The uncertainty of how physicians will practice medicine in the next few years weighs heavily on doctors in Florida. And, the Republican primary candidates campaigning in the state recently said nothing that allayed their fears, according to the head of the Palm Beach County Medical Society.

Top of mind for physicians is technology and the economy.

Physicians in South Florida who responded to a recent survey from the Palm Beach Medical Society said they were “overwhelmingly” concerned about the coming changes in healthcare, whether related to the current health reform law, the move toward a digital health system and the state of the economy.

Florida has some unique healthcare features, according to Sam Bierstock, MD, who no longer practices but is a technology consultant based in Delray Beach, Fla. The senior population can be migratory. “Snowbirds” come in from other states, stay a few months to take advantage of the warm weather during winter months and then leave. 

“That generates a different attitude in terms of treatment because many practices are still built on traditional models,” where providers built relationships taking care of families, he said. “Now, it’s a steady stream of older people coming and going,” he said.

Similar to other states, the younger doctors in Florida who have grown up with technology or those clinicians who used computers early in their career will be more likely to invest in health IT and participate in meaningful use of electronic health records, Bierstock said.

“They have a long career ahead of them and don’t want penalties applied to their reimbursements for not adopting meaningful use,” he said. For those close to retirement, the eventual reductions in payments aren’t stiff enough to induce change.

About four years ago, the number of doctors being trained per year or coming into the system exceeded the rate at which older doctors were returning, he said.

“We were thinking that somewhere around 2012 that 70 percent of the doctors in practice were either going to be those trained on computers or grew up with them or looking to be located where the technology was in place. My guess is that there are now more of them than those doctors who are retiring,” Bierstock said.

Physician shortages, as Zeltzer said, leave little time for strategizing for the fast-approaching future. The impact of millions more coming into the healthcare system, with or without health reform, will be enormous.

“We don’t have enough primary care providers now for the current population,” Bierstock said. That will drive even more people to emergency rooms for primary care, and hospitals don’t have the capacity to handle these volumes.

And in Florida, “If we have any mass event, say a hurricane, they will be incapable for the most part of taking care of a large number of people for more than a short period of time,” he said.

Medicare cuts weigh heavily

The economic situation makes providers just as anxious, said Dr. Jack Zeltzer, a surgeon and president of the Palm Beach County Medical Society.

“There is no defined course for medicine, for where healthcare is going. Even if you acknowledge that Obamacare will come in, I don’t think anyone has been given a comprehensive picture,” he said.

For Florida primary voters, the Republican presidential candidates have not provided any details about where they see healthcare headed, only that they are going to repeal the health reform law, he noted.

More provider anxiety stems from the pending 30-percent cut in Medicare reimbursement, which Congress will reconsider in a few weeks. 

A Medicare payment cut “crops up annually and gets settled at the last minute, always a sword hanging over our heads, and at the last minute we get a reprieve, and it comes up again the next year,” he said.

Physicians say they may not be able to continue to practice if Medicare payment rates are reduced.

“I’m not certain if physicians can make their margins in terms of what it takes to take care of a Medicare patient,” Zeltzer said. And Florida is a magnet for retirees.

“We’re just trying to keep the lights on in our offices to take care of patients. We are busy because of the manpower shortage and just trying to put a finger in the dike to keep everything from falling part,” he said.

For more of our primaries coverage, visit the Elections 2012 page.