Physicians’ Biggest Challenges: MedCentral’s Survey Results

Physicians are facing turbulent times, between long hours that lead to burnout and competition on many fronts. In this national report on the new realities of medical practice, physicians share some surprising challenges affecting their practice and income, and how they’re succeeding in the face of it all. They reveal what they’re doing to improve profits and streamline operations, as well as which healthcare shifts irk them most.

Following are the results of MedCentral’s annual report on the evolution of medical practice, based on 864 physician responses. Of these, most work in primary care, including 332 family physicians and 276 internists.

For further insights, experts including, AAFP's President-Elect and ACP's President Emeritus, provide thoughtful commentary about what these results mean to the future of medical practice, and what is likely coming next for the field.

When asked what factors challenge them the most in practice, two-thirds (66%) of physicians said administrative tasks were very or somewhat significant, which is in line with previous studies showing that almost half of a doctor’s work time is spent on administrative work. But physicians also told us reimbursement issues (57%) and staffing shortages (56%) hindered their efforts to run their practices.

Many physicians have been nimble in responding to the current healthcare environment, and have modified areas of their workflow and staffing to see more patients and work more effectively.

More than half (56%) of survey respondents reported they have added nonphysician practitioners (NPPs) to their medical practice. Among those who have added NPPs, 60% said the NPPs helped increase profits.

About one-third of respondents said they implemented a new scheduling policy – such as same day or open scheduling – which gives patients more flexibility and convenience to see their doctor. This type of scheduling also helps physicians compete with retail clinics and urgent care clinics.

Much of a primary care physician's time is spent caring for patients with chronic conditions. Among respondents, 57% said they saw an increase in the percentage of time they spent caring for patients with chronic conditions, while 40% said the percentage of time stayed the same.

Two-thirds of respondents (65%) reported that diabetes was the most challenging chronic condition to treat, with obesity (48%) and mental health (41%) following.

The US Food and Drug Administration introduces an average of 53 new drugs each year. However, they often don’t reach patients who could benefit from them.

Eighty-five percent (85%) of surveyed physicians said lack of patient access was their biggest barrier when prescribing new therapies over the past year; patients were unable to get the recommended drug either due to lack of insurance coverage or cost.

Drug shortages were another crucial factor (60%). The American Society of Health-System Pharmacists noted 323 active drug shortages for the first quarter of 2024.

Nearly two-thirds of all physician respondents (61%) said their practice income remained about the same as the prior year, while nearly one in four said they saw a decrease. Just over 16% said their practice income increased in the last year.

Several factors impacted physician earnings, including the particular specialty, level of experience, and geographic location. Among respondents, those in internal medicine and general practice were most likely to report a decrease, while non-primary care specialists were most likely to report an increase.

The desire for new sources of revenue has spurred many medical practices to add services that they can bill for while also offering patients convenience and desirable services.

Telemedicine hit a peak of popularity during the COVID pandemic. Its popularity has tapered off, but the virtual platform remains appealing since becoming reimbursable through Medicare in 2020. More than one-third of surveyed physicians (37%) said they have added telemedicine to their practice. Adding laboratory testing was the second most common service addition.

Between the surge in high deductible insurance plans, job layoffs, and inflation, collecting payment from patients has become more challenging. Just over half of surveyed physicians (51%) said they have seen an increase in the number of patients who either don’t pay their bills or require repeated requests.

Some respondents said they avoid nonpayment by requiring payment before or at the time of visit. One doctor said they withhold medication refills until payment.

A study conducted by a healthcare revenue cycle company showed that patients were more likely to pay outstanding bills if the amount was under $500, and to avoid paying outstanding bills that were over $500.

Close to half of respondents said they had a side gig in the past year, typically to bring in extra income. With a medical-related side gig, physicians tap into knowledge they already possess.

Among those who reported having a side gig, medical consulting (19%) and moonlighting at a part-time job (18%) were the most common. Several respondents mentioned other side gigs, such as taking online medical surveys for extra income, working part-time as a medical director at a nursing home or hospice program, and teaching or giving lectures.

MedCentral previously reported on physicians serving as expert witnesses, insurance reviewers, or podcaster/vloggers to increase income while the most popular non-medical side gigs were investing in real estate and individual investing.

Burnout, overwork, and low reimbursement have prompted many physicians to consider alternative forms of practice that could reduce some work hassles.

Close to one-fifth of all physician respondents said they already switched to direct primary care (DPC), in which their practices don’t take insurance, and patients pay a monthly or annual fee for care. DPC physicians also tend to emphasize preventive care. The model is profitable for many physicians, but may not be as beneficial for patients with multiple chronic conditions who require regular specialist visits.

Among respondents who self-identified as being in Family Medicine, General Practice, or Internal Medicine (630 individuals), 165 (26%) said they are considering DPC and 125 (20%) have already adopted the practice model.

Concierge medicine was provided by a small minority of surveyed physicians (7%), but more than one-quarter of respondents said they are considering it. In the early days of concierge practice, only well-off patients could afford it. However, concierge and hybrid concierge models have evolved so that it’s now affordable for a broader base of patients.

Physicians said the biggest financial struggle at home was saving for retirement, with nearly half reporting the challenge regardless of how long they’d been in practice. Mortgage payments and earmarking money for their children’s education were the next most commonly cited challenges, particularly among physicians with fewer years in practice.

On the other hand, physicians with 30 or more years in practice were more subject to increased family medical bills and supporting adult children. But nearly one-third of them (32%) said they didn’t face any particular financial challenges.

According to an AMA report, almost 30% of physicians retire between ages 60 and 65 years old; 12% retire before age 60, and most of the rest work until their late 60s or 70s.

Artificial Intelligence (AI) usage in medical practice is still emerging and is mostly used for administrative tasks. Despite the media hype, about two-thirds (66%) of respondents said they didn’t use it at all. Of those who did, most did so for medical records documentation such as transcribing notes (18%), automated billing and coding (11%), and differential diagnosis (11%). About 10% use it to search through patient records.

Among the physicians who said they used AI, 28% considered it beneficial; 58% said it was somewhat beneficial, and 14% said it had not been useful.

The AMA and other medical organizations are convinced that AI ultimately has great potential for helping physicians with patient care, treatment outcomes, and assisting in diagnosis.

The survey was conducted online from April 16 to May 19, 2024. Questions were fielded directly through MedCentral.com and the company’s newsletters. Questions focused on business aspects of medical practice and the changes physicians are making to keep their practices profitable while providing optimal patient care.

Respondents included 864 physicians, of whom 38% are family physicians; 32% are internists; almost 3% in general practice; 7% work in hospital medicine; and another 20% are comprised of several other specialties and subspecialties, including just under 3% in hematology-oncology. More than half of respondents (52%) work in suburban areas, with another 33% in urban areas, and 14% in rural areas.

Almost two-thirds (62%) reported that they work in private offices; 12% in academic hospital/inpatient care; 9% in community clinic/government outpatient clinics; 9% in non-academic hospital/inpatient care; 3% in urgent care; and another 3% said they work in other situations.

In terms of established practice, 7% have been practicing for more than 40 years; 25% for 30 to 39 years; 33% for 20 to 29 years; 22% for 11 to 19 years; 9% for 6 to 10 years; and 4% for less than 5 years.

All percentages have been rounded up and percentages may sum to more than 100 as a result.

Responses have been anonymized and reported in aggregate.