For all the excited talk about the potential for IT to transform the healthcare industry for the better, many doctors are skeptical about the future, according to a recent survey conducted by athenahealth, the provider of online practice management and EMR tools, and Sermo, the largest online community for physicians.

The first-of-its-kind "Physician Sentiment Index," released on Thursday, shows that 59 percent of physicians believe that the quality of American medicine will decline in the next five years — and only 18 percent feel that it will improve.

Moreover, 62 percent expressed pessimism about doctors' future ability to practice independently or in small groups, and 64 percent indicated that their clinical decisions are based more on what payers were willing to cover than what they think is best for their patients. A full 92 percent of doctors reported that getting paid by insurers has "become increasingly burdensome and complex."

"Physicians want to focus on being the best doctors they can be, but there are all these things getting in the way," said Jonathan Bush, chairman and CEO of athenahealth. "They're caught between caring for their patients and remaining viable businesses. You've got stimulus dollars encouraging them to abandon a pen and paper system for electronic health records that are yet unproven, huge headaches that come from dealing with reimbursement protocols, hospital systems pressuring independents, and heath reform that will expand overly stressed state Medicaid programs — it's no wonder the sentiment is pretty bleak."



Other findings from the study found deep skepticism about the just-enacted healthcare reform.

The majority (54 percent) of respondents disagreed or strongly disagreed that more active government involvement in healthcare regulation can improve outcomes. Less than a quarter felt the other way.

At the same time, nearly half of those polled expressed some optimism that a shift from fee-for-service to pay-for-performance would improve quality of care — even as 53 percent believed pay-for-performance would have a negative impact on the effort required to get paid.

Frustration with payers' regulations and reimbursement protocols was widespread. More than three quarters (77 percent) said that time spent dealing with payers and other third parties inhibited their ability to spend time with patients. Meanwhile, 83 percent said that administrative costs incurred in order to comply with payer rules significantly affects their bottom line. And just 16 percent of doctors said they based clinical decisions on what's best for the patient rather than what payers are willing to cover.

"We're seeing this cottage industry of 5-10 group physician practices go out of business because they are focused on patient care and not focused enough on their business," said Daniel Palestrant, CEO of Sermo. "These are MDs, not MBAs, and here they are on the front lines dealing with the burden of balancing patient interaction with reimbursement complexities and managing a practice. They are frustrated."

Cautious optimism about health IT
But for all the frustration and pessimism expressed in the survey, doctors' views on electronic health records and other new technologies were somewhat brighter — even as many indicated initial discontent that EHRs' convenience and usefulness were not yet at the level that they'd like to see.

Eighty one percent of docs expressed a very favorable or somewhat favorable opinion of EHRs, but barely half (51 percent) felt that EHRs are designed with them in mind. Moreover 54 percent said that EHRs slow down the doctor during patient exams, and 60 percent said they distracted from face-to-face interaction with patients.

Only five percent of doctors, meanwhile, felt that EHRs are alleviating the effort to stay on top of changing payment requirements and incentives.

Read the full survey here.