November, when physicians, other healthcare professionals, and their businesses frequently begin planning for the upcoming year. It is also time to look inward/backward and consider those goals not achieved, surprises (pleasant and unpleasant), disappointments, and unanticipated issues that has have arisen during the year. All of this reflection will go for naught without identifying what improvements and corrections need to be made, likely upcoming challenges, and obtain the assistance of knowledgeable professionals (accountants, attorneys, certified coders, etc.) to address them. Otherwise, it is almost impossible to set and achieve new goals and address new challenges.

For many physicians addressing the issues of professional dissatisfaction and the changes that appear to be inevitable are critical to this process.


1. Professional dissatisfaction.

Unlike Mark Twain’s death, rumors that many physicians are not happy with the practice of medicine do not appear to be greatly exaggerated. There are probably as many reasons for professional dissatisfaction as there are professionals. According to the Physicians Foundation’s “2016 Survey of America’s Physicians Practice Patterns and Perspectives”, a biennial study, of over 17,000 physicians, the most common bases for these professionals’ unhappiness include:

- 80% reporting that they are overextended, overworked, or not do not have time to see additional patients;

- 72% view interference by third parties as restricting their ability to provide quality care;

- 63% are concerned about the future of the medical profession;

- Poor morale was reported by 54% of the surveyed physicians; and

- Professional “burn out” was a factor for 49% of the physicians responding to this survey.


These physicians’ reactions to professional dissatisfaction included:

- 48% are planning to reduce their hours, retire, take non-clinical positions, or become “concierge” practitioners.

- 36%/27% are restricting their participation in the Medicaid/Medicare program.



The Physician Foundation’s findings are that much more disturbing because they do not reflect the impact of the Medicare Access and CHIP Reauthorization Act (“MACRA”), perhaps the most profound change in determining physician reimbursement since the adoption of the Medicare program. CMS intends to begin implementing MACRA in January 2017. Yet, it is estimated that 50% of physicians, and even larger portions of the PAs, ARNPs and CRNAs (collectively referred to herein as “Allied Professionals”) have little, if any, understanding of MACRA, including whether their practices fall within its scope and MACRA’s impact on their practices. Inasmuch as the Advisory Board Company believes that at least 80% of those practices including those with less than 100 physicians are likely to be adversely impacted, the future does not bode well for physicians and other Healthcare Professionals who do not take the time and make the effort to understand MACRA.


Physicians and Allied Professionals who want to minimize their future professional dissatisfaction should begin taking a number of steps immediately. These include:

- Determine whether their practice is exempt from the Merit Based Incentive Payment System (“MIPS”).

- Analyze and modify practice patterns to strengthen the individual/practice’s

- quality,

- resource use,

- clinical practice improvement, and

- meaningful use of certified EHR technology.

- Become familiar with alternative payment mechanisms, such as accountable care organizations and bundled payments.


Based on their findings, physicians and Allied Professionals should investigate a number of options in order to minimize MACRA’s potential adverse impact, including:

- joining or forming an accountable care organization;

- merging with or expanding the number of physicians and Allied Professionals in the practice; and/or

- affiliating with other groups of physicians and Allied Professionals.


A Russian proverb counsels “there is no shame in not knowing, the shame lies in not finding out.” Many physicians are not happy with their profession. Those who do not want to or cannot leave the profession need to become proactive – identify the issues, plan for and make appropriate changes. In today’s healthcare environment change is a constant. It is almost impossible to practice medicine, keep up with changes, and make effective adjustments without the help of professionals with the necessary expertise.