Gallup regularly monitors citizen concerns including healthcare. With all the turmoil going on, it is interesting to note that 55% of the public worries a 'great deal' about availability and affordability of their healthcare.
This is followed by crime and violence (51%), federal spending/deficits (51%), guns, drug use etc. Some issues are related to the most recent problems but healthcare is tied for either first or second for the fifth year in a row.
As the political food fight continues into the fall, expect these polls to push politicians to discuss this more.
The NPs tussle
A festering issue for PCPs and all physicians is the public face off occurring in the press between physicians and Nurse Practitioners. This is of concern. The public thinks it is all about money. Some of it is but also about what is perceived as respect or lack of it by both sides.
The shortage of physicians, the Affordable Care Act with Medicaid expansion, extensive lobbying efforts by NP organizations have put NPs in many positions where physicians were in practice. ANP, the NPs organization wants total parity nothing less. Undoubtedly, there are bad physicians as well as NPs. Thousands of Nps and physician work together harmoniously to benefit patients. However, when NPs are allowed almost full practice without physician supervision like the VA, it creates a problem. It is obviously about the cost.
The battle is being fought at many State legislatures. The same fight is occurring in many specialties not just primary care NPs. The ideal approach would be to have a dialogue but I think with this many fronts open, this tussle has gone too far ahead. Physicians generally do not come together as long as the issue does not affect them personally and so they do not get involved. Each specialty has a very narrow view and does not look at the big picture.
So, unless that happens the tide has turned towards NPs simply based upon cost.
Physician turnover & leadership
This is an interesting piece by a radiologist detailing what radiologists change jobs.
The average turnover rate for physicians is about 11 or 12% for private and academic practices but there is a wide variance. The article lays out these reason: Partnership (or lack thereof), group dysfunction/dishonesty, Group acquisition and lost contracts, Financial dishonesty, Workload expectations, Leadership/management deficiencies, Location and family and proper staffing = security.
While this is an all compassing list, there are some obvious items that should be at the top of the list.
Certainly family and location is one of the top reasons for a change in jobs. But, I would argue that lack of leadership and poor management skills are also very important. The larger the group the more important these skills are. These skills are 'soft' skills but vital. I have been involved in physician development for over 10 years and would recommend all physicians looking ahead to lead in any capacity learn by getting trained in something we as physicians never learnt in medical school, residency or in early practice.
See https://www.beckershospitalreview.com/hospital-management-administration/6-management-tips-for-physician-leaders.html, https://www.sciencedirect.com/science/article/pii/S0741521413019411, http://bulletin.facs.org/2017/08/2017-leadership-summit-leading-from-behind-building-resiliency-and-strengthening-nontechnical-skills/#.WsjmJIjwaUk, https://www.ncbi.nlm.nih.gov/labs/articles/27101665/ and https://medicine.osu.edu/faculty/fame/programs/leadership/pages/index.aspx