[caption id="attachment_50659" align="alignright" width="317" caption="Dr. Richard Anderson, Mark Knight"][/caption]

NAPA -- A new survey found that nine out of 10 physicians across the country are unwilling to recommend the profession to others, while 43 percent said they are contemplating retirement as a result of "transformative changes" in the health care system -- results that will likely exacerbate a well-documented nationwide physician shortage. 

The Doctors Company, the largest physician and surgeon medical liability insurer in the county, surveyed more than 5,000 of its members for "The Future of Health Care" and found that the "overwhelming indication" is current physician sentiment will make the shortage all the more difficult, but critical, to confront.

[caption id="attachment_50826" align="alignleft" width="220" caption="Predicting a shortage (click to enlarge)"][/caption]

With the federal Affordable Care Act taking shape over the next several years, some 32 million Americans will enter the health care system by 2014, which will add further strain in the industry. And while health experts have long warned of the shortage, particularity as it relates to primary care, The Doctors Company survey found the troubling sentiment to be spread relatively even across the field of medicine -- not just primary care.[poll id="9"]

This NBBJ Pulse Poll runs through March 20. View all polls.

"We surveyed a cross section of our membership and received responses from a relatively even number of primary care, surgical specialty and nonsurgical specialty physicians," said Dr. Richard Anderson, chairman and CEO of The Doctors Company, based in Napa. "The challenges to primary care are well known and are a major problem with or without health care reform. The responses from primary care physicians and specialists were similar in direction and tone."

Recent efforts to address the simultaneous influx of patients and shortage of physicians include WellPoint, the nation's largest health insurance carrier, raising its reimbursement rates for primary care. Other efforts include increasing usage of nurse practitioners and other so-called "physician extenders" to address the rise in patient volume, a development that will likely continue, health experts said.

"There is no question that physician extenders will have an important role to play in the future of health care," Dr. Anderson said. "Right now, their role is governed by a mismatch of clinical practice, state laws and local customs. Until we come to grips with this on a national basis, there will be no simple answer for this question."

Likewise, with higher reimbursement rates, Dr. Anderson said that it's a step in the right direction but by no means is a cure-all.

"More appropriate compensation for primary care is certainly welcome. Compensation trends, however, tend to be a zero-sum game. Where do the dollars come from then?" he said.

Mark Knight, a health care consultant and former vice president of strategic services for Northern California for St. Joseph Health System, said the findings of the new survey were surprisingly high but not all that shocking given the health care landscape.

"That's higher than I would have guessed," he said, citing a similar 2010 New England Journal of Medicine survey that put the number at 63 percent. "That's quite a change in a two-year period."

Mr. Knight echoed many of the survey's findings, noting that physicians increasingly struggle with insurance reimbursement rates and burdensome debt from their eduction. But, he said, overtime the landscape is likely to change, and younger physicians will have much different expectations as they shift toward the managed care model and away from private practice.

Across California, health systems and hospitals have attempted to address the matter by increasingly merging, aligning or consolidating with physician foundations and HMOs, or creating accountable care organizations that are encouraged under health care reform. Hospitals in particular have invested heavily into physician foundations, partly as a means of retaining physicians, Mr. Knight said.

Only 20 percent of respondents said they were planning to change their practice models over the next five years; of those, the majority said they would likely pursue a larger practice model, according to Dr. Anderson. Another 24 percent of respondents did not select a future  practice model, "suggesting that respondents feel substantial uncertainty about their prospects," Dr. Anderson said.

And 57 percent of respondents said they were undecided on whether they would participate in an ACO, according to the survey. Another 51 percent were either undecided or needed more information about patient-centered medical homes before considering them.

One potential benefit of larger group practice, Dr. Anderson said, is the "cross-subsidization of specialties within a group."

The Doctors Company has some 71,000 members nationwide.

To view the survey, go to www.thedoctors.com/KnowledgeCenter/Publications/CON_ID_004672.