Many young doctors worried about future of medicine

When medical resident Brent Smith, MD, completes his training in family medicine and a fellowship in family/sports medicine in September 2013, he plans to return to his hometown of Cleveland, Miss., to work at a small practice alongside the family physician who has cared for him since childhood. He said he’s looking forward to seeing familiar faces and doing what he has trained for ­— what he calls “cradle to the grave” medicine.

Dr. Smith, 28, is excited about his future. But like many young physicians, he worries about the direction the medical system is going. His mix of personal optimism and professional pessimism is echoed in a survey of 500 doctors younger than 40 taken by The Physicians Foundation and released in April.

Most respondents were happy in their practice situation. Eighty percent were either “highly satisfied” or “somewhat satisfied,” and 52% said they planned to stay at their practice for eight or more years. But more than half — 57% — were pessimistic about the future of the U.S. health care system. An additional 21% were “neutral,” 18% were “somewhat optimistic” and only 4% were “highly optimistic.”

The panel of respondents came from an online pool of physicians maintained by Medical Marketing Research, based in Raleigh, N.C. Of the 500 respondents, 250 were described as primary care physicians, 175 as medical/surgical office-based specialists, and 75 as hospital-based specialists. The survey did not identify the gender mix of respondents.

The level of pessimism reflected in the survey is “very troubling,” said Lou Goodman, PhD, president of The Physicians Foundation. “It’s a reflection of the huge debt level they face, uncertainty about the future and the lack of opportunities they see to practice they way they want to practice — to take care of patients and get the business side out of it.”

Why there’s pessimism

Goodman, also executive vice president and CEO of the Texas Medical Assn., said it was surprising to see how many young physicians expressed frustration with the health care system.

“One would think the level of pessimism would be low, given how much effort and time they have put in to it, and the best and brightest students are still going into medicine. What I think they find is that their expectations aren’t being met.”

The Physicians Foundation is a nonprofit funded by health plans as part of the settlement of a class-action lawsuit brought by physicians against private insurers. The foundation funds research and initiatives aimed at helping doctors. It conducted the survey of “next generation” physicians in the hopes of identifying ways the foundation could help them succeed, maintain their autonomy and protect the physician-patient relationship, Goodman said.

The duality in the responses to the survey made sense to Russell Kohl, MD, 35, a family physician who recently took an academic position as associate professor in the Dept. of Family Medicine at the new School of Community Medicine at the University of Oklahoma.

“I think most of the physicians I talk to are optimistic about the future of health and medicine, but not at all about health care system,” he said. “The relationship I can have with my patient about their individual health, the uses of technology are making that an even more beneficial interaction on both sides. But the way the health care system is designed right now, there are many barriers between that physician and that patient.”

Many young physicians see the government as responsible for that barrier. The survey asked what made them feel negatively about the future, leaving the answer open rather than offering multiple choices. The Physicians Foundation then grouped those answers into categories. Government was by far the most commonly cited reason for negative feelings, with 34% of the pessimistic respondents citing “the new health care law or regulations.” Meanwhile, 4% said they did not trust government to “do the right thing,” 4% said “patient care may suffer due to government intervention,” and 2% said “Medicare is a mess.”

Uninformed about health reform?

Those answers dismayed Mona Mangat, MD, 39, an allergist who practices in St. Petersburg, Fla. She is on the board of directors of Doctors for America, a group of physicians and medical students who support the Patient Protection and Affordable Care Act. She said she doesn’t think the reform law is perfect, but she is optimistic about its potential to improve the health care system.

“I spend a lot of my free time educating other physicians and the general public about why we need health reform and what is in the Affordable Care Act,” she wrote in an e-mail. “What I see is that physicians are no better informed about the ACA than lay people.”

Robyn Liu, MD, MPH, 36, said young physicians might like the idea of pushing government out of medicine, but that’s not particularly realistic. A family physician, she splits her time among caring for patients, teaching and working on health policy research at Oregon Health & Science University in Portland. She is serving a one-year term on the AAFP board of directors as the “new physician” representative.

Dr. Liu said she is optimistic about the future of the health care system because some policymakers finally are asking the right questions.

“The health care system is extremely broken,” she said. “It’s neither about health nor is it a functional system. But there has been movement, and a lot of energy about returning to a strong foundation of primary care. That conversation is happening, and that makes me excited and optimistic.”

Dr. Smith, a resident member of the AAFP board of directors, said the young physicians he knows don’t all share that optimism.

“For physicians who are about to enter what we call the real world, there’s a lot of trepidation,” he said. “We still want to help people — the outlook on that is good. But the practice of medicine is getting more onerous.”