Only 58 percent of patient care physicians in California are accepting
patients with HMO coverage, and the "California Model" of loose networks
private practice physicians organized into large managed care
organizations is unraveling, according to UCSF researchers.
Results of the 2001/2002 California Physicians Survey, commissioned by
California HealthCare Foundation (CHCF) and conducted by researchers at
The survey included a representative sample of 1033 physicians throughout
major urban regions of California.
"California led the nation's charge into managed care. Our study of the
physicians tells us that California has now sounded the retreat," said
Grumbach, MD, UCSF professor of family and community medicine at San
Francisco Hospital General Medical Center (SFGHMC) and director of the Center
for California Health Workforce Studies. "Private physicians are starting
abandon HMOs, IPAs and managed care networks. A major exception is
Permanente, which has maintained much greater allegiance among its
The survey indicates that more than 33 percent of specialist physicians in
state have no patients in their practice insured by HMO plans, up from
percent of specialists without HMO patients in 1998. The rate of
participation in private HMO plans is approaching the historically low rate
physician participation in Medi-Cal, the state's insurance plan for low
Californians, according to survey results.
"The problem of lack of availability of physicians in many regions of
California is largely due to physicians not accepting patients with
types of insurance, rather than due to an absolute deficiency of the number
physicians practicing in California," said Grumbach.
In addition, fewer physicians are participating in Independent
Associations (IPAs), the most common form of physician managed care
Five years ago, 73 percent of all office-based primary care physicians
California were members of an IPA. In 2001/2002, 62 percent belonged to an
Just over half (55 percent) of specialist physicians in California
in an IPA in 2001/2002, down from two thirds (65 percent) in 1998. Almost
(46 percent) of specialists and one third (34 percent) of primary
physicians in the state are in solo practice.
The UCSF researchers noted that Kaiser Permanente appears to have the
most"staying power" for California physicians. In fact, physicians working
Kaiser Permanente consistently express more positive opinions about
medical practice organization than do physicians working in IPAs and
types of managed care networks, according to the UCSF researchers. About
percent of the state's primary care physicians and 15 percent of
work in the Kaiser Permanente system.
The California Physicians Survey was conducted by the California
Initiative (CWI) at the UCSF Center for the Health Professions.
findings from the 2001/2002 California Physicians Survey titled
Physicians 2002: Practice and Perceptions include the following:
* Compared to one year ago, physicians are working more hours per week
* Overall satisfaction with being a physician has been stable for the
several years. About 80 percent of California physicians are satisfied
their work, similar to satisfaction rates in previous surveys.
* Physicians are dissatisfied with the practice environment in their
community. Most perceive major problems in recruitment and retention
physicians, payment rates, and overall practice climate in their
* Retirement plans among physicians have not changed over the past
years. About 80 percent of physicians plan to be seeing patients in
years, similar to responses in previous surveys.
* Like many policy analysts, physicians are uncertain about whether there
too many, too few, or just the right number of physicians in their
* Most physicians do not feel threatened by regulations that increase the
of practice for non-physician clinicians, such as nurse
optometrists, and midwives.
* Many physicians recognize that there are social disparities in access
Additional researchers, all affiliated with the UCSF Center for the
Professions, include: Catherine Dower, JD; Sunita Mutha, MD; Jean Yoon,
William Huen; Dennis Keane, MPH; Diane R. Rittenhouse, MD, MPH; and Andrew
B. Bindman, MD.
The survey was funded by the California Healthcare Foundation, which,
partnership with The California Endowment, funds the California
The California HealthCare Foundation, based in Oakland, is an
philanthropy committed to improving California's health care delivery
financing systems. Formed in 1996, its goal is to ensure that all
have access to affordable, quality health care.
The California Endowment, a private, statewide health foundation, was
established to expand access to affordable, quality health care for
individuals and communities. The Endowment provides grants to organizations
institutions that directly benefit the health and well-being of the people
UCSF News Source:Maureen McInaney