Doctors across the United States might be rich in salary, but they're poor in satisfaction.
That's mainly due to the changing health care landscape — most notably the effects from the Patient Protection and Affordable Care Act.
An annual survey of nearly 25,000 physicians by Medscape found that uncertainty still plagues doctors, their decisions and their relationships with patients, even though they're paid well.
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More than half (53 percent) of doctors surveyed, for example, say they're not sure whether they'll participate in the public health exchanges, while 25 percent of physicians might refuse new Medicare and Medicaid patients.
Their trepidation about the exchanges could be linked to income insecurity: 43 percent of doctors said they expect their paycheck to shrink if they were part of health insurance exchanges. Another 50 percent said they expected no change, and 7 percent said they expected a raise.
"Changes in the health care landscape, increased paperwork, more rules, less autonomy and legal woes are having a major impact on physicians' career choices and overall satisfaction," said Leslie Kane, director of business of Medicine for Medscape.
Meanwhile, Medscape found, physician compensation jumped slightly in 19 medical specialties this year, and the pay gap between men and women is narrowing. Orthopedics ($413,000), cardiology ($351,000), urology ($348,000), gastroenterology ($348,000), and radiology ($340,000) are the five top-earning specialties.
But coverage changes and a flood of newly insured patients are weighing on doctors, taking a toll on their patient relationships. In 2014, doctors reported spending less time with their patients ever before.
Doctors surveyed also said they're concerned with smaller carrier reimbursement rates — since they might be offering cheaper plans under the exchanges. This is causing a quarter of physicians to say they'll drop those carriers who pay less.
All this is leaving doctors caught "between a rock and a hard place when it comes to the relationships they share with patients," Kane said.
"Many doctors refuse to drop patients for insurance-related issues, primarily because they care about their patients and consider it inappropriate," Kane said. "However, others realize that time is money, and have made the tough decision to drop patients in order to keep their practices viable."
Just 58 percent said they'd still choose medicine again if given the opportunity.
Additionally, the survey found participation in accountable care organizations is still on the rise.
In 2011, 8 percent of physicians were either in an ACO or were planning to join one that year. Last year, that number rose to 34 percent.
The online survey, conducted from Dec. 11, 2013, to Jan. 24, was of 24,075 physicians in 25 different specialties for Medscape.
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