Dissatisfied docs may soon be singing "California, here I go"

Managed care and low reimbursement cited as reasons why more than half of the doctors in California may quit or leave the state by 2004.

By Jay Greene, amednews staff. Aug. 6, 2001.

More than half of the physicians in California are so dissatisfied with managed care that they plan to quit, retire or move out of state in the next three years, according to a new California Medical Assn. survey.

While some workforce experts and HMO executives in California criticized the survey as overly pessimistic, CMA officials say they aren't surprised by the results, given the number of fed-up doctors they know.

A frustrated bunch

More than half of the physicians surveyed also said they had problems recruiting new physicians for their practices. The CMA represents about 35,000 of the state's 80,000 licensed physicians.

"We have partners in our group who have surprised us by retiring earlier than expected or who have moved out of the state because of better opportunities," said Ronald Bangasser, MD, a family physician with Beaver Medical Group in Redlands, Calif.

"This survey shows frustration and the difficulties in practicing in a state where reimbursement is so low and hassle is so high," said Dr. Bangasser, speaker of CMA's House of Delegates.

"Whether or not people retire or leave, this shows people are very unhappy," he added.

Frustrations noted in the survey included the growing shortage of specialists and not having adequate time to spend with patients.

While the CMA first discussed the need for a survey last year, Dr. Bangasser said the timetable to conduct the survey was moved up after the University of California at San Francisco released a report in April that concluded the state does not have a physician shortage.

The UCSF study, which analyzed physician licensure data, showed California increased its physician-to-population ratio 7%, to 190 patient care physicians per 100,000 population in 2000 from 177 per 100,000 in 1994.

The California ratio is slightly lower than national averages between 195 and 200 patient care physicians per 100,000 population.

The major differences in the two reports are that the UCSF study reviewed historical licensure data and the CMA survey assessed physician attitudes about the future.

"We felt that report did not accurately account for part-time doctors and those retiring early because of managed care," Dr. Bangasser said. The shortage is most severe among primary care doctors, neurologists, orthopedic surgeons and neurosurgeons, he said.

To gather more data and address the problem, the CMA is sponsoring two bills in the state Legislature.

One would allow the state medical board to collect information at license renewal about an individual physician's specialty and whether he or she works in patient care, research, teaching or other pursuits.

Another bill would allow physicians and health plans to jointly negotiate contract renewals through a voluntary mediation process. Texas and Washington state have passed similar antitrust exemptions for doctors.

"I hope this creates awareness with patients that doctors are trying to hold things together in the face of low reimbursement and a terrible practice climate," Dr. Bangasser said.

"Patients who have read the articles are concerned with me as an individual. Do I have enough time off? They don't worry that I won't take care of them. I tell them anytime I walk and talk is a good day. They understand our hassle," he said.

ADDITIONAL INFORMATION:

A frustrated bunch

Of the 2,300 physicians participating in the California Medical Assn.'s most recent survey:

75% have become less satisfied in the past five years.
66% would not advise their children to practice medicine.
58% have experienced difficulty attracting other physicians to join a practice.
44% spent less time with patients than five years ago.
43% plan to leave medical practice in the next three years.
33% who would still choose medicine would not choose to practice in California.
25% would no longer choose to practice medicine if starting over today.
12% will reduce their time spent in patient care.

Source: "And Then There Were None: The Coming Physician Supply Problem," California Medical Assn., July