American Academy of Family Physicians CEO talks about doctors’ concerns

Family physicians are facing a challenging environment.

R. Shawn Martin, executive vice president and CEO of the American Academy of Family Physicians, says doctors are treating a wide variety of patients with an array of health issues. But doctors also face the administrative complexity of practice, as physicians routinely deal with a dozen or more health insurance products, he says.

And doctors spend a good amount of time documenting patient visits and dealing with insurers to get authorization for treatment.

“It's a very friction-filled practice style,” Martin tells Chief Healthcare Executive®.

“More importantly, it takes time away from them doing what they really want to do is take care, which is take care of the person in the room with them,” he says.

In a recent interview, Martin discussed the concerns of family physicians, including the pervasive levels of burnout, the aging physician workforce, and the need to get more doctors into family medicine.

(See part of our conversation in this video. The story continues below.)

The health of doctors

Martin says the well-being of family physicians is “still a really serious problem.”

“I think there's lots of reasons to be concerned about the state of the physician workforce generally, and frustration and the lack of autonomy that they're experiencing in many parts of the country and in many systems or employment situations,” he says.

While he says there have been some improvements in efforts to improve the mental health of doctors, physician burnout remains a persistent issue.

“A a time that we have a shrinking physician workforce overall, burnout is a real concern,” Martin says. “Because you have a lot of really talented physicians that, quite honestly, don't want to practice medicine anymore, or don't want to practice medicine full-time, and that hurts a lot of communities.”

“I think the one thing, I talk about this a lot, I think anything we can do to restore autonomy to physicians, I think will go a long way towards resolving or reducing the burnout issues,” he says.

Physicians are also worn down by the demands of working with insurance companies to gain approval for treatment, he says. Prior authorization is regularly cited as a contributing factor to physician burnout, and doctors say that patient care is hurt too often in delays in getting approval.

“They're devoting a ton of resources to these processes,” Martin says. “It's really time-consuming. But I think what really concerns my members most is, it's a delay in care. You know, a patient is facing a delay in care or treatment that I think our members oftentimes refer to as unnecessary.”

• Read more: Insurers must approve care more quickly, but providers aren’t overly optimistic

The aging workforce

The physician workforce is shrinking, and many doctors are getting older and approaching retirement age. Nearly a quarter (23.4%) of all active doctors are 65 and older, according to data from the Association of American Medical Colleges.

“From a macro policy position, I think we as a country should be really worried about it,” Martin says of the aging physician workforce.

“There's a lot of physicians that … are reaching that age where, even if they don't retire, they're going to reduce their overall contributions in clinical care, and that will have capacity impacts and access aspect impacts on many communities,” he says.

More doctors need to pursue careers in family medicine, Martin says. Nearly 5,300 medical students matched to family medicine last year.

“That pace has got to pick up,” he says. “We've got to get more.”

And Martin says that it’s not a problem with an easy solution.

“We're going to have to create some strategies, either through technology, enhanced capacity or, you know, different distribution strategies of positions, better team-based care models,” he says. “But none of that replaces the fact that we need a lot more physicians coming to medical school and getting out into the community faster.”

The American Academy of Family Physicians works “every minute of every day” to encourage more medical students to go into family medicine. Medical students often opt for more lucrative specialties, particularly as many have hundreds of thousands of debt after med school.

“It's a competitive environment,” he says. “We need to get more of them. You know, we don't have to get them all, but we need to get more of them, to go into family medicine and primary care.”

Martin also worries about new federal caps on borrowing for medical school that take effect in July. Students will be able to borrow $50,000 per year, and are capped at $200,000 over four years.

“Student loan policies that the administration has put in place don't help,” Martin says.

“We continue to advocate for better student loan financing and better opportunities for students to reduce their overall debt load,” he says. “We know that helps them go into careers of need. And we continue to encourage the administration to focus on that.”