"If we are to endure further cuts in an already under-reimbursed sector of our patient base," the doctor continued, "we will likely stop accepting new Medicare patients. It's something most internists in the area will be forced to do. And it will cause an even greater access-to-care crisis than is already the case in our area."

While nearly nine out of 10 responding internal medicine physicians said they will make changes to their practices, 30 percent said they already have taken some steps to make changes in their practices in anticipation of the scheduled Medicare cuts. The changes they have taken include not accepting any new Medicare patients; postponing capital purchases for their practice; and reconsidering plans to purchase health information technology.


Also reflecting a frustration about patient-access was the finding that 48 percent of the physicians who already have made changes to their practices said one of their changes is accelerating their plans to retire from practice. And, 62 percent of the physicians who indicated they will make changes if the July cut takes effect said that they will further accelerate their plans to retire from practicing medicine.

Seventy-two percent of respondents said Medicare patients already need to put in a high level of effort to find a primary care physician in their communities.

Another part of the survey asked medical students and physicians in academic settings about the effects that cuts to Medicare payments could have on the careers of future physicians. "ACP wanted to know what the not-too-distant future for care of the increasing number of Medicare patients may be," noted Dr. Harris.

The most dramatic response was that 100 percent of the responding medical students said that Medicare physician payments are at least somewhat important in a medical student's selection of a specialty.
More than 60 percent of the medical students said that if they chose to specialize in internal medicine they will choose to sub-specialize rather than go into general internal medicine.

By contrast, some 89 percent of the teaching physicians said they believe that positive and predictable Medicare payments would increase the number of students choosing to train in primary care medicine.

One internal medical educator pointed out that, "teaching in a residency program, I come across medical students who are less likely to choose internal medicine as their career due to already low pay and high education loans. The scheduled cuts will certainly drive them away from internal medicine, making future healthcare difficult for all ages."

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