There is an insidious crisis in medicine today that is profoundly impacting on our ability to care for our patients, and yet isn’t receiving the attention it deserves. This crisis is physician burnout, and it’s driven largely by problems and inefficiencies that are deeply ingrained in our health care system and external forces that are complicating our jobs like never before.
Prior authorization demands, shrinking Medicare payment amid sharply rising practice costs, attacks on science and medical disinformation, an increasingly impersonal and bureaucratic health system that places enormous administrative hassles and burdens in our lap each day, and leaves us feeling powerless to make any meaningful change. And that’s just the starting point.
But it doesn’t have to be this way. Many of the pressures brought to bear on a shrinking physician workforce can be greatly reduced—and in some cases stripped away entirely—by advancing bipartisan legislation already pending in Congress. As I outlined in the remarks I delivered today at the National Press Club, we should begin the process of rebuilding and revitalizing the tremendous resource that our physician workforce represents by taking five steps.
These steps are to:
- Provide physicians with proper financial resources, starting with Medicare reform.
- Slash the administrative burdens posed by prior authorization.
- Expand residency training and improving the J-1 visa waiver program.
- Stop criminalizing evidence-based health care widely recognized as safe, and
- Ensure that physicians are not punished for addressing their mental health needs.
As one of the five pillars comprising the AMA Recovery Plan for America’s Physicians, reforming an unsustainable Medicare payment system is essential to the long-term financial viability of physician practices. Adjusted for inflation, Medicare physician payments have plunged by 26% since 2001, with additional cuts planned next year.
Physicians deserve payment models that recognize and invest in their contributions in providing high-value care to patients, while generating cost savings across all parts of Medicare and the broader health care system. A measure currently pending in Congress, the Strengthening Medicare for Patients and Providers Act, represents a huge step in the right direction by providing annual physician payment updates pegged to the Medicare Economic Index.
Mountains of paperwork, hours of phone calls and other administrative tasks tied to the prior authorization process imposed by insurers not only rob physicians of face time with patients, but also drive burnout by fostering a sense of powerlessness and a lack of autonomy. Excessive prior authorization directly harms patients by inappropriately delaying or even denying necessary care.
While some progress is being made on this front, more action is needed. About a dozen states have already passed comprehensive prior authorization reforms this year, based on model legislation crafted by the AMA, and several more are currently considering doing the same. At the federal level, another bill now pending in Congress—the Improving Seniors Timely Access to Care Act—would further expand the steps taken by the Centers for Medicaid & Medicare Services to reform this onerous practice by insurers.
By prompting many physicians to accelerate plans to cut back their hours or leave the profession entirely, the COVID-19 pandemic only deepened the crisis our nation faces in a shrinking physician workforce. It is estimated that more than 83 million people in our nation live in areas that lack access to a primary care physician. Our population is aging, and of course this includes our physician workforce, nearly half of whom are over age 55. The Association of American Medical Colleges predicts a shortfall of at least 37,000 physicians—and possibly well over 100,000—over the next decade.
Tackling this issue immediately and effectively is vitally important. The AMA enthusiastically supports several bipartisan measures pending in Congress that take on this task. One of those is the Conrad State 30 and the Physician Access Reauthorization Act, would refine and improve J-1 visa waiver programs to ease physician shortages in rural and underserved areas, while promoting physician workforce diversification.
Additional measures supported by the AMA include the Healthcare Workforce Resilience Act (PDF) and the Retirement Parity for Student Loans Act. The former would recapture some 15,000 unused employment-based physician immigrant visas, while the latter would permit retirement plans to make voluntary matching contributions to physicians during residency. The AMA also backs the Physician Shortage GME Cap Flex Act (PDF), which would expand residency training programs in primary care and other specialties where shortages are the most severe.
Last year’s U.S. Supreme Court decision overturning Roe v. Wade triggered an unprecedented amount of third-party intrusion—primarily by state governments—into the patient-physician relationship that continues to compromise access to safe, evidence-based clinical care. Legislatures in more than 20 states have enacted full or partial bans on abortion, while a similar number have adopted laws to greatly restrict or entirely ban gender-affirming care for transgender minors.
These actions continue to inflict grave consequences upon patients and physicians alike. Measures like these jeopardize the health and well-being of patients by allowing lawmakers to impose their own views in place of a physician’s expert medical judgment in the practice of sound, evidence-based medicine and shared decision-making with patients.
Such laws have also exposed physicians and other health care workers to intimidation and the risk of physical harm. And in some cases, these laws impermissibly violate medical ethics by forcing physicians to choose between offering care that reflects their best medical judgment or risking the loss of their medical licenses.
Every physician I know has either dealt with burnout firsthand, or has a friend or colleague who has experienced its devastating effects. The solution to this complex problem must include removing the barriers that deter physicians from obtaining needed care, such as probing questions about past mental health or substance-use history contained on licensure and credentialing applications.
The AMA favors providing a support system that enables physicians to address their own mental health needs without fear of a negative impact on their career. The AMA is working at the state and national levels to remove outdated and stigmatizing language on licensing and credentialing applications. In partnership with the Dr. Lorna Breen Heroes Foundation and the nation’s state medical societies, the AMA is seeking to remove questions that ask about “past diagnosis” and replace them with questions that only ask about “current impairment.”
There isn’t much that our two major political parties see eye to eye on right now, but on these issues they do. We just need the will—and the urgency—to get it done. We need leaders in Congress to step forward and make this happen.
Sadly, every day we wait the size of this public health crisis grows. There is no time to waste.