In a June 10 Medscape article, Shawn Martin and Patricia Turner, MD, detail how the current Medicare physician payment system adversely affects both physicians and the patients they serve.
The authors argue that while short-term boosts to reimbursement are being proposed, these changes fall far short of the systemic overhaul needed.
Here are five takeaways from the article:
1. This year marks the fifth consecutive year physicians have experienced cuts to Medicare payments, the authors write. The latest federal budget package — referred to as the “One Big Beautiful Bill” by former President Donald Trump — includes a proposed 2.25% increase to Medicare physician payments for 2025. According to a report from the American Medical Association, if enacted, this proposal could result in a 4.3% increase in annual Medicare payments by 2035. However, the authors emphasize that such incremental changes do not address the deeper structural issues plaguing the system.
2. Mr. Martin and Dr. Turner write that Congress and several presidential administrations have failed to implement meaningful reform of Medicare physician payments for more than 30 years. The result, they argue, is visible in today’s healthcare access challenges.
“The consequences of this failure are manifesting in long times in waiting rooms, increased hospital visits, and decreased access to care,” the authors write.
3. Even if Medicare payments are increased, the authors note that most of those funds are directed toward keeping practices operational rather than improving physician compensation.
“When the payments fail to cover the full scope of these costs, as is the case now, staff wages stagnate, appointments are shortened to increase the number of patient visits, and, in some cases, physicians may not be able to receive a salary of their own just to keep the practice afloat,” they write.
4. The current system is accelerating an exodus from private practice and even from the medical profession itself, according to the authors. This trend exacerbates the ongoing physician shortage and further limits patient access to care.
“Patients are not just losing access to care; they are losing lifelong relationships with trusted physicians, and they are losing access to care for cancer and after trauma,” they write. The authors note that delays in preventive care and chronic disease management lead to worse health outcomes and higher long-term healthcare costs. “These are not hypothetical situations but are a bleak reality that cannot continue.”
5. The authors underscore the unique threat the current payment design poses to surgical services.
“Many communities already lack enough surgeons to address the elective, urgent, and emergent needs of their residents,” they write. They argue the structure distorts the value of complex procedures and fails to keep pace with rising costs related to equipment, innovation, staffing and regulatory compliance. As a result, many surgeons are scaling back their Medicare patient loads or leaving practice altogether. This contributes to longer wait times and can turn otherwise routine procedures into more complex — and costly — interventions. For older adults, they note, these delays can be life-altering and ultimately more expensive.
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