Should Floridians care when doctors say they’re not making enough money?

by | Sep 3, 2023




Healthcare experts would like for us to believe that Florida – and indeed the nation – is on the brink of yet another “crisis,” marked by a significant shortage of doctors that extends into suburban and rural areas. Is it true?  The data seems to indicate a growing problem. For example, last year, Jacksonville alone was found to have a deficit of 510 doctors – a number based on how much of the population each physician can serve – and forecasts for the future, helpfully provided by advocacy groups, suggest the problem will get much, much worse if we don’t do something about it now.

Just what is the problem, exactly? It’s longer wait times, extended drives to neighboring towns to see a primary care physician, and even longer trips (and wait times) to see specialists. Higher costs come with the territory, too, and ultimately, worse health care outcomes for everyone.

It turns out that Florida’s rural patients are in the same boat as the state’s urban patients when it comes to getting face time with the right doctor, and for the same reasons: too many patients, not enough doctors. But pick your poison: in rural areas, you might drive long distances to see a doctor, while urban patients just have to sit in more traffic to get across town. Either way, the doctor shortage is making itself felt. And it’s only going to get worse, experts say.

Contributing to the shortfall are three converging factors: a shakeout in the profession following the COVID-19 pandemic, an uptick in retirements combined with a general workforce shortage, and finally, a state population that has ballooned by 21 percent while the influx of doctors and other health care specialists hasn’t kept pace. A report from 2021 anticipated that by 2035, doctors in Florida will meet only about 76 percent of the healthcare demand.

But another factor also plays a key role: the influx of new doctors completing their medical training and entering the profession. While few people are sympathetic to the notion that doctors aren’t making enough money, the fact of the matter is that the healthcare future of Florida and the rest of the nation depends highly on finding ways to convince young men and women with the right aptitude to dedicate many years to the long, expensive and grueling process of becoming doctors in the first place.

Doctor compensation plays an outsized role in that process, so when doctors say they aren’t making enough money, we can easily validate their complaints by checking to see if we have a shortage of people lining up to become doctors. As with any job in a free market system, when there are plenty of people vying for a job, it’s safe to assume the compensation package is lucrative enough to attract ample talent. But when there’s a shortage, one of the key questions we have to ask is: Are we offering the right compensation?

Medicare reimbursement rates are one of the key factors in doctor compensation. Over the past two decades, physicians have seen an effective 26 percent reduction in these rates, according to the American Medical Association (AMA), which represents doctors before Congress and state legislative bodies. The group also says the cost of running a private medical practice has shot up by nearly 50 percent over that same period, causing many doctors to downsize their practices or withdraw from the Medicare system altogether.

In Florida, that hits hard, with more than 22 percent of all residents dependent on Medicare.

Those numbers have also gotten the attention of U.S. Rep. Gus Bilirakis, who has recently said that consistent cuts to Medicare providers jeopardize seniors’ access to quality care. Given that Florida is home to more than 4.8 million Medicare beneficiaries—the second-largest number in the nation—the matter is of considerable importance.

“Continued year over year cuts to Medicare providers jeopardizes seniors’ continued access to quality care,” said Bilirakis. “Further reductions will only serve to accelerate healthcare consolidation – whereby limiting patient choice and access, exacerbating healthcare inequities and a continued rise in overall healthcare costs. We need patient-centered reforms that ensure continued access to quality care for all Americans.”

Right now in Congress, a pair of Florida Republicans, Rep. Neal Dunn (FL-2) and Rep. Bill Posey (FL-18) are pushing to support H.R. 2474, known as the Strengthening Medicare for Patients and Providers Act. The bill proposes to link Medicare physician payments to the Medicare Economic Index (MEI), thereby providing a sustainable solution to an outdated payment model.

It may be tempting to think that doctors are wiping their tears with money. But ignoring the underlying impact – a shortage of doctors – is like ignoring that nagging pain in your stomach only to find out later that it’s a serious ulcer. It is best to treat the problem now, before it becomes more acute.

7 Comments

  1. Just a thought

    Good article but leaves out percentages of corporation doctor employees vs self employed. Easier to tell employees what to do or which Big Pharma product to push then ask self employed doctors.

  2. Dennis Barton

    One way to make more compensation is to work more hours. Doctors I am familiar with are closed one weekday or one afternoon a week. When doctor’s offices are open more the self inflicted shortage will go away.

    • Independent Thoughts

      Good article, however, it ignores the reality that the vast majority of physicians (70%) are no longer independent practitioners. They are employed by either a hospital/health system, large group with a pyramid structure (older docs on top), or private equity. The employer of the docs determines how much they get paid, not some Medicare fee schedule. Their leverage for more $$$ is the lack of supply.

  3. F A Howell

    Yes absolutely Floridians should care! The sacrifices, the challenges, and the expenses to become a physician are enormous. Not everyone has the intelligence and perseverance to become a physician and when you need one, you’re blessed they’re there! When it comes to your health, you get what you pay for and physicians deserve maximum compensation for their intellect, education and dedication to their profession.

  4. Becky Ayech

    This is one of the many unintended consequences of the growth in Florida. When a government can’t guarantee protecting the health, safety and welfare of its population then government is not doing its job. Perhaps we should quit encouraging people to move to Florida. Would a State income tax slow down growth? Or would a governor who doesn’t push to get people to move here a better solution. It is time we look at Florida’s immigration policies from other states. It is time to stop pretending we don’t have problems like home owners insurance or toxic blue green algae.

  5. Crystal Griffith RN

    It’s fairly easy to figure out the issues in Florida. A large majority of the citizens are insured under Medicare which pays less than commercial insurance companies. The other issue is the number of doctors who are not independent practitioners. They work for a medical conglomerate like Ascension Healthcare or Millennium Healthcare. They get a set paycheck regardless of the number of patients they see each day. On the other hand, if they don’t see the number of patients that corporate thinks they ought to, they can be fired. I know many docs who worked under these conditions and decided that it was not the best thing for them. However, EVERYBODY has a non-compete clause in their contract so the doc has to move X number of miles away before they can set up a practice. I only know one doctor who got around the 2 yr clause. She quit her Internal Medicine practice, became a hospital consultant on Medicare coding and waited out the 2 yr clause before she opened her own practice down the street from the Clinic she had been under contract to. She is living her best life!
    Rural areas just don’t have the number of patients to make any office profitable. Let’s face it. None of us work for free. My personal feeling is that Nurse Practitioners are a great way to get medical care to the underserved areas. Having been an RN for over 50 yrs now, I have slowly come to learn that many of the NPs are better at scoping out the issues with a patient than some MDs. They listen to the patients!

  6. MICHAEL GARRY RACHOR

    DOCTORS ARE OVERWORKED AND UNDERPAID! THEY WORK LONG HOURS 7 DAYS A WEEK! MUCHOF THEIR PAY COMES FROM THE FEDERAL GOVERNMENT VIA MEDICARE AND MEDICAID WHO PAY 80% OF THEIR BILLS TO PATIENTS WHO ARE ELDERS AND NEED LOTS OF ATTENTION!

    A LARGE NUMBER OF OUR DOCTORS COME TO US AS LEGAL IMMIGRANTS FROM INDIA, MEXICO, THE MIDDLE EAST AND ALL OVER THE WORLD 🌎!

    WE ARE BLESSED TO HAVE THEM!

    NURSES ARE IN DEMAND AND LIKE DOCTORS COME FROM ALL OVER THE WORLD AND HAVE TO WORK VERY HARD TO GET LICENSED AS AN RN AND LATER AS A PRACTICING CERTIFIED RN IN LIMITED MEDICAL PRACTICE THAT TAKES THE LOAD OFF THE DOCTOR YOU KNOW AND TRUST.

    BECOME A NURSE OR A DOCTOR AND FIND OUT WHAT YOU HAVE TO DO TO BE ONE OF THEM!

    THEN YOU TOO CAN BE IN POSITION TO TAKE ON LIFE AND DEATH 💀 MEDICAL PRACTICE RESPONSIBILITIES!

    AND PAY 💰 A HUGH STUDENT DEBT!

    SUPPLY AND DEMAND IS THE WAY OF THE WORLD 🌎!

 

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