9 things ruining medicine for physicians

9. MOC costs and requirements

Physicians have a lot of complaints about maintenance of certification (MOC), with its notable commitment of physician time, effort, and financial expense ranking near the top.

In that context, primary care physicians’ perception that much of the information on which they are evaluated is irrelevant to their daily practice amplifies their frustrations. 

8. Imbalance in primary care versus specialist reimbursement

Primary care pay has increased by more than 10 percent over the past five years, nearly double the rate of specialist compensation during the same time period, according to data from the Medical Group Management Association (MGMA).  

But even with these gains, primary care physicians earned a median salary of $257,726 in 2017-while specialists hauled in a median of $425,136. 

7. Rising staff and overhead costs 

Every business grapples with rising employee and overhead costs, but these increases are particularly distressing for physician practices. Since 2013, the median operating costs for primary care practices rose by 13 percent, according to a 2018 MGMA report. 

6. No negotiating leverage with payers

Negotiating contracts with payers has always been an unpleasant task for doctors. But it has become even more difficult in recent years, thanks to trends such as value-based care and consolidation among commercial payers.  

“The big payers don’t want to negotiate with small practices. They say ‘take it or leave it,’” Rebecca Jaffe, MD, owner of a Wilmington, Del. internal medicine practice, told Medical Economics.

5. Replacing primary care physicians with NPs/PAs

The number of new nurse practitioners (NPs) and physician assistants (PAs) continues to outpace the number of new physicians nationwide, causing some concern from primary care doctors.

• More than 248,000 NPs are currently licensed to practice in the United States, up from about 120,000 in 2007, according to the American Association of Nurse Practitioners.

• An estimated 85.5 percent of new graduates have been trained in primary care. 

• The number of physician assistants has also grown exponentially, from just four in 1967 to more than 115,000 in 2018, according to the American Academy of Physician Assistants.

• Slightly more than 30 percent of PAs work in family medicine.  

4. Prior authorizations  

Physicians find the prior auth process insulting, as they argue they know what’s best for each patient under their care, and have the medical training and expertise to back up their clinical decisions.

3. Government regulations

When it comes to value-based care, government regulations often get in the way of physicians’ best efforts and that’s a challenge that irks many in healthcare.  

Physicians told Medical Economics that complying with government regulations was one of the top reasons their practice finances worsened in the last year. Many physicians also cited penalties from pay-for-performance initiatives as a reason.  

2. Difficulty using EHRs  

Physicians largely dislike their EHR systems and feel like they are stuck with the ones they have, even when they are lacking. 

The Medical Economics EHR Report, published last October, found that 70 percent of physicians would like to switch systems but don’t because of high costs and lack of better options. In addition, about 57 percent would not recommend their current system to a fellow physician. 

1. Paperwork and administrative burdens

It’s no surprise that physicians chose paperwork and administrative burdens as the top issue ruining medicine. Earlier this year, in the 2018 Medical Economics Physician Report, nearly 80 percent of doctors said it was the top challenge they experience in practice. 

Much of this burden is a result of changes in the last several years, notably the advent of value-based care.