CMS is floating a 3.34 percent conversion factor decrease in its proposed 2024 Medicare physician fee schedule, and some leaders say this could be the final straw in recruiting young physicians.
Harry Severance, MD, adjunct assistant professor at Durham, N.C.-based Duke University School of Medicine, joined Becker's to discuss the dangers of declining physician pay.
Editor's note: This response was edited lightly for brevity and clarity.
Question: What is the danger of declining physician pay?
Harry Severance: The danger becomes this: We now already face the following disruptors for practicing physicians:
1. A clinical workplace now adjudged to be the most unsafe workplace in all the U.S. with more that 75 percent of all assaults now occurring in healthcare and with healthcare workers now facing a five times greater likelihood of being assaulted, while at work, than in any other workplace.
2. An expanding cadre of hospital managers/administrators who increasingly view physicians as "oppositional" — with corporate healthcare leaders being quoted as saying that physicians are "one of the bigger obstructions to profitable healthcare."
3. An increasingly chaotic workplace highlighted by management-driven (profit-motivated) increasingly unsafe per-hour patient volumes, worsening impossible-to-safely-complete daily workloads, increasing prior authorization denials and persistent drug shortages that further worsen patient outcomes and noncompete clauses if you want to change jobs.
4. An evolving "moral injury" dilemma, where physician-employees are ordered by their nonclinical supervisor/administrators to carry out clinical actions that the physician feels are not in the best interest of patients, or outright harmful, but are still legally responsible for (unlike the ordering managers — who are indemnified under most jurisdictions). This in an atmosphere of record levels of physician burnout, depression and PTSD.
5. A workplace in which over 100,000 physicians quit healthcare in one year alone — 2021 — and this exodus is continuing.
6. A physician-in-training period of a minimum of eight to 12 years, sometimes longer, where little if any income is earned, but over $250,000 to $500,000 of training debt is accrued. Thus young physicians face an eight- to 12-plus-year career delay before entering into an earning marketplace and already saddled with up to a half million dollars in debt.
Now let's add into this chaotic mix the threat of declining physician pay. How many bright young minds when facing an option of a decadelong delay in earning potential while simultaneously accruing up to a half million-dollar debt, all while considering entry into an increasingly hostile and dangerous workplace of insane workloads and increasing liability and burnout, where the patients you sought this career in order to help are increasingly assaulting you, and where your management feels you are oppositional and a threat to their profits — now with the added insult of declining pay — would now even consider entering into such a career? Does this look like a smart career choice? Declining pay could be the final straw that, if not checked, will lead to increasingly fewer bright young minds choosing a career in healthcare and thus further accelerate the already critical shortage of physicians in this country.