The Southern California Physician, September, 2001

You may recall receiving the Physician "Brain Drain" Survey in February. It was distributed to more than 19,000 physicians by CMA and its component medical societies. I hope you were one of the 2,300 physicians who returned their questionnaires. The results have been compiled into a comprehensive report that includes results by each county. Being naturally curious about the statistics relating to San Bernardino County, I turned quickly to that section. Your answers are very interesting and not far off from the consensus of your colleagues statewide. Of the 127 physicians in our county who returned a survey,

• 77% said the practice of medicine is less satisfying now than 5 years ago.
  
• 54% said patient relationships are the greatest source of professional satisfaction.
  
• Sources of dissatisfaction rank as follows: 49% managed care; 40% reimbursement; 28% loss of autonomy; 26% government regulation.
  
• 55% said they planned to move out of state, retire early or change professions.
  
• 9% plan to reduce the amount of time spent in direct patient care.
  
• The time physicians spend in direct patient care has decreased by 5% since 1996.
  
• Time spent in medical administration has increased 5%. Time spent with each patient decreased. Time spent in non-patient care profession increased 5%.
  
• 47.7% of respondent's patients are enrolled in HMOs; 14.4% PPO; 19.4% Medicare; 9.8% Private FFS; 20.8% Medi-Cal.
  
• Physicians experienced an average 26.3% decrease in income since 1995.
  
• 19% reported difficulty attracting new physicians to a group or practice.
  
• 91% said California reimbursement levels and the regulatory environment negatively impact the quality and availability of patient care.
  
• 60% would still have chosen medicine as a career. However, only 30% would have chosen to practice in California. Only 17% are advising their children to choose medicine as a career.
  

We have received incredible statewide publicity on the "Brain Drain" survey. CMA provided a copy to Governor Gray Davis and will get a report out to every member of the Congressional Delegation in Washington. The survey results reflect the reality of health care in California today - that a physician shortage is looming and patient care is in peril. While the survey is not the definitive study that everyone would prefer, it does capture the current and disturbing mood of physicians throughout the state. It's a mood that cannot be ignored because its impact threatens the entire medical care system in California. I encourage you to read CMA's report. You will find it on CMA's web page, www.cmanet.org or call the SBCMS offices, (909) 825-6526, and staff will e-mail you a copy. You can also pick it up at the offices located at 952 S. Mt. Vernon Ave. in Colton.

How should we respond to this survey information? We must shine a light on the coming crisis. We must communicate to our patients, the public and our legislators that access to medical care will become increasingly difficult if current attitudes and trends are not altered. We need to improve the way we monitor physician supply and workforce trends. CMA-sponsored AB 1586 would accomplish that. This assembly bill requests the Medical Board of California to collect more useful physician data to allow regular tracking of physician supply and provide a more accurate picture of the state's health care scene.

But how can we improve physician mood and keep doctors practicing in California and in San Bernardino County? What must be fixed are the barriers that interfere with the physician-patient relationship. Specifically, problems with managed care hassles, government regulation and low health plan reimbursements. Many of these problems are being addressed in CMA-sponsored AB 1600. Currently, six health plans control 80% of the health care market in California. This substantial market dominance enables health plans to hand down unfair and unreasonable contract rates, terms and practices that are harmful to patients and physicians. AB 1600 would help level the playing field between physicians and health plans by allowing doctors to negotiate fair contracts for patient care.

What else are we doing? On May 25, 2000, the California Medical Association filed a federal (RICO) lawsuit against the three largest for-profit national health plans in California for imposing unfair contract terms, unnecessarily denying and delaying payments for procedures patients need, and reimbursing physicians at rates that are insufficient to cover costs.
CMA and our local legislative key contacts are sharing this data with legislators and regulators on the difficulties physicians are experiencing. We keep them informed on the current problems with access to on-call specialists, enforcement of timely payment laws, and the need for appropriate Medi-Cal reimbursement levels.
CMA is also addressing health plan coordination of benefits provisions, which are resulting in unfairly discounted reimbursement rates to physicians. Lastly, but very important for you to know, CMA's Reimbursement Advocacy program was developed to assist CMA members with their reimbursement related issues by providing coding, billing and payment casework advocacy. For reimbursement assistance call (888) 401-5911 or you may put your question in writing on a Hassle Factor Report (available on the CMA website www.cmanet.org) and send by mail or fax to CMA, Attn:Reimbursement Advocacy, P.O. Box 7690, San Francisco, CA 94120-7690; Fax (800)355-5090.
These are just a few examples of how SBCMS and CMA are working very hard on your behalf. To my fellow members of SBCMS/CMA, know that we appreciate your continuing support. And for those of you who are not members, it is very critical that you join organized medicine. We need your support and the strength that comes with uniting our voices. Together we will turn the tide.

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