A Snapshot of U.S. Physicians

Key Findings from the 2008 Health Tracking Physician Survey

News Release
Sept. 3, 2009

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Almost 75 percent of physicians were accepting all or most new Medicare patients, the vast majority of physicians contracted with managed care plans, and slightly fewer than six in 10 physicians provided charity care in 2008, according to findings released today from the nationally representative Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey.

Funded by the Robert Wood Johnson Foundation, the 2008 Health Tracking Physician Survey covers a wide variety of physician and practice dimensions, from basic physician demographic information, practice organization and career satisfaction to insurance acceptance, compensation arrangements and charity care provision. The 2008 survey includes responses from more than 4,700 physicians who provide at least 20 hours per week of direct patient care, and had a 62 percent response rate. Because of changes in survey administration, results from the 2008 physician survey cannot be compared to findings from earlier HSC Community Tracking Study Physician Surveys. However, the 2008 physician survey establishes a new baseline that will allow future tracking of how physicians organize and practice medicine.

"Physicians’ clinical decisions affect how up to 90 percent of every health care dollar is spent, so understanding how physicians are organized and practice medicine is critical for policy makers, especially as they engage in the most serious discussion of comprehensive health care reform in 15 years," said HSC President Paul B. Ginsburg, Ph.D.

The survey findings are detailed in a new HSC Data Bulletin—A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Physician Survey—available here. Other key findings include:

• Almost three-quarters of U.S. physicians were men in 2008. But for physicians under age 40, slightly more than 41 percent were women, signaling how the composition of the physician workforce may change in the future.
• Three out of four physicians identified themselves as white, non-Hispanic, while 3.8 percent were black, non-Hispanic, 5.3 percent were Hispanic and 17.2 percent were Asian or other races. However, among physicians under age 40, about two-thirds were white and 33 percent were minority-black (4%), Hispanic (5.4%), and Asian or other race (24%).
• Nearly one-third of physicians worked in solo or two-physician practices, 15 percent worked in groups of three to five physicians and 19 percent worked in practices of six to 50 physicians.
• More than 80 percent of physicians surveyed worked full time, more than half (53%) were 40 to 55 years old, and almost four in 10 have practiced medicine for more than 20 years. Nine in 10 physicians were board certified, and 22 percent received their medical training outside of the United States or Canada. Almost 40 percent were primary care physicians, 35 percent were medical specialists, including psychiatrists, and 26 percent were surgeons, including obstetrician/gynecologists. A slight majority of physicians (56%) were either full or part owners of their practices, while 44 percent were employees or independent contractors.
• In 2008, 44 percent of physicians reported receiving some form of performance-adjusted salary, for example an adjustment based on their own productivity. Roughly a quarter indicated payment by fixed salary, and 20 percent received a share of practice revenue. Productivity factors and overall practice financial performance were the most common financial incentives affecting physicians’ compensation.
• Slightly more than half of physicians (53%) reported their practices were accepting all or most new Medicaid patients; 28 percent reported accepting no new Medicaid patients. Almost nine in 10 physicians (87%) reported their practices were accepting all or most new privately insured patients, and almost three-quarters (74%) reported their practices accept all or most new Medicare patients.
• The vast majority of physicians (87%) had managed care contracts in 2008. Compared with physicians with one or more managed care contracts, physicians without managed care contracts were more likely to have practiced for more than 20 years, work fewer than 40 hours per week, lack board certification, work in solo or two-physician practices, live in the western United States and report practicing in a "non-competitive" environment.
• In 2008, slightly fewer than six in 10 U.S. physicians (59%) reported providing charity care—defined as free or reduced-cost care—to patients in financial need. On average, physicians who provided charity care provided 9.5 hours of charity care in the month preceding the survey, which amounts to slightly more than 4 percent of their time spent in all medically related activities.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.