The dire state of physician pay: AMA's president-elect on the need for reform

The American Medical Association named Bobby Mukkamala, MD, an otolaryngologist from Flint, Mich., president-elect.

Dr. Mukkamala joined Becker's to discuss the need for Medicare physician pay reform and the ramifications of shortages on patient care. 

Editor's note: This interview was edited lightly for clarity and length. 

Question: What are your biggest concerns regarding the physician workforce right now?

Dr. Bobby Mukkamala: As far as the workforce itself, the number of physicians isn't keeping up with the changing demographics of this country. We're living longer but we're not necessarily healthier, and there's healthcare issues at the core of that. That's one of my main concerns as far as the state of healthcare in this country. 

Other aspects of that are when you look at the elderly population, almost all of them are insured by Medicare. And when you look at Medicare, and the fact that other payers use that to base their compensation on, it's dragging behind. My wife and I share an office, and in the past few years our costs have gone up by more than 20%, and yet we're getting almost a 2% cut in Medicare payments this year. So there's a big disconnect between the reality of what it takes to take care of patients in this country and how we're getting reimbursed from the main insurer in the country. Additionally, Medicare is sort of set on their fee schedule. So I would really like to see that change and am excited to be in a position to sort of push for reform of Medicare to compensate us. When a hospital's costs go up, hospitals get paid more the next year by Medicare because of that change in the index, and I think physicians should be the same way, and I'm excited to make that case. The pay structure should follow the cost of providing the care as opposed to completely disconnected from that cost because it's a congressional budgetary process every year. 

Q: What are the long-term ramifications of these pay declines?

BM: You're going to see a lot of physicians — and we're already sort of seeing hints of that in our surveys — departing the profession early because of this stagnation and payments relative to the cost of providing that care. That's going to exacerbate the already-projected physician shortage. 

My parents came here to Flint in the early seventies when there was a need for physicians in the international medical graduate community to fill that need. It's concerning to me that, here I am, in my 24th year of practice, and we're facing a hundred thousand physician shortage in this country. Unfortunately what a lot of states are now looking at as a solution for that is having non-physicians provide care independently of a physician. That's not a great solution. I think that we shouldn't lower the standard of care by having non-physicians do what physicians do better as part of a physician-led team. That's related to AMA's scope of practice work. I would love to see more of that funnel that exists in graduate medical education that restricts how many physicians graduate every year be widened to make up for the fact that we have an aging population that needs more physicians. 

Q: What about its effect on patient care?

BM: Already I'm seeing the effects in my own community. It used to be that maybe once a week I would see a patient who didn't have a primary care physician listed that were coming to my office to take care of their ear, nose and throat problems based on a referral from an urgent care because they just were between primary care physicians or something, That used to be a once a week at most and now I see that at least half a dozen times a day. It's just because of that physician shortage. 

I used to think that maybe this was a Flint issue, because it's not necessarily on the list of the most desirable places to live in the country. But then I heard my colleagues on the board of the American Medical Association talk about what they were experiencing in San Diego, Calif., the other end of the spectrum of desirability of where to live in this country. They were also facing an issue where they don't have enough physicians, and this was a pediatrician. If it's happening in Flint and San Diego, then it's happening everywhere  in between. The consequences are that patients won't be getting the best level of care that they can when they don't have a medical home in the office of their primary care physician. 

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