Only 58 percent of patient care physicians in California are accepting
new
patients with HMO coverage, and the "California Model" of loose networks
of
private practice physicians organized into large managed care
practice
organizations is unraveling, according to UCSF researchers.
Results of the 2001/2002 California Physicians Survey, commissioned by
the
California HealthCare Foundation (CHCF) and conducted by researchers at
the
The survey included a representative sample of 1033 physicians throughout
the
major urban regions of California.
"California led the nation's charge into managed care. Our study of the
state's
physicians tells us that California has now sounded the retreat," said
Kevin
Grumbach, MD, UCSF professor of family and community medicine at San
Francisco Hospital General Medical Center (SFGHMC) and director of the Center
for California Health Workforce Studies. "Private physicians are starting
to
abandon HMOs, IPAs and managed care networks. A major exception is
Kaiser
Permanente, which has maintained much greater allegiance among its
physician
staff."
The survey indicates that more than 33 percent of specialist physicians in
the
state have no patients in their practice insured by HMO plans, up from
23
percent of specialists without HMO patients in 1998. The rate of
physician
participation in private HMO plans is approaching the historically low rate
of
physician participation in Medi-Cal, the state's insurance plan for low
income
Californians, according to survey results.
"The problem of lack of availability of physicians in many regions of
California is largely due to physicians not accepting patients with
certain
types of insurance, rather than due to an absolute deficiency of the number
of
physicians practicing in California," said Grumbach.
In addition, fewer physicians are participating in Independent
Practice
Associations (IPAs), the most common form of physician managed care
network.
Five years ago, 73 percent of all office-based primary care physicians
in
California were members of an IPA. In 2001/2002, 62 percent belonged to an
IPA.
Just over half (55 percent) of specialist physicians in California
participated
in an IPA in 2001/2002, down from two thirds (65 percent) in 1998. Almost
half
(46 percent) of specialists and one third (34 percent) of primary
care
physicians in the state are in solo practice.
The UCSF researchers noted that Kaiser Permanente appears to have the
most"staying power" for California physicians. In fact, physicians working
in
Kaiser Permanente consistently express more positive opinions about
their
medical practice organization than do physicians working in IPAs and
other
types of managed care networks, according to the UCSF researchers. About
20
percent of the state's primary care physicians and 15 percent of
specialists
work in the Kaiser Permanente system.
The California Physicians Survey was conducted by the California
Workforce
Initiative (CWI) at the UCSF Center for the Health Professions.
Additional
findings from the 2001/2002 California Physicians Survey titled
California
Physicians 2002: Practice and Perceptions include the following:
* Compared to one year ago, physicians are working more hours per week
on
average.
* Overall satisfaction with being a physician has been stable for the
past
several years. About 80 percent of California physicians are satisfied
with
their work, similar to satisfaction rates in previous surveys.
* Physicians are dissatisfied with the practice environment in their
community. Most perceive major problems in recruitment and retention
of
physicians, payment rates, and overall practice climate in their
community.
* Retirement plans among physicians have not changed over the past
several
years. About 80 percent of physicians plan to be seeing patients in
three
years, similar to responses in previous surveys.
* Like many policy analysts, physicians are uncertain about whether there
are
too many, too few, or just the right number of physicians in their
community.
* Most physicians do not feel threatened by regulations that increase the
scope
of practice for non-physician clinicians, such as nurse
practitioners,
optometrists, and midwives.
* Many physicians recognize that there are social disparities in access
to
medical care.
Additional researchers, all affiliated with the UCSF Center for the
Health
Professions, include: Catherine Dower, JD; Sunita Mutha, MD; Jean Yoon,
MHS;
William Huen; Dennis Keane, MPH; Diane R. Rittenhouse, MD, MPH; and Andrew
B. Bindman, MD.
The survey was funded by the California Healthcare Foundation, which,
in
partnership with The California Endowment, funds the California
Workforce
Initiative.
The California HealthCare Foundation, based in Oakland, is an
independent
philanthropy committed to improving California's health care delivery
and
financing systems. Formed in 1996, its goal is to ensure that all
Californians
have access to affordable, quality health care.
The California Endowment, a private, statewide health foundation, was
established to expand access to affordable, quality health care for
under served
individuals and communities. The Endowment provides grants to organizations
and
institutions that directly benefit the health and well-being of the people
of
California.
UCSF News Source:Maureen McInaney