A recent survey by the California Medical Association predicts an exodus of physicians within the next three years.
Critics, like the California Association of Health Plans, say the CMA study aims to give physicians more bargaining power with health plans and raise consumers’ fears.
The study, titled, “And Then There Were None: The Coming Physician Supply Problem,” found half the 2,300 doctors surveyed plan to move out of California, retire or quit the profession within the next three years.
Reasons range from inadequate reimbursements to problems in attracting new doctors and an overregulated health system. Dr. Rodrigo Mu & #324;oz, president-elect of the San Diego County Medical Society and a psychiatrist in private practice, applauded the CMA survey.
“Finally, it’s out in the open,” Mu & #324;oz said. “Physicians have known for a long time that our colleagues are leaving.”
He said the number of San Diego psychiatrists listed as members of the Medical Society dwindled from 170 in 1986 to 106 today.
Mu & #324;oz speculated they either retired or left San Diego. He said he knew of four psychiatrists who have died since 1986.
Out of the 174 San Diego doctors who responded to the survey, 33 percent said they plan to practice in another state, retire early or change professions.
Low Reimbursements Blamed
The majority of respondents cited reasons of low reimbursements and a negative regulatory environment.
According to the Medical Board of California, 18,872 doctors listed California as their primary address.
The state licensing agency’s data also pointed to a rise in new licenses: 4,043 new licenses were issued on an annual basis in the years 1998 through 2000. That compares to 3,684 new licenses between 1997 and 1998.
These figures don’t reflect doctors’ feelings, said James Hay, president of the San Diego County Medical Society.
He warned, “There may not be a large documentable change yet, but there are a very large number of doctors contemplating change.”
Bobby Pe & #324;a, spokesman for the California Association of Health Plans, said the CMA survey largely reflects the view of disgruntled doctors that worked on a fee-for-service basis.
“In the (last) 10 years, (we) asked doctors to change the way they practice medicine,” he said. In the old days, doctors were paid based on “how much they worked,” he said, referring to traditional health coverage where patients or insurers were billed for services provided.
Prevention Emphasized
“In California, in a capitated system (where medical providers receive a fixed amount to provide care), we now ask doctors to focus on prevention and become more efficient to keep costs down.”
Mu & #324;oz contended the penetration of managed care destroyed San Diego’s health care system.
“The HMOs have contributed to over-regulation of medicine,” he said. “There is too much paperwork, too many rules and too much small print which leaves doctors confused.”
Pe & #324;a also said the survey was released as tensions between doctors and health plans are rising over a proposed state law that would give doctors more bargaining power with health plans.
The bill, sponsored by CMA, passed the state Assembly and is scheduled to move to the Senate committee in August.
“I think in general right now the CMA’s biggest agenda is to pass AB-1600,” said Pe & #324;a.
“If you can frighten consumers and legislators into believing that doctors’ incomes are dropping and leaving the state, that will help push their legislative agenda.”
Both, Mu & #324;oz and Hay found the argument absurd.
“The bill is in response to a problem created by the insurance companies,” Mu & #324;oz said.
“The survey has been developed over a number of months,” Hay said. “We have no control over how bills move through the Legislature. The biggest thing we want to get across is physicians are depressed and upset.”
A vast majority of the local doctors surveyed said practicing medicine is less satisfying now than five years ago. At the same time, they didn’t regret becoming doctors.
Mu & #324;oz agreed. A psychiatrist for the past 32 years, he has no plans to retire: “I am planning on staying and fighting.”
In January, Mu & #324;oz will succeed Hay as president of the Medical Society.
