I was reading about a survey by the Physicians Foundation recently which had some rather sobering findings. They sent out these 48 question surveys to 630,000 doctors and only heard back from 13,575, and skewed heavily toward docs over 50 (65% of respondents as opposed to 47% of physicians) so perhaps we shouldn't read too much into them. But let's take them one at a time and try to draw some conclusions from the findings.
Patient Access Issues
Several findings from the survey were interesting with regard to patient access issues. The surveyors note that doctors are working 5.9% fewer hours since 2008 and are seeing 16.6% fewer patients per day. I suspect the fewer patients per day statistic reflects the widespread adoption of EMRs decreasing physician productivity. 52% of physicians have limited the number of Medicare patients in their practice and 26% have closed their practices to Medicaid patients. In the next 3 years, over 50% of respondents plan to cut back on patients, work part-time, retire, switch to concierge medicine, or take other steps that would reduce patient access. The respondents also indicated they spent 22% of their time doing paperwork. When you add all these factors together, it's the equivalent of losing hundreds of thousands of doctors a year (and there's only about a million of us in the US). At a time when there is already a known doctor shortage, docs are working less, seeing fewer patients while they are working, and accepting fewer payment options. All that will add up to decreasing patient access and probably increased demand for physicians.
Yet despite this apparent increased demand for their services, 77.4% of physicians are “very pessimistic” about the future of medicine and 84% believe the medical profession is “in decline.” 57.9% would not recommend medicine to their children. Over a third wouldn't choose to go to medical school again. 82% of physicians believe they have little ability to change the healthcare system. 92% of physicians are unsure how they will fit into the medical system in 3-5 years. Surprisingly, practice owners and specialists are more pessimistic than employees and primary care docs. Perhaps this is a reflection of decreasing income levels, but it doesn't look like they asked about that.
62% of docs surveyed reported they provided $25,000 or more in uncompensated care a year. My first thought was, “That's it?” ACEP reports the average emergency doc provides around $150K a year in uncompensated care. If I were only providing $25K that'd be like a $125K per year raise. I guess I'm surprised that 38% of docs are doing less than $25K worth. Really? I'm not sure whether to say good for you or shame on you.
The statistic in the survey most relevant to the mission of this website, however, is that 60 percent of doctors would retire now if they could. That makes me very sad for two reasons. One, it means the majority of doctors are only practicing medicine for the money. There's no way I could go to work just for the money each day. Obviously, financial motivation is part of it for all of us, but if that were the only reason I was practicing medicine I'd have quit long ago to do something I enjoyed more (which hopefully would at least provide a similar income.) The second reason it saddened me was that there are an awful lot of doctors who seem to have squandered an opportunity for early retirement. Let me explain.
If you really hate your job that much, on an average physician income, you could live a middle class lifestyle and still retire in your 40s. Do the math. Take a physician making $200K starting at age 30. Have him live off a solid middle class income of $60K a year. Assume another $40K in taxes. So this doctor puts $100K a year toward retirement. At what age can he retire off his portfolio? If you assume 5% returns, the answer is age 42.
So, why haven't these hundreds of thousands of doctors just retired?
I've got a few hypotheses:
1) They refuse to live that frugally now (consciously or subconsciously.)
2) They refuse to live that frugally in retirement.
Remember that with this “extreme early retirement” plan you don't live on $60K a year while working then magically have $200K a year to live on in retirement. It's still just $60K a year.
3) They are saddled with debt.
Debt is like an anti-investment. It's pretty hard to retire with student loans, credit cards, car loans, and a mortgage. If you come out of medical school with $400K in debt at 6%+, you may not actually have a positive net worth until you're nearly 40. It could be longer if you were a non-traditional student, practice a less lucrative specialty, or had a few extra years of post-graduate training.
4) Government programs are not available at an early age.
The vast majority of Americans, including physicians, rely at least partially on Social Security to provide their retirement income. You just can't get it before age 62. More importantly, spanning the gap between early retirement and Medicare eligibility is a real issue with the rising cost of health insurance.
5) They didn't know it was possible.
You've probably noticed that financial ignorance is not uncommon among physicians. More likely, they didn't realize they'd want an early retirement until it was too late. Even if early retirement is possible in 12 years, it still takes 12 years from the time you make the commitment to do it, more if you're saddled with debt.
6) They are unable to achieve adequate growth on their savings.
I assumed a 5% real growth rate on investments. After taxes, fees, and poor investment choices, that can be a tall order.
7) They're lying and don't really want to retire.
It is just a survey after all. Perhaps our reflex answer is that “Sure, I'd retire if I could,” but when it really comes down to it we don't actually want to quit practicing. It's okay to dream of some idealized version of retirement where you enjoy decades of excellent health, travel, and good times with friends and family. We all know that's pretty rare.
What do you think of the results? Comment below.