The State of Primary Care
A Startling Report from The Physician's Foundation
Natalie Hodge MD FAAP
Co-Founder Personal Medicine
nhodge@personalmedicineinternational.com
A recent study by The Physicians Foundation and Merritt Hawkins surveyed
12,000 physicians in primary care practice in 2008. At a time when our
government is calling for expanded heathcare access and solutions to our
healthcare crisis, the state of physicians current practices is an important
crucial viewpoint. The results of the study paint a grim picture that will
drastically impact the future of our nation's healthcare.
* 50% of physicians - more than 150,000 primary care doctors
nationwide- say they plan to reduce the number of patients they see or stop
practice entirely.
* 94% say the time they devote to nonclinical paperwork in the last three
years has increased, 63% say the paperwork is causing less time per patient
in visits.
* 82% of physicians said their practices would be unsustainable if
proposed cuts to reimbursements were made.
* 60% of doctors would not reommend medicine as a career to young
people.
Physician plans for the future
Of the 49 % of physicians who plan to reduce the number of patients seen
7% plan to switch to cash pay models of care. The remainder are split
between pursuing nonclinical healthcare jobs, early retirement, and jobs
entirely unrelated to healthcare.

Perspectives and Practice Plans
The majority of physicians 65% find their medical practice either "less
satisfying" or "unsatisfying" Unsatisfying aspects of practice include
"reimbursement issues" " defensive medicine pressures" and "government
regulations" as well as "difficulty with managed care organizations"
Practice Financials and Workload
Only 17% of physicians reported their practices to be financially rewarding
and profitable. Over 30% of practices are not making a profit. This fact
should be not only concerning for any primary care physician, but for any
resident considering embarking on a career in primary care. Our current
system requires an accelerated pace to offset external financial pressures.
63% of physicians are working 51 or more hours per week. and 38% are
working 61 or more hours per week. The majority of physicians 63% feel
that they "sometimes do not have the time" or "do not have the time to fully
communicate with patients"
The Myth of "Expanding Coverage"
The numbers of physicians closing their panels to medicare/medicaid and
HMO panels is accelerating. One third are closed to medicaid. 30% are
closed to certain HMO's and 5% have closed their panels to new patients
entirely.
These numbers illustrate coverage does not equate access. Expanding
coverage may only lengthen the lines to see physicians as happened in
Masachussets since advent of health reform in that state.
Reimbursement Woes are Universal
In addition 64% of physicians note Medicaid reimbursement is lower than
the cost of providing office based care. 43% say that HMO and PPO plans
often reimburse less than the cost of providing office based care. 36% say
that medicaid reimbursements are less than the costs of providing care. Due
to flat or declining reimbursement, 39% of physicians have been unable to
provie staff with raises, 35% have not been able to purchase new

equipment. 77% of physicians do not have the financial resources to make
capital purchase of EMR hardware/software and IT personnel.
Physician Morale is low
42% of physicians report that morale of collegues is low. Physicians ranked "
practice closures due to declining reimbursement/rising costs" as the top
reason for the shortage in primary care. Many physicians put in writing
written comments within the survey that voice being tired of the battle with
third party payors that rob them of time, money, energy and empathy.
"Costs of running a solo practice and the time needed to manage practice
administration are killing me"
"We are drowning in a sea of regulation and paperwork"
"Primary Care medicine is the most vital to our healthcare system, and is the
poorest reimbursed. "
" It amazes me how paralegals an plumbers make more money per hour
than pediatricians. As fewer medical graduates pursue primary care,
everyone will suffer."
Strategy – The Art of Creating and Sustaining Competitive
Advantage
Successful private practices approach strategy as the compilation
of processes to define the boundaries of the business, redefine the basis of
competition through innovation, and create a medical practice capable of
success in ever-changing and unpredictable markets. Primary care practices
face unparalleled challenges in these challenging days.
Strategic Vision- Choose the Future
A strategic vision is the guiding theme that articulates a practice's intent for
the future. In a challenging business environment it is easy to focus on the

myriad problems that face you in your day. But it is critical to focus on the
future in order to create a new reality for your career.
Strategic Innovation- Find new customers
Innovation is the hallmark of competitive strategy. Successful practices
pursue innovation, in products, in methodologies, in services that they
provide to customers. It takes disruptive innovation and new thinking to
deliver value in private practice. For primary care practice to succeed in this
market they must innovate, find new ways to serve customers, and rethink
the broken model of third party payor practice. There are four major recent
innovations that enable a return to a simpler more gratifying service line of
your medical practice. Wireless internet, ecommerce, social media and
device ( iphone/tablet pc), SAAS (software as a service)
Start calling patients "customers"- Ideas into Action
It is time for primary care physicians to move into action and plan for your
future through disruptive innovation and new thinking. Personal Medicine
International would like to share with you our weekly webinar which features
a disruptive innovation that any primary care practice can implement today,
with
*no upfront licensing costs
*no risk of losing revenue from leaving your current practice
*minimal additional overhead structure
*no costly servers, IT staffing for server maintenance
*cutting edge social networking strategies for cash pay top line growth
*turn key local marketing strategies for new referrals
*malpractice discounts for emerging attentive model of care
*integrated customized web design to feature you in your zips of interest
*ecommerce platform for systematized patient payments
this will transition you into a new practice environment with a segmented
group of your customers, adding an attentive high tech, high touch service
line of house calls in a direct medical practice model. Please visit
www.personalmedicineinternational.com for our webinars, patient

testimonials, free weekly newsletter and let us know how we can assist you.
You have the capabilities to strengthen your practice's long-term position
in the face of unreliable third party payors, impending government
interventions, and organizational challenges of traditional office practice
management.
www.personalmedicineinternational.com