Health Equity
Medicaid Enrollment Touches 39% of the Residents of The District of Columbia; DC’s 70/30 FMAP is Vital for the Maintenance of Health & Human Services
A reduction in the District’s FMAP would not lead to long-term government savings and would have a ripple effect throughout the entire health system in the DMV, crippling access to care for not only Medicaid beneficiaries but also all those who live, work, and visit the District of Columbia, including members of Congress and their staffs.
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Why does DC receive an Enhanced FMAP Rate?
The DC FMAP rate of 70% established by the Revitalization Act resulted from bipartisan analysis, discussion, and negotiation by Congressional leadership aiming to balance fairness with the District’s restricted ability to generate revenue. Congress recognized that the District of Columbia faces unique financial challenges due to its non-state status and the significant amount of federally-owned land within its boundaries. The District is unable to tax non-residents’ earnings, so these workers pay no taxes to support the infrastructure and services, such as roads, public safety and emergency services that they benefit from in the District. The District is also unable to tax up to 40% of the real property within its borders due to statutory restrictions.
Why are we concerned about DC's FMAP now?
Members of Congress have proposed reducing the DC FMAP to the statutory minimum for all other states, which is currently 50% (but could be reduced even more). Such a change would impact every physician and every practice, regardless of type, location, and payers contracted. Even practices who take no insurance will not be able to send patients for specialist care, hospital admissions, or other types of care.
What can MSDC members do?
- If you know a member of Congress or staffer, reach out to them and share how DC cuts will hurt your patients.
- Share your relationships and outreach with hay@msdc.org so we can help coordinate advocacy efforts.
- Email hay@msdc.org if you would like to be paired with a physician member of Congress office and trained by MSDC staff on how to reach out.
Resources
- DC FMAP cut fact sheet
- California Medical Association fact sheet on Medicaid cuts
- MSDC and healthcare association letter to Congress arguing against DC FMAP changes.
- MSDC original story on Medicaid changes.
News, Statements, and Testimony on Health Equity Issues
The Staggering State of Physician Wellbeing, Compensation, and Practice Realities
There is no debating the enormous value that highly trained physicians contribute to society. However, most physicians do not feel adequately valued for their contributions, according to two recent surveys by Medscape and Doximity.
Fewer than one-third of all physicians surveyed said they believe that their compensation matches the expertise and effort required by their role, according to the Doximity Physician Compensation Report 2024 (or the “2024 Doximity report”). Not only do female physicians feel undercompensated, but they also earn 23% less on average than their male counterparts according to the 2024 Doximity report.
The study did not provide state-level data, but MSDC’s Gender Equity Task Force is conducting a physician compensation survey to evaluate the gender pay gap in our nation’s capital and all physicians are encouraged to take part here.
The 2024 Doximity report suggests that more money isn’t the only solution. In fact, three in four physicians surveyed said that instead of negotiating a raise, they would accept, or already had accepted, lower pay for greater autonomy or work-life balance. Whereas 6 in 10 physicians were dissatisfied with their salary, even more (8 in 10) were dissatisfied with their workload and reported that they are overworked. This highlights the extreme toll that burnout and poor wellbeing pose to the physician workforce.
Burnout in healthcare is pervasive and well-documented, and led the U.S Department of Health & Human Services to issue an advisory stating, “The realities of our health care system are driving many health workers to burnout.” Among these realities are administrative burdens and paperwork, increased patient volume, physician shortages, excessive paperwork that gets done after hours during “pajama time”, prior authorization hurdles, and more. The impact is staggering and directly impacts society at large:
- More than nine in 10 physicians (95%) reported that prior authorization somewhat or significantly increases physician burnout
- Almost 90% of younger physicians report feeling overworked
- 88% of physicians say their clinic has been impacted by physician shortage
- 70% of physicians reported wanting to leave their employer or physician practice.
- An estimated one million Americans lose their physician to suicide each year
Fortunately, there are opportunities to ensure a healthy physician workforce. Individuals and organizations can support the Healthy Physician Foundation, established by MSDC to address burnout and support physician wellbeing, with a focus on Washington, D.C. On a broader scale, the Medscape Physician Compensation Report 2024 identified several strategies to alleviate the impact of a physician shortage and overall dissatisfaction.
- increase medical education funding to train more physicians
- implement loan forgiveness programs to incentivize work in underserved areas
- leverage AI and technologies to streamline administrative tasks
- eliminate barriers to side gigs
- preventive care programs to reduce the overall demand for care.
Physician wellbeing, compensation, and practice is critical to a sustainable health care workforce and a healthy population. MSDC is a vigorous ally for physician practice and wellbeing and for patient care in DC. Learn more at www.msdc.org.
Reminder: Take MSDC’s physician compensation survey if you are a physician in metropolitan Washington.