Unfunded mandates, declining payment spell burnout: State of the Specialty 2015

Urologists' primary concerns

National Report-In some ways, 2015 was a watershed year for the U.S. health care system and its practitioners. April saw congressional passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which President Obama signed into law. MACRA repealed the flawed sustainable growth rate (SGR) formula for Medicare reimbursement, the bane of U.S. physicians for more than a decade, and ushered in a new era of value-based payment. 

Commentary - Pay down, oversight up: Twin threat to urologists

Early in the year, Health and Human Services Secretary Sylvia M. Burwell set a goal of tying 30% of traditional (fee-for-service) Medicare payments to quality or value through alternative payment models by the end of 2016, and tying 50% of payments to these models by the end of 2018. Physicians spent much of 2015 preparing for the 10th revision of the International Classification of Diseases (ICD-10), which debuted Oct. 1 without the gloomy effects many had predicted.

For urologists, however, little has changed, and discontent remains widespread, according to Urology Times’ annual State of the Specialty survey. In fact, only 5% of urologists responding to the survey say the elimination of the SGR and the introduction of MACRA have improved their outlook on the financial health of their practice.

Current ABU certification

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Burnt out and working harder

Urologists are disenchanted with the onslaught of mandates and paperwork requirements from the government and private insurers, including prior authorization, reporting of quality metrics, and the transition to ICD-10.

“More and more time [is] wasted doing meaningless work,” wrote one urologist in an open-ended survey question.

“I am mainly burnt out as I am working harder than I was as a resident and making minimum dollars,” said another urologist. “The residents who are at our hospital have a better quality of life. The stress is affecting my personal life.”

When asked to rate their concern about a list of possible issues, urologists put declining reimbursement at the top of the list, with 89% ranking it a 4 or 5 on a scale of 1 to 5 (5 representing “very concerned”). Increasing government regulations (86%) came next, followed by prior authorization requirements (84%), increasing overhead/overhead management (83%), and quality metrics/reporting requirements (78%). The top concerns in 2015 were similar to those listed in the survey’s 2014 installment, with one exception: “Prior authorization requirements” was added to the list of possible responses in 2015 and came in third.

Similarly, government influence in medicine and declining reimbursement were the most influential factors in urologists’ decision on when to retire (67% and 64%, respectively), followed by burnout (56%), loss of interest/enjoyment (48%), and not wanting to take the recertification exam (45%).

The State of the Specialty survey, now in its tenth year, takes the pulse of urologists’ current challenges, business and clinical practices, satisfaction, and opinions on a variety of hot-button topics. It is developed independently by Urology Times. Responses were collected via an online survey sent to active Urology Times subscribers in October 2015. A total of 335 respondents, who identified themselves as urologists or urology residents, completed the survey.

The average age of respondents is 50, and just over half are in private practice. (Also see, “How the survey was conducted")

Do you plan to recertify at 60 or older?*

Other survey highlights

Other highlights, as shown in the graphics beginning on this page, include:

• Maintenance of certification remains a contentious issue. More than half (53%) of survey respondents say they will not take the recertification exam when they reach age 60.

• 89% of urologists report that insurers’ prior authorization demands are on the rise, with prescriptions and imaging listed as the areas most commonly affected (89% and 86%, respectively).

• If they could do it over again, 36% of respondents would still choose a career in medicine, and of those physicians, 92% would choose urology as their specialty.

• Nearly 30% have considered employment by a hospital or health system, primarily because it lessens administrative hassles (89%) and offers better reimbursement (40%).

• Thirty-one percent of urologists say the number of non-physician providers they employ will increase next year, and one-fourth predict the hours these providers work will also climb.

• Twelve percent plan to change their electronic health record system next year.

Expected change in use of non-physician providers in 2016

How SGR repeal, MACRA affected outlook on your practice's financial health

Factors influencing plans on when to retire

Here are some responses we received to this question:

“More and more time wasted doing meaningless work”

“Just all of the accumulating crap from government and private insurances that is destroying medicine”

“Working harder than I was as a resident and making minimum dollars”

“Unable to recoup 2008 disaster”

Planned age of retirement

Would you retire now if you had enough money?

Do you plan to change your EHR within the next year?

Are prior authorization demands increasing?

Areas where prior authorization demands are increasing

Reasons for considering hospital employment

Here are some responses we received to this question:

“If I don’t, somebody will, and referrals will dry up”

“Tried already-can’t tolerate loss of control of patient options for financial benefit of employer”

“Don’t have to worry about overhead”
 

Urologists who have considered hospital employment

Would you still choose medicine as your career?

Would you still choose urology as your specialty?*

Plans for 2016

Urologists who believe IMRT facility ownership is a conflict of interest

How the survey was conducted

The Urology Times State of the Specialty survey was conducted via email in October 2015. Survey recipients, who were subscribers to Urology Times with email addresses on file, were required to indicate that they were a urologist or urology resident before proceeding with the survey. A total of 335 responses were obtained. As an incentive, those who responded were eligible to enter a drawing to win one of three $100 Visa gift cards.

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