Journal of Medicine - In 2012, Physicians faced many changes in their profession including the growing trend of employment, increased use of electronic medical records and more responsibility as they take the lead in care teams as the healthcare community strives to become more coordinated. These changes, and their effects, will carry over into the new year. The Physicians Foundation has identified five issues that will likely have the largest impact on physicians in 2013, based on research studies and policy papers. "We hope [the research] will help…healthcare providers formulate smart policy decisions that are beneficial to America's patients and doctors," said Walker Ray, MD, vice president of The Physicians Foundation and chair of the research committee.

Here are the top five physician issues the foundation identified and how hospitals and health systems can help.

1. Ongoing uncertainty over PPACA. Despite the Supreme Court decision upholding most of the provisions in the Patient Protection and Affordable Care Act (PPACA) and the re-election of President Obama, considerable uncertainty persists among patients and physicians regarding actual implementation of the Act. Much of the law has yet to be fully defined and a number of key areas within PPACA – including accountable care organizations (ACOs), health insurance exchanges, Medicare physician fee schedule and the independent payment advisory board – remain nebulous. The uncertainty surrounding health reform was among the key factors contributing to 77 percent of physicians being pessimistic about the future of medicine. In 2013, physicians will need to closely monitor developments around the implementation of these critical provisions, to understand how they will directly affect their patients and ability to practice medicine.

2. Consolidation means “bigger.” But is bigger better? Large hospital systems and medical groups continue to acquire smaller / solo private practices at a steady rate. According to a Foundation report pertaining to the future of U.S. medical practices, many physicians are seeking employment with hospital systems for income security and relief from administrative burdens. However, increased consolidation may potentially lead to monopolistic concerns, raise cost of care, and reduce the viability and competitiveness of solo / private practice. As the trend toward greater medical consolidation continues across 2013, it will be vital to monitor for possible unintended consequences related to patient access and overall cost of care.

3. 12 months to 30 million. In 2014, PPACA will introduce more than 30 million new patients to the U.S. healthcare system. This provision has considerable implications relative to patient access to care and physician shortages. Americans are likely to experience significant challenges in accessing care if current physician practice patterns continue. If physicians continue to work fewer hours, more than 47,000 full-time-equivalent (FTE) physicians will be lost from the workforce in the next four years. Moreover, 52 percent of physicians have limited the access of Medicare patients to their practices or are planning to do so. As the 12-month countdown to 30 million continues across 2013, physicians and policy makers will need to identify measures to help ensure a sufficient number of doctors are available to treat these millions of new patients – while also ensuring the quality of care provided to all patients is in no way compromised.

4.Erosion of physician autonomy. Physician autonomy – particularly related to a doctor’s ability to exercise independent medical judgments without non-clinical personnel interfering with these decisions – is markedly deteriorating. Many of the factors contributing to a loss of physician autonomy include problematic and decreasing reimbursements, liability / defensive medicine pressures and an increasingly burdensome regulatory environment. In 2013, physicians will need to identify ways to streamline these processes and challenges, to help maintain the autonomy required to make the clinical decisions that are best for their patients.

5.Growing administrative burdens. Increasing administrative and government regulations contribute to pervasive physician discontentment. Excessive “red tape” regulations are forcing many physicians to decrease their time spent with patients in order to deal with non-clinical paper work and other administrative burdens. In 2013, physicians and policy makers will need to work closely together to determine steps that will effectively reduce gratuitous regulations that negatively affect physician–patient relationships. The creation of a Federal Commission for Administrative Simplification in Medicine could help reduce these regulations by evaluating and reducing cumbersome physician reporting requirements that do not result in cost savings or measurable reductions in patient risk.

“2013 will be a watershed year for the U.S. healthcare system,” said Lou Goodman, Ph.D., president of The Physicians Foundation, “It is clear that lawmakers need to work closely with physicians to ensure that we are well prepared to meet the demands of 30 million new patients in the healthcare system and to effectively address the impending doctor shortage and growing patient access crisis.”