Survey: Bureaucracy Crushing Texas Physicians

Seeing your doctor or any doctor might become more difficult for Texas patients, according to The Physicians Foundation’s 2014 Survey of America’s Physicians. More than half of Texas doctors (52 percent), plan in the next three years to cut back on work hours or the number of patients they see, find another job in health care that doesn’t involve seeing patients, or retire.   

Those findings are significant as nearly half of Texas physicians (49 percent) work in a private practice — the second-highest number among all states and much higher than the national average (35 percent).   

What is causing physicians to make this difficult decision? Physicians today feel overworked and overburdened by mountains of federal regulations, and dread the looming transition to a new, complex, and expensive medical billing and coding system. Doctors believe others are trying to make health care decisions for them and their patients, and that they have been forced to implement new, expensive electronic health records systems (EHRs) that many do not believe improve patient care. In general, they are pessimistic about the state of the medical profession. 

“Physicians love caring for patients — it’s why we get up in the morning — but this survey reflects the crush of red tape and bureaucracy doctors feel is eating away at that privilege and turning physicians into office administrators instead of healers,” said Joseph S. Valenti, MD, The Physicians Foundation board member and chair of Texas Medical Association’s Council on Socioeconomics. 

Red tape and administrative hassles 

Close to two-thirds (64 percent) of Texas physicians are “very” or “somewhat” negative about the current state of the medical profession, compared with 55 percent nationally. More than three out of four Texas doctors say they are “overextended and overworked” or “at full capacity.” Part of that time crunch is due to red tape and bureaucracy, as the survey found nearly one-third of Texas physicians (30.1 percent) spend as many as 10 hours per week filling out nonclinical paperwork. 

Implementing new bean-counting regulations and federal reform 

Federal mandates and regulations dictating how doctors provide patient care are not helping. More than half of Texas physicians (58 percent) say next year’s forced upgrade to the government’s new billing and coding system, ICD-10, will “create a severe administration problem.” That is because ICD-10 will require doctors to use 69,000 diagnostic codes — up from the current system’s 13,500 codes. All physicians, hospitals, providers, and insurance companies must shift from ICD-9 to ICD-10 by Oct. 1, 2015, but only 8 percent of Texas physicians say the shift will “improve diagnosis or quality of care.” Many doctors believe ICD-10, 20 years in the making, is a boondoggle of a system that will help only health care researchers.  

While four of five Texas doctors report having installed an EHR in their practices, only one-quarter of them say the EHR has improved their quality of patient care. In fact almost half (49.4 percent) say it has detracted from practice efficiency, and almost as many (48.7 percent) say it has detracted from their interaction with patients. 

Though neither ICD-10 nor the new EHR mandates are part of federal health system reform, most doctors don’t like that either. More than one-third (36.4 percent) of Texas doctors give the Affordable Care Act an “F” grade. 

Patient-care decisions: Who makes them? 

Time and again physicians say their relationship with their patients and their ability to make health care decisions without third-party influence are most important to them. Yet most physicians feel health care decisions are at least partly taken out of their hands. More than 50 percent of physicians said they experience “some limitations, my decisions are sometimes compromised.” Add the doctors who believe “many” of their health care decisions are “often” compromised, and the total is nearly three out of four Texas doctors (71.1 percent). Just 28.9 percent of doctors believe they have “no limitations, I am free to make decisions I think are best.” 

That may be partly why more than half of Texas doctors (56.9 percent) say they would not recommend medicine as a career to their children or other young people. Still, given the opportunity to do their own career over, more than two-thirds would choose to be a physician. 

Patients are most important 

Caring for people inspires doctors. Nearly four of five Texas physicians say interacting with patients is the most satisfying part of being a doctor. 

“Our strength comes from our patients. We’re nothing without [them],” said Dr. Valenti, a Denton obstetrician-gynecologist. “[The patient-physician relationship] is the most sacred thing that we have.” 

The Physicians Foundation’s 2014 Survey of America’s Physicians is one of the largest and most comprehensive physician surveys conducted in America. 

The Physicians Foundation is a nonprofit 501(c)(3) organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients. It pursues its mission through a variety of activities including grant making, research, white papers and policy studies. Since 2005, The Foundation has awarded numerous multi-year grants totaling more than $28 million. In addition, The Foundation focuses on the following core areas: physician leadership, physician practice trends, physician shortage issues, and the impact of healthcare reform on physicians and patients. As the healthcare system in America continues to evolve, The Physicians Foundation is steadfast in its determination to strengthen the physician-patient relationship and assist physicians in sustaining their medical practices in a difficult practice environment. For more information, visit www.PhysiciansFoundation.org. 

TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 112 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.  

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