A report from the Center for Studying Health System Change (HSC) released in May notes that the percentage of physicians who do not have contracts with any managed care plans has taken its first jump after remaining stable for a number of years—from 9.2 percent in 2000-2001 to 11.5 percent in 2004-05. Although the increase doesn't seem large, HSC believes it signals a significant trend.

HSC is a nonprofit research organization that studies the U.S. health care system and is funded primarily by the Robert Wood Johnson Foundation. A survey group of 12,000 practicing physicians provides HSC with information about how health care delivery is changing.

Despite complaints, most physicians continue to contract with managed care organizations (MCOs). However, according to the HSC survey, 34.6 percent of psychiatrists have chosen to opt out of managed care. This contrasts with 9.4 percent of primary care physicians and 10.5 percent of all medical specialists.

The HSC report notes that physicians in solo or two-physician practices are less likely to contract with MCOs, possibly because of the administrative burden. It also notes that physicians who have been in practice for more than 20 years are less likely to have managed care contracts than those who have been in practice for 10 years or less, suggesting that more experienced practitioners may have a patient base and reputation enabling them to bypass managed care plans.

According to the HSC, psychiatry is the medical specialty that has always had the largest number of physicians without managed care contracts. The reasons include low reimbursements and the utilization management imposed on psychiatry by MCOs and managed behavioral health companies. HSC also suggests that the high percentage of nonparticipating psychiatrists may reflect the shortage of psychiatrists in many areas. ▪