National Survey Points to a ‘Silent Exodus’ of Physicians

By Phillip Miller, vice president of communications for Merritt Hawkins/AMN Healthcare

October 30, 2012 - Patients nationwide are likely to experience increasing challenges in accessing care if current physician practice patterns trends continue, according to a comprehensive new survey of 13,575 practicing physicians. One of the largest physician surveys ever undertaken in the United States, the survey was completed by Merritt Hawkins, a company of AMN Healthcare, on behalf of The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients. 

Physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of significant changes to the medical practice environment, according to the research, titled “A Survey of America’s Physicians: Practice Patterns and Perspectives.” The survey indicates that if these patterns continue, 44,250 full-time-equivalent (FTE) physicians will be lost from the workforce in the next four years. 

The survey also found that over the next one to three years, more than 50 percent of physicians will cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access. In addition, should 100,000 physicians transition from practice-owner to employed status over the next four years, the survey indicates that this will lead to 91 million fewer annual patient encounters.

“It is clear that the introduction of nearly 30 million new patients into the U.S. healthcare system through healthcare reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its research committee. “Combine this with changes in practice patterns that reduce the number of hours physicians spend seeing patients and the situation is truly alarming. These practice changes amount to a silent exodus of physicians from the workforce.  When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”

More than half of physicians (52 percent) have limited the access of Medicare patients to their practices or are planning to do so, while one out of four physicians (26 percent) have already closed their practices altogether to Medicaid patients, the survey shows. Physicians cited rising operating costs, time constraints and diminishing reimbursement as the primary reasons why they are unable to accept additional Medicare and Medicaid patients.

Physician morale

The survey found a majority of physicians, 77 percent, are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the healthcare system.

Multiple factors were cited as driving widespread feelings of discontent among the nation’s physicians. “Liability/defensive medicine pressures” (related to potential malpractice lawsuits) was cited first, followed by “Medicare/Medicaid/government regulations,” “reimbursement issues” and “uncertainty/changes of health reform.” These issues and others cited throughout the study tend to distract or interfere with the time physicians spend with their patients, according to survey respondents. 

Additional survey findings of note include:

  • Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now.
  • More than 62 percent of physicians said accountable care organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs, or that that any quality or cost gains will not be worth the effort.
  • Physicians are divided on the efficacy of the “medical home” concept, and many (38 percent) remain uncertain about their structure and purpose.
  • While close to 70 percent of physicians have implemented electronic medical records (EMRs), 47 percent have significant concerns that EMRs pose a risk to patient privacy.

A preview of survey results can be found at, while complete results can be obtained by calling Merritt Hawkins at 800-876-0500.

About the author:
Phillip Miller serves as vice president of communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare; he can be reached at