Number of Physicians Taking New Medicaid Patients Continues to Shrink

Physicians continue to drop out of the Medicaid program, leaving a dwindling number of physicians to see an increasing number of Medicaid patients, concludes an analysis of new data from the Center for Studying Health System Change.

Across specialties, 21 percent of physicians accepted no new Medicaid patients for 2004 and 2005, up from 19.4 percent who turned away new Medicaid patients in 1996 and 1997. Among family physicians, 27.3 percent took no new patients last year, compared with 25.5 percent who did so nearly a decade ago. The percentage of internists turning away new Medicaid patients last year was 30.5 percent, while among pediatricians, the percentage refusing new patients was 15 percent, according to the report, "Medicaid Patients Increasingly Concentrated Among Physicians" (PDF file: 5 pages / 124 KB. More about PDFs.).

In part, those numbers seem to be driven by a shift away from care being provided by traditional physician offices and toward care provision by physicians in large group practices, hospitals, academic medical centers and community health centers, according to the report.

"Relatively low payment rates and high administrative costs are likely contributing to decreased involvement with Medicaid among physicians in solo and small group practices," said one of the report's authors, Peter Cunningham, Ph.D., a senior fellow at the center, a nonpartisan think tank in Washington, D.C.

Eighty-four percent of responding physicians said inadequate payment was a "moderate or very important reason" for deciding to stop accepting new Medicaid patients, while billing requirements and paperwork were cited by 70 percent of physicians as moderate or very important reasons for doing so.

The survey also showed that small practices were much more likely than large practices to begin turning away new Medicaid patients. Thirty-five percent of one- and two-physician practices were not accepting new Medicaid patients, while 24 percent of small group practices and 13 percent of large group practices stopped taking new patients.

The number of physicians opting out of the program altogether also is on the rise. In 2004-05, 14.6 percent of physicians were deriving no revenue from Medicaid versus 12.9 percent in 1996-97, according to the survey.

According to data collected on a continual basis by the AAFP, Medicaid beneficiaries make up about 12.3 percent of the patient population of the average family physician.