TMA Survey: Physicians Confused and Anxious

For Immediate Release
Feb. 28, 2011


Contact: Pam Udall
phone: (512) 370-1382
cell: (512) 413-6807

Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320

  Click here to follow TMA on TwitterOr visit TMA on Facebook. 

More than ever before, physicians are confused and anxious about their profession, and believe the health care system continues to be broken, according to a new survey by the Texas Medical Association (TMA).  

“Last year was a tough year on physicians,” says Susan Rudd Bailey, MD, TMA president. “Medicare threatened to cut physician payments not once but six different times, and Medicaid did cut doctor payments. And no one knows exactly what the new health law means for physicians, their practices, or their patients.” 

Doctors worry that these threats coupled with additional bureaucratic red tape will make it more difficult for patients to see a doctor.  

Evidence of Texas doctors’ concerns is found in the latest TMA biennial survey of its physicians, medical students, residents, and interns . TMA conducts the survey to identify emerging issues, track the impact of practice and economic changes, and assess physician priorities.  

As in years past, the biggest challenges for Texas physicians are rising practice costs, declining payments, and the struggle to keep their doors open. While physicians worry about low or declining payments from all health plans, their primary concern is Medicare.  

William B. “Ben” Edwards, MD, the only physician in Garza County, is a solo family physician in tiny Post, Texas. The young physician accepts all new Medicaid and Medicare patients, even though he struggles financially to accept people on those government health plans. (Medicaid covers low-income women, children, and people with disabilities; Medicare insures senior citizens and people with disabilities.) Dr. Edwards says he breaks even seeing Medicare patients, and he loses money seeing Medicaid patients. About half of his patients are on one of the two plans. 

“I’m the only doctor in the county. I feel morally obligated to accept them,” he says.  

He joins thousands of physicians across the state struggling with this decision. In TMA’s 2010 biennial survey, 66 percent of physicians accepted all Medicare patients, while 16 percent declined them and 18 percent limited acceptance of them. The number of doctors who accept all new Medicaid patients is even lower. Only 42 percent of physicians accept all new Medicaid patients.  

Henrietta family physician David Greer, MD, has run his solo practice in a rural Texas for 40 years. He has to limit services to some Medicare and Medicaid patients due to the low payments. “We have an attitude that we take care of our own [in his county],” he says, “so I still continue to take some Medicaid patients, but only those who are within the boundaries of our county.” That means he sometimes has to deny callers from Wichita Falls who are Medicaid patients. He believes his practice would fail if he accepted more Medicaid patients from the neighboring city 20 miles away. He does continue to take new Medicare patients, however. 

Doctors in large and small practices regularly face similar tough financial decisions. TMA physician survey data show 61 percent of physicians have witnessed a decrease in their income from medical practice in the past two years. Twenty-seven percent have seen no change, and only 12 percent have seen an increase. 

In fact, El Paso urologist Francisco Rodriguez, MD, who has been in practice since 1976, says his income is about half what it once was. He cites rising overhead costs, and dropping Medicare, Medicaid, and TRICARE (military families) payments.  

“We used to counteract that [low government payments] with the private insurance that was able to pay us 150 percent of Medicare or 125 percent of Medicare, according to your contracts,” he says. “But now they’re wising up. There’s a company out there right now that’s paying less than Medicare.” 

If doctors’ practices have financial problems, they might not be able to serve patients; like any small business, they do what they can to survive. TMA’s survey says 44 percent of physicians have withdrawn personal funds to keep their medical practice afloat; 29 percent secured commercial loans; 28 percent laid off employees; 20 percent terminated or renegotiated health plan contracts; and 18 percent reduced or terminated services to Medicare, Medicaid, or TRICARE patients. Dallas obstetrician-gynecologist Deborah Fuller, MD, had to dip into personal savings to pay office overhead earlier this year. She also says her revenues have decreased as overhead has increased. She, Dr. Greer, and Dr. Rodriguez all have incurred cash flow problems in their practices over the past two years.  

Dr. Greer also has had to draw personal funds to pay overhead. “I’m in family medicine in rural Texas. I certainly didn’t go into it to get rich, and I don’t expect to,” Dr. Greer says. “But I also have bills to pay from running a business. I’m in private, solo practice, and the business aspect of it has to be addressed.” 

Financial uncertainty is just one reason why physicians say they are concerned about the new health law.* In the TMA physician survey, 59 percent of Texas physicians have a very unfavorable opinion of the health reform law. Seventy-eight percent of physicians say they are disappointed, 74 percent are anxious, 62 percent are confused, and 62 percent describe themselves as angry. Only 14 percent say they’re pleased with the reforms, and 12 percent say they’re relieved about them. 

“There’s really not any part of health system reform I like. Some elements look good on the surface, but I’m afraid they’ll have detrimental consequences for the health care system,” Dr. Edwards says. 

Duren Michael Ready, MD, a Temple family physician and chair of the governing council of TMA's Young Physician Section, agrees. “It’s monumentally an error to say we’re going to add millions of patients to the insured roles and do nothing to increase the physician supply. If we don’t have enough physicians to see Medicaid patients, for instance, they’ll end up in the emergency room,” says Dr. Ready. 

Yet doctors worry about any suggestion amounting to lowering the standard of medical care in Texas. 

“You have to be careful when you start allowing nonphysicians to have too much leeway in their practice capabilities. At the same time, I use a physician assistant. In a supervised setting, midlevel practitioners do great work and provide a valuable service to the patients,” Dr. Edwards says. 

“Primary care is so broad, and even though many conditions are common, the knowledge base is hard to master without residency and medical school training. When you don’t know what you don’t know, you’re dangerous,” Dr. Ready says. 

Physicians agree that a primary care medical home, fortified by a health care team led by a physician, is the best and most cost-effective health care model for patients. A big reason doctors find this practice model favorable is that it ensures medical care decisions are made by the two who ought to make them — the patient and the physician. According to the TMA survey, 77 percent of physicians say personal control of clinical decisions is a “very” satisfying aspect of their current practice environment. Nearly three-fourths of physicians are full or part owners of their main practice. Doctors who begin as owners or part owners of their practice are more likely to report personal control over clinical decisions (94 percent), and personal control over practice decisions (89 percent). These scores emphasize the top reason why physicians are leery of the “corporate practice of medicine,” the model in which physicians are direct employees of hospitals or other entities.  

“The hospitals don’t provide care to the patients; they provide service,” says Dr. Ready. “The doctors provide health care as part of a team. Anything that places a barrier between the doctor and patient is a potential obstacle to providing that care.” 

TMA is the largest state medical society in the nation, representing more than 45,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.  

– 30 – 

*Editors note: Dr. Susan Bailey recently led a team of TMA physician leaders to Washington, D.C., to discuss TMA’s concerns about the health system reform legislation. Click here to view a copy of the TMA position paper the group shared with members of Congress.