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December 2, 2002

California Physicians are Dropping out of Managed Care, According to UCSF Researchers

Only 58 percent of patient care physicians in California are accepting new
patients with HMO coverage, and the "California Model" of loose networks of
private practice physicians organized into large managed care practice
organizations is unraveling, according to UCSF researchers.

Results of the 2001/2002 California Physicians Survey, commissioned by the
California HealthCare Foundation (CHCF) and conducted by researchers at the
UCSF Center for the Health Professions, appear at
The survey included a representative sample of 1033 physicians throughout the
major urban regions of California.

"California led the nation's charge into managed care. Our study of the state's
physicians tells us that California has now sounded the retreat," said Kevin
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 to
abandon HMOs, IPAs and managed care networks. A major exception is Kaiser
Permanente, which has maintained much greater allegiance among its physician

The survey indicates that more than 33 percent of specialist physicians in the
state have no patients in their practice insured by HMO plans, up from 23
percent of specialists without HMO patients in 1998.  The rate of physician
participation in private HMO plans is approaching the historically low rate of
physician participation in Medi-Cal, the state's insurance plan for low income
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 certain
types of insurance, rather than due to an absolute deficiency of the number of
physicians practicing in California," said Grumbach.

In addition, fewer physicians are participating in Independent Practice
Associations (IPAs), the most common form of physician managed care network.
Five years ago, 73 percent of all office-based primary care physicians in
California were members of an IPA. In 2001/2002, 62 percent belonged to an IPA.
Just over half (55 percent) of specialist physicians in California participated
in an IPA in 2001/2002, down from two thirds (65 percent) in 1998. Almost half
(46 percent) of specialists and one third (34 percent) of primary care
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 in
Kaiser Permanente consistently express more positive opinions about their
medical practice organization than do physicians working in IPAs and other
types of managed care networks, according to the UCSF researchers.  About 20
percent of the state's primary care physicians and 15 percent of specialists
work in the Kaiser Permanente system.

The California Physicians Survey was conducted by the California Workforce
Initiative (CWI) at the UCSF Center for the Health Professions. Additional
findings from the 2001/2002 California Physicians Survey titled California
Physicians 2002: Practice and Perceptions include the following:

* Compared to one year ago, physicians are working more hours per week on

* Overall satisfaction with being a physician has been stable for the past
several years. About 80 percent of California physicians are satisfied with
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 of
physicians, payment rates, and overall practice climate in their community.

* Retirement plans among physicians have not changed over the past several
years. About 80 percent of physicians plan to be seeing patients in three
years, similar to responses in previous surveys.

* Like many policy analysts, physicians are uncertain about whether there are
too many, too few, or just the right number of physicians in their community.

* Most physicians do not feel threatened by regulations that increase the scope
of practice for non-physician clinicians, such as nurse practitioners,
optometrists, and midwives.

* Many physicians recognize that there are social disparities in access to
medical care.

Additional researchers, all affiliated with the UCSF Center for the Health
Professions, include: Catherine Dower, JD; Sunita Mutha, MD; Jean Yoon, MHS;
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, in
partnership with The California Endowment, funds the California Workforce

The California HealthCare Foundation, based in Oakland, is an independent
philanthropy committed to improving California's health care delivery and
financing systems. Formed in 1996, its goal is to ensure that all Californians
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 under served
individuals and communities. The Endowment provides grants to organizations and
institutions that directly benefit the health and well-being of the people of

UCSF News Source:Maureen McInaney 


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