Physicians overcoming gap between revenue, expenses

The opioid epidemic and the fate of Obamacare occupy most of the public’s attention  but outside the media spotlight many primary care practices face the more basic challenge of staying afloat financially. 

In fact, 79 percent of primary care physicians (internists, family doctors, pediatricians and obstetricians/gynecologists) surveyed by Medical Economics about the financial condition of their practices said it was worse or about the same compared with the previous year. Among those who said they were worse off, two of the top reasons cited were higher overhead costs (64 percent) and lower payer reimbursements (54 percent).

Closely related to these was the growing quantity of time spent on tasks for which they are not compensated, a problem cited by 69 percent of primary care doctors. The findings are part of the exclusive 89th annual Medical Economics Physician Report. 

In follow-up interviews, survey participants say they are using a variety of strategies to bridge the widening gap between practice revenue and expenses. On the revenue side, they are seeing more patients and seeking out new sources of income, such as taking on additional employment or adding ancillary services to their practices.

On the expense side, they are reducing staffing and/or asking existing employees to take on additional tasks, and in some cases making adjustments to their lifestyles.

“You start saying, ‘I’m not going to buy that new car, or I’ll skip the ski trip,’” says Howard Mandel, MD, a Los Angeles-based OB/GYN in his 34th year of practice. “I’m comfortable with making less money today than I used to. I don’t think it’s fair, but then I ask, ‘What’s my alternative?’ And there
really isn’t one.” 

As for what keeps them going in the face of mounting frustrations and often-declining incomes, physicians who spoke with Medical Economics are virtually unanimous in their response: relationships with patients. 

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