Highlights: The following responses were from FP docs, these include those satisfied or somewhat satisfied:

142 of 189 were satisfied with FP as a specialty.

142/190 were satisfied with their community life.

139/187 were satisfied with their local schools.

132/186 were satisfied with their practice arrangement.

118/190 Fps were satisfied with the medical profession.

109/179 were satisfied with job opps for spouses.

109/188 were satisfied with coverage for vacations or CME.

106/186 were satisfied with their incomes.

88/140 were satisfied with their opportunities to consult with other practitioners.

74/190 were satisfied with the amount of time off.

In 1995, the Department of Health (Office of Rural Health, Tom Rauner) surveyed 488 rural doctors, those outside of Douglas, Sarpy, and Lancaster counties. Of these, 293 responded including 192 in FP/GP, 27 general surgeons, 14 pediatricians, 10 Ob-Gyns, 9 psychiatrists, and 25 internists.

Of the 27 General Surgeons, about half planned to leave Nebraska practices in the next 5 years (12 planned to retire and 1 planned to leave the state). Replacing the experienced general surgeons will not be easy. Two Nebraska general surgeons discontinued OB services in 1995 or 1996 while 4 decided to keep doing OB work. Iowa faced a similar problem for obstetrical backup for C-Sections when their general surgeons retired. What will FP docs do without surgical backup? Hospitals depend heavily on surgical income. How can hospitals justify anesthesia with lower volume? Obviously this is not a good time to lose surgeons. There are also few general surgeons trained to go to rural locations.

Of the 9 psychiatrists responding, 2 planned to retire and 4 planned to relocate outside of Nebraska in the next 5 years. Psychiatry is the only one of the professions surveyed where most of the rural physicians came from outside of the state. Only 20% of the psychiatrists came from Nebraska training programs. Perhaps training and selection could be a factor. Also could it be that it is tough to survive as a psychiatrist in a state that ranks 52nd in mental health expenditures per capita? This may be a reflection of lack of utilization of mental health resources. Or is this a result of the demographics of a state where wide open spaces distribute the population such that psychiatrists can’t group up effectively? Nebraska trains nearly all of the other specialties at home, including 9/10 FP rural docs, 7/10 general surgeons, 8/10 pediatricians, 9/10 OB-Gyns, and 8/10 internists. 56% of all physicians received residency training in Nebraska

Of the 192 FP/GPs who responded, 44 planned to retire, 8 planned to leave the state, and 11 planned to move within the state in the next 5 years (8 to a community of over 20,000). For rural doctor concerns check out their comments. The provision of OB services by FP docs continues to gather interest. While 6 FP docs never did OB, 120 plan to continue, 46 have discontinued OB recently, 15 plan to discontinue OB, and 1 FP doc plans to initiate OB services. Among those responding to the survey, only 8 OB docs do OB outside the most metro 3 counties and 1 OB doc plans to add OB services. The changes are more dramatic for smaller towns. While there is little change in OB in towns of 20,000 or more, in smaller towns, there is a continuing decline in OB services in towns of 10-20K. This continues to be in the range of 5-10% per year of current docs. When combined with nationwide declines of training in OB during primary care residency...... Even the usual training locations in Louisiana are swamped with residents seeking advanced OB training, diluting the overall experience. Nebraska will need a rebirth of obstetrics emphasis to hope to address this need.

Satisfaction with your current specialty

Satisfaction with your Practice Arrangement

Satisfaction with your Income

Satisfaction with your Community Life

Satisfaction with your Local Schools

Satisfaction with Spouse Job Opportunities

Satisfaction with Opportunities to Consult with Other Practitioners

Satisfaction with Coverage for Vacation or CME

Satisfaction with the Amount of Time Off

Satisfaction Summary

Satisfaction Summary

Comparison

From Nebraska Academy of Family Practice Survey                    

Main concerns are increasing role of managed care and hospitals in physician case management, losing patients to HMOs, CME, large hospital takeovers, independent PA and NP, liaisons for psych services, regulations, reimbursement.

Best thoughts on preparing greater NE for Medicaid is speakers, regional seminars, info, updates on progress at Lincoln, panel at March NAFP, revise prior to outstate implementation, any willing provider.

CME topics listed were new trends instead of reviews, nuggets for practicing cost effectively, managed care topics, business operations, nursing home issues, computers, health care policy, mental health topics.