist in a multispecialty group: “My documentation is excellent. I do my best for my patients. I’m not concerned.”

Board certification

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Board certification—some physicians value it, others vilify it. About one-third of physicians are significantly concerned about it, according to our survey. This includes about 16% who are moderately concerned and nearly 18% who are very concerned. 

“I am board certified and I think it is a good benchmark of knowledge,” said a nephrologist in an academic teaching hospital. 

Board certification is “now a de facto requirement for hospital privileges and insurance panel participation,” said a hospitalist. 

“Board certification is an independent way to see a level playing field, but should not be a ‘make or break’ point,” argued a family physician in a hospital-owned practice.

“Board certification is not the best way to gauge a physician's competency,” said an internist in a hospital-owned practice. 

One hospital pulmonologist summed it up this way: “It's outrageously expensive and time-consuming and a total scam.”

Non-physician providers

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More than 28% of physicians said they’re either moderately (14%) or very concerned (15%) about having fewer work opportunities due to the availability of lower-cost non-physician providers. 

“As a sub-specialist, this hasn't been a concern for me but I think it could be concerning for primary care physicians and anesthesiologists,” said a hospital cardiologist. 

“Mid-level providers look appealing to money counters, [but] with a definitive decrease in quality of care,” said a family physician at a military facility. “While access and costs are important factors, when dealing with people's lives, quality should be paramount.”

“I believe the low-cost providers have an important role in delivering healthcare, but their limited knowledge can be dangerous to the patient if they have no supervision,” reasoned an internist at a community health center. 

Said an internist at a Veterans Affairs hospital: “There is enough work for everyone.” 

For now and the foreseeable future, medicine’s main concern is the coronavirus pandemic. Perhaps by working together to solve this crisis, legislators—not to mention health insurance companies, pharmaceutical companies, health facility administrators, and other “stakeholders”—will work better with physicians to solve these longstanding concerns. 

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