By Tim Bonfield
The Cincinnati Enquirer

A survey of more than 1,000 Greater Cincinnati physicians released Thursday shows that doctors feel overworked, underpaid and concerned about what they see as declining quality of care in the community.

The survey findings indicate that complaints raised for at least two years by some physicians - including weak compensation and trouble recruiting new doctors to town - are shared widely among local doctors.

"If doctors were just complaining about their compensation, that would be one thing," said Robert Miller, president and chief executive of Cooper Research Inc., the company that conducted the survey on behalf of the Academy of Medicine of Cincinnati.

"But in between the lines here, doctors are saying they are having a lot of trouble filling positions and sometimes they are filling positions with less qualified candidates," Miller said. "As a consumer, I'm asking, 'Are our doctors as good as they used to be?'"

The findings include:

• 50 percent of doctors say access to care in Cincinnati is "fair" and 25 percent say it is "poor" compared with 23 percent who say it is "good" and 2 percent who say it is "excellent."

• 64 percent of doctors responding say their workload has increased, while 50 percent of doctors say their personal income from patient care has decreased.

• 59 percent of respondents plan to cut back hours within two years, 47 percent plan to reduce their hospital privileges and 9 percent plan to close their practices.

• 28 percent of practice administrators say they gave up searches because they could not find a willing candidate, while 21 percent report hiring people who were less qualified than standards that were initially set.

The survey was conducted in April. Of about 2,900 surveys mailed out, more than a third responded - a high rate for such surveys, Miller said. Cooper Research said the margin of error was plus or minus 3 percentage points.

Doctors say the survey puts even more data behind complaints and concerns they say have been largely dismissed by insurers and employers. In late May, a study commissioned by a task force of business and health-care interests concluded that short supplies exist in 14 of 33 medical specialties in Greater Cincinnati.

"The issue isn't with managed-care companies, but with the businesses in Cincinnati that are pressuring managed-care companies to provide the lowest rates possible," said Mike Gilligan, president and chief executive of the Mayfield Clinic neurosurgery group.

Just the fact that 1,000 doctors in town took the time to fill out a detailed survey was impressive to Don Jansen, chief operating officer for Wellington Orthopaedic & Sports Medicine.

"The significance is that these views are widespread," he said.

Doctors have been frustrated for many reasons, and not just in Cincinnati.

In some states, doctors are holding mini-strikes over soaring malpractice insurance rates. Doctors fear they will suffer from proposed cuts in Medicare reimbursement and from potential changes in Medicaid programs as budget-pinched states look to slow spending.

But doctors say the Cincinnati picture is further aggravated by years of cost-cutting pressure from insurers and employers.

"When we sit down to talk to people about these problems, I don't think we'll have to prove anything or justify ourselves anymore," said Russell Dean, executive director of the Academy of Medicine.

Some insurers, however, are less than swayed by the survey.

"The survey accurately reflects frustration. But you can't lay all that on the payers' lap," said Larry Savage, president and chief executive of Humana Health Plan of Ohio Inc. "You could also do a survey of 1,000 employers and find frustration about the amount of money it costs them to have health benefits for their employees."

Humana has been increasing reimbursement rates for doctors in certain specialties for five years, Savage said. But what an HMO pays out in reimbursement rates isn't the same as what a doctor takes home in income.

Other factors also play roles, including rising malpractice rates, costs of office technology and pay for employees. Most recently, the biggest threat to doctor income has been the government, not private insurers, Savage said.

The local survey reflects opinions that don't sound much different than surveys of physicians nationwide, said Paul Beckman, vice president of health care management for southern Ohio at Anthem Blue Cross and Blue Shield.

Anthem recently pledged $100,000 to work on projects to help attract more doctors to Cincinnati and is willing to address concerns facing certain specialties. But only some of the concerns frustrating doctors are local in nature, Beckman said.

Despite such comments, Dr. Marvin Rorick, a neurologist with Riverhills Healthcare and a past president of the Academy of Medicine, said not enough attention is being paid to the value of community doctors.

"Children's Hospital is a bright star. The research at the University of Cincinnati is building a national reputation. But there are problems with the regular, day-to-day practice of medicine," Rorick said. Community physicians "are not being celebrated for the good job they do. They want to be listened to."

E-mail tbonfield@enquirer.com