ACOs Are Making Their Impact Felt
An ACO is a group of doctors, hospitals, and other health care providers who work together to provide care to patients who use Medicare.
In 2011, 8% of physicians were either in an accountable care organization or were planning to join one that year. In 2013, that percentage rose to 34%.
The growth in ACO participation has been steady: In 2013, almost a quarter of doctors (24%) who responded were already in ACOs, and 10% planned on joining one; in our 2012 survey, only 8% of doctors were either in an ACO or were planning to join one.
Cash-Only Practices Becoming More Appealing?
While still in the minority, the percentage of doctors involved in cash-only practices rose from 3% of respondents in 2011 to 6% in 2013. This is in line with physicians who are dissatisfied with payments and are looking for ways to practice that don't involve insurers.
Medicine as a Career Has Lost Some Appeal
Compare answers from Medscape's 2011 report to the 2014 report:
- Would you choose medicine again? Yes (69% in 2011, 58% in 2014)
- Would you choose the same specialty? Yes (47% in 2011, 61% in 2014)
- Would you choose the same practice setting? Yes (50% in 2011, 26% in 2014)
Insurance Is a Huge Issue
When asked whether they were planning to participate in a health insurance Exchange, more than a quarter of respondents (27%) said yes, 20% said no, and more than half (53%) said they were not sure. Their caution probably has to do with fears about income: 43% of doctors said they expected their income to go down if they were part of health insurance Exchanges, 50% said they expected no change, and 7% said they expected their income to increase.
In general, although a majority of doctors will continue taking new and current Medicare and Medicaid patients, about 25% haven't yet decided whether they will or won't. A very small percentage (3% at most) will stop taking these patients. In regard to private insurance, 25% said they will drop insurers who pay poorly, while 39% will not.
Satisfaction With Compensation Has Not Changed Much
In 2013, 50% of all doctors said they felt fairly compensated. The figure for primary care doctors is 48%. These figures are very close to the 2011 report percentages, in which 48% of all doctors felt fairly compensated, and 51% of primary care doctors felt that way.
The specialties that feel the most fairly compensated are dermatology (64%), emergency medicine (61%), pathology (59%), and psychiatry (59%). Family medicine (50%) and internal medicine (46%) score around the middle of the pack. Least satisfied with their compensation are plastic surgeons (37%), pulmonologists (39%), neurologists (41%), and endocrinologists (41%).