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Will some doctors say 'no' to health insurance? Posted: October 15th, 2012

By Maryalene LaPonsie

A comprehensive survey of U.S. physicians includes some surprising revelations, including the fact that 6.8 percent of doctors plan to switch to practice models that may result in direct payments being shifted from health insurance plans to patients.

Despite a government mandate requiring all citizens to maintain health insurance coverage by 2014, a small number of physicians told The Physicians Foundation they plan to switch to a cash or concierge service in the next one to three years. The finding is part of the foundation's 2012 survey of more than 13,500 U.S. physicians.

Cash practices can be set up in several ways, and physicians working under this model may decline to participate in health insurance plans. Instead, patients pay in full at the time of service and then file claims for reimbursement from their insurer. Meanwhile, concierge practices charge patients a monthly or annual fee in exchange for more direct access to physicians. These practices may or may not bill health insurance plans for services rendered.

In addition to the interest in cash and concierge services, the survey discovered physicians are feeling pessimistic about the future of their profession, and many do not see the health care reforms enacted in the Patient Protection and Affordable Care Act as positive for the nation's health care system.

Physicians worry about their futures

Overwhelmingly, respondents feel negative about the future of the medical profession with 84 percent of those surveyed agreeing the profession is in a decline. In addition, 58 percent would not recommend that their children or other young people enter a career in medicine.

The pessimism surrounding the medical field may be related in part to the uncertainty created by health reforms scheduled for implementation by 2014.

  • About 92 percent of respondents are uncertain about the future of health care or their role.
  • Eighty-two percent believe physicians can do little to change the health care system.
  • Seventy-seven percent are somewhat or very pessimistic about the future of the medical field.
  • Fifty-nine percent say health reform legislation has made them less positive about the future of health care.

One in three physicians also report they would not pick medicine, if they could go back and choose their careers again.

Patient access may decline

While only 6.8 percent of doctors may be thinking of using practice models that could opt them out of medical insurance networks, a larger number is reporting plans to limit services or cut hours.

Within the next three years, 22 percent expect to cut back hours while 13 percent will retire. Another 26 percent say they will reduce the number of patients they see, switch to a part-time schedule or seek a non-clinical job within the health care field. Already, 52 percent limit the number of Medicare patients they see, and more than one in four decline to treat anyone with Medicaid health insurance coverage.

"It is clear that the introduction of nearly 30 million new patients into the U.S. health care system through health care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care," Walker Ray, vice president of The Physicians Foundation, said in a prepared statement.