In this survey of doctors’ attitudes about their personal professional situations—-which is generally encouraging—-there are three red-hot findings.

- 14% of physicians now are not accepting Medicare patients and more than 25% are not accepting Medicaid.

- Internists had the lowest “very satisfied” rate. Only one-third say they are “very satisfied” compared to the 51 percent of pediatricians who are “very satisfied.” Internists—primary care specialists for adults—-are key to helping patients reduce their health risks, monitor known problems and take action when a condition warrants. If their numbers decline, medical care will become even more fragmented than it is today. It is the internist who can help pick specialists. It is the internist whose role it is to stand back, listen to all the specialists’ advice, and help the patient sort through what to do, especially when they don’t agree.

- “A surprisingly large proportion of physicians, 41%, said they didn’t provide any free or reduced-cost care. Of those who did, the average number of hours spent per month treating charity cases was 9.5%.”  Those who did tended to be in institutional settings.

If health care reform is going to work, an open question, these are issues which have to be resolved. They are intertwined.

Practically speaking, the elderly and the poor have more medical problems and more complex medical problems. Physicians are paid the least for seeing the sickest patients. How long can that continue? I have heard a number of physicians say that, distinct from “free care” or “reduced cost care,” they feel that already are contributing time and money by taking Medicare and Medicaid patients.

Internists’ lower satisfaction rate is, in part, related to the payment and paper-work requirements of the two programs above.

Medpage Today

“The average U.S. physician — a white male practicing in a managed care network in a large city — has some complaints about his job but is likely to be satisfied overall, a survey found.

“Overall, 39% of physicians surveyed by the Center for Studying Health System Change (CSHSC), a nonpartisan Washington think tank, said they were “very satisfied” with their careers, while 43% reported being “somewhat satisfied.”

“At the other end of the spectrum, 15% were somewhat or very dissatisfied.

“Internists had the lowest “very satisfied” rate at 33%, while 51% of pediatricians said they were very satisfied (P<0.01). Also, physicians in mid-sized group practices were significantly more like to report being very satisfied compared with those in solo or two-physician practices.

“Non-Hispanic white physicians were considerably more likely to report being highly-satisfied (40%) than non-Hispanic black doctors (29%) or Hispanics (34%).”

Source: Medpage Today, September 4, 2009

Source: Center for Studying Health System Change Survey. Funded by Robert Wood Johnson Foundation