|Jeffrey E. Kaufman, MD||Dr. Kaufman,|
In this transitional year 18 months after passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Urology Times’ annual State of the Specialty survey has a great deal of useful information on how urologists view their practice and the state of health care delivery. Basically, the survey’s questions fall into three categories: Are you happy?, Why/why not?, and, if not, What are you going to do about it?
Of course, maintenance of certification weighs heavily on many of you. Two-thirds agree with the value of certification but disagree with the process. Some 87% of you are reimbursed less but are more stressed than in previous years.
Responses to a number of questions show the biggest concerns driving those opinions. Not surprising, falling reimbursement, increased overhead, and more intrusive regulations and oversight are driving dissatisfaction. About one-fifth do not fully understand MACRA or appreciate the changes we are going through, which will affect your future performance ratings, financial security, and satisfaction.
Indeed, disruptive change is…. well, disruptive. Some plan to seek employment, some will associate with larger groups, and some plan to leave practice. In fact, reflecting the average age of urologists in general (we are the second oldest specialty), 22% of you are actively planning retirement, and a full 40% intend to leave clinical practice in some way, further exacerbating our already pressing manpower crisis.
MACRA will generate many new practice pressures that will make solo or small group practice very challenging in years ahead. This survey shows 31% are in solo practice today and 78% of responders are in groups of nine or fewer. It will be interesting to see how those numbers change in the coming years and how we will cope.
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