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Physicians Foundation survey points to real challenges, potential solutions for 2023

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CEO discusses findings and low morale, social determinants of health, telehealth.

In November 2022, The Physicians Foundation released part three of its 2022 Survey of America’s Physicians, and the results did not paint a cheery outlook for 2023.

Morale is dropping.

Administrative burdens are growing.

Staff shortages are widespread for nurses, nursing assistants, social workers, physicians, and licensed practice nurses.

The physician respondents identified their areas of importance and potential solutions that could improve their work environments – and patient care – in 2023 and beyond.

Robert W. Seligson, MBA, MA, spent years as a physician advocate with the North Carolina Medical Society, and now he is chief executive officer for The Physicians Foundation. He discussed the findings and the need for systemic solutions with Medical Economics.

The following transcript was edited for length and clarity.

ME: As an introduction, can you talk about the physician survey? What is it and why do you do it?

Robert W. Seligson: The Physicians Foundation does regular surveys to keep its pulse on what's going on in health care. And to try to identify problem areas and solutions to those problems. We want to use it as a template to identify opportunities to make changes in the health care system, to improve the system, and also to become aware of things that we may not be aware of that need to be addressed as well.

ME: In those latest findings, what was the biggest surprise for you?

RWS: Over 50% of physicians do not have high professional morale right now. I mean, that was huge to me, knowing that physicians are very stressed right now as a result of a multitude of factors, notwithstanding the COVID-19 epidemic that hit us, but also the reality of what's happening with shortages and their practices, manpower shortages, demands on their practice, nonmedical demands that keep them away from taking the care of their patients. It puts incredible stresses on them. I always felt like a lot of the morale was low, I didn't realize it was to that large extent of the physician population. Over half of the physicians said that they would not recommend their children to go into medicine, which is very unusual as well, and that over 50% of doctors didn't have a positive feeling about the future of health care in our country. And that goes back to the exact reason why we do these surveys, to try to pinpoint what the problems are, and to come up with potential solutions on how to how to eliminate these problems.

ME: We're still dealing with the effects of the COVID 19 pandemic, and in the aftermath of that, a lot of monetary inflation. Do you think those affected the survey results? Are there other outside factors that may be influencing how the physicians are feeling right now?

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RWS: I think they influenced it, I think they added to the challenges that physicians were facing. I think it just compounded it, made it made it worse, intensified it. Obviously it not only affected physicians, but it affected all the health care system and all the health care workers that go along with contributing to the health care and well-being of our citizens. So it just added to the strain on the system. And it's going to continue to occur until we have solutions and ways in which we feel we make things better. We feel that the Foundation has an obligation to help address these challenges, to help make the system better. And it's a responsibility that we take seriously.

ME: Can you discuss the primary care burdens and challenges that physicians had identified in the survey? Some of those include administrative and prior approvals, lack of insurance, not prioritizing mental health.

RWS: All of those are significant contributing factors to the demands on practice. Social drivers – your doctors want to take care of the patients, but in some cases, their economically disadvantaged patients come in and they don't have access to medicines, they don't have access to good food or good housing. Sometimes patients can't get to the doctor's office to see them or can't afford to get the medicines or can't afford to eat right. And so no matter how good of medicine that the doctor provides them, and certainly in primary care, the outcome is going to be the same or not improving, if we don't have an opportunity to help these people get some of the basic essentials they need so that when they're given the right care, they can actually improve.

You know, we talk about the well-being of physicians in primary care. I share this story only because it was a wake-up for me as an executive and CEO. Several years ago, my primary care physician committed suicide. And this was a doctor that was well loved by his patients, was a great physician, well respected by his colleagues. And because of all the stress that he was under, he was afraid that if people found that he was seeking mental health or getting some medication, that he may lose his license, and just the pressure came on him and ultimately took his life. And having to advocate for doctors my whole life – and certainly understanding that value and significance of primary care and how important primary care is in the health care system – it really shook my world, if you will, because of the high pedestal, I put physicians on. We all do, because of their significant contributions and sacrifices they make. But they're human, just like the rest of us. And so it opened my eyes about other aspects of health care that we weren't looking at when we were advocating for how to improve health care. And so this is another area that is really significantly important in the in the area of physician, physician wellness and their health, that we have to do things to help address some of these stresses that are put on, on that on that specialty, because clearly, they're the they're the first people that the first person a patient sees is primary care.

And so we need to make sure we can preserve that specialty, and make sure that the that the physicians that are in primary care are motivated and rested. And feel appreciated, and have the power within their own being to be good physicians, without having all these outside influences that you mentioned, interfere with the daily practice of medicine.

ME: Staffing is a huge concern heading into 2023. It sounds like there may be some practices not able to provide services because the physicians can't find the support staff that they need. Can you talk about those findings, especially, for example, in nursing and social work?

RWS: I wasn't surprised with the results. I'm surprised with the volume of how it's been, it's becoming a greater percentage of what I thought of the folks in the system are experiencing. But again, whether it's in a physician's practice or hospital, you know, it's not just throwing more money and trying to pay more money. It's the actual system and the strains that go along with that. I was visiting with a hospital worker the other day that's kind of like in the second tier of a hospital administration. And they're just saying, I can't keep up with the workload. You know, people don't want to work these hour – I can't work anymore, I'm already on burnout, I want to go someplace, I need to get out of health care, or I want to do something where I'm not as stressed and working 60 or 70 hours a week. Same thing in a practice when the doctors are having problems with their overhead, because they're fighting reimbursement issues or prior approval issues, they go along with it in the revenue stream of a practice and still have to deal with the pressures and their staff have to deal with the pressures. They get in a very volatile situation. It's a systemic issue that we have to address, whether it's the health care system or practice. If we don't make the changes, then some of the practices will either go either go out of business or they'll be bought out and go into a bigger, health care system, or private equity firms come in.

ME: The survey talked about partnerships with primary care physicians and some other organizations or community health experts. Can you talk about partnerships that would enhance the preventive health measures, especially for rural and low income areas?

RWS: I'd be glad to. In North Carolina, for instance – I know this for a fact, because of the role the foundation played in pushing on the importance of social drivers of health. When the state of North Carolina decided to turn its Medicaid program over to managed care, an $18 billion program, we had some things built into the RFP that basically said that, when you do this, you have to partner with a local community to address the social drivers to health issues, to work with the local practices, and the local agencies, whether it's a rural health center, whatever the case may be. So the plans had to build this in their proposal on how to address this very issue. And so instead of just putting it on the doctors, it became companies working collaboratively with their communities. And certainly in the rural areas, where there's less services available to coordinate, whether it's transportation, whether it's food, whether it's drugs, whatever the case may be, there's where a physician's office could call a coordinator and coordinate this work. It's been a little over a year, two years, since they implemented the program, I'm seeing some positive light at the end of the tunnel of it, basically, improving health care.

CMS just passed some measures about the federal government measuring social drivers of health and practices to see where the deficiencies exist, and if changes are made doesn't improve outcomes. And we all know, common sense, that if the patient's basic needs are being taken care of, and they're very economically disadvantaged, and they're getting all the basic housing and drugs and proper nutrition and transportation, then when they're in the health care system, their health status will improve, because of those other factors have been addressed, as opposed to trying to address hunger, trying to address transportation, and then the health status of a patient. So it makes a difference.

ME: For primary care, how important is it for physicians to receive reimbursement for responding to questions via email, text, and telephone calls?

RWS: It takes up an extraordinary amount of their time. And they're giving health care, really good health care. I like to use live examples of how telemedicine has changed as a result of the pandemic. And I had a psychiatrist president, who was not technologically savvy, didn't believe in Zoom calls with his patients, he’s a pediatric psychiatrist. And when the pandemic hit, he was forced into doing the telemedicine and he just he flipped 180 degrees from well, this is not the necessarily the best way I want to treat my patients, but I could talk to them on a regular basis, I have access to them, they have access to me, and it's pretty efficient.

Now, all of a sudden, managed care companies are saying, well, it's overutilized, it’s this, that, and the other, and I'm saying, well, alright, show us the areas where it's not being used properly, let's take corrective action. Let's not throw the baby out with the bathwater here. This is a new technology that has worked, it's demonstrated beyond a shadow of a doubt it worked during the pandemic. And the use of technology, whether it's telemedicine or it's over telephone, is part of health care nowadays. And whether the patient is being seen in the doctor's office, whether the doctor is talking to the patient on the phone, or talking to them on a screen, the doctor’s time is being committed to that patient's welfare. So why not pay for it? That's part of the problem, of our challenge. We have to make sure that it's utilized properly, that care is being given appropriately, and that's what we want. But don't just say, no, we're not going to pay for it. Wait a minute. They are actually providing care to that patient, in one way or the other.


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