• Factors affecting physician professional satisfaction

    I was just alerted to a RAND study, sponsored by the AMA, which gets at physician satisfaction:

    One of the American Medical Association’s core strategic objectives is to advance health care delivery and payment models that enable high-quality, affordable care and restore and preserve physician satisfaction. Such changes could yield a more sustainable and effective health care system with highly motivated physicians. To that end, the AMA asked RAND Health to characterize the factors that lead to physician satisfaction. RAND sought to identify high-priority determinants of professional satisfaction that can be targeted within a variety of practice types, especially as smaller and independent practices are purchased by or become affiliated with hospitals and larger delivery systems. Researchers gathered data from 30 physician practices in six states, using a combination of surveys and semistructured interviews.

    I’m always interested in data on this subject, since – if you read the mainstream media – you’d think the only thing doctors care about is making money and avoiding lawsuits. Oh, and making other doctors work more. But these are anecdotes. Bring on the evidence! Key findings were in four areas:

    The Importance of Delivering High-Quality Care

    • When physicians perceived themselves as providing high-quality care or their practices as facilitating their delivery of such care, they reported better professional satisfaction.
    • Obstacles to such care could originate within the practice (e.g., a practice leadership unsupportive of quality improvement ideas) or could be imposed externally (e.g., payers refusing to cover necessary medical services).

    The Pros and Cons of Electronic Health Records

    • Physicians approved of EHRs in concept and appreciated having better ability to remotely access patient information and improvements in quality of care.
    • However, for many physicians, the current state of EHR technology significantly worsened professional satisfaction in multiple ways.
    • Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.

    The Value of Income Stability and Fairness

    • Few physicians reported dissatisfaction with their current levels of income.
    • However, physicians reported that income stability was an important contributor to overall professional satisfaction.
    • Payment arrangements that were perceived as fair, transparent, and aligned with good patient care enhanced professional satisfaction.

    The Cumulative Burden of Regulations

    • Physicians and practice managers described the cumulative burden of externally imposed rules and regulations as having predominantly negative effects on professional satisfaction.
    • At the time of the study, “meaningful use” rules for EHRs were the regulations most commonly singled out by physicians and practice leaders.

    Looks to me like EHRs are a big problem. This doesn’t surprise me. But notice that tort reform didn’t seem to be the big deal others might have you believe. I leave you with one other nugget I dug out of the longer summary:

    Health Reform. Aside from incentives to adopt EHRs, our study did not identify recent health reforms as prominent contributors to overall physician satisfaction, either positively or negatively.

    Remember that the next time you read how doctors are all going to quit just because of the ACA.

    Full report here.


    • Since income is the principal source of everybody’s satisfaction or dissatisfaction, my observation is that dissatisfaction isn’t so much a product of the absolute level of income but the relative level of income – relative to the physician’s peers. Here’s one anecdote to prove my point. I once represented an orthopaedist whose sub-specialty is pediatrics who worked for a large single-specialty group practice. He was lowest compensated partner in the group, and my job was to convince the group to raise his compensation. I failed. Why? Because he was the lowest producer in the group – as a pediatric orthopaedist, he performed all of his surgery in the hospital (believing that outpatient surgery was too risky for children), which tends to be less profitable for the surgeon. More importantly, roughly half his patients were Medicaid-eligible, which meant lower reimbursement. Why half? Because (and this came as a surprise to me) that’s the percentage of children who are Medicaid-eligible in my region. Having failed to convince his partners to increase his compensation, he left the group and took a position where he has experienced a high level of professionally satisfaction. No, not in a position with higher compensation, but in a position in a multi-specialty pediatric group in which his compensation was comparable to every other physician’s in the group. Much has been written lately about the super rich never quite achieving satisfaction with their (very high) incomes? Why? Because there’s always a peer who makes more.

    • These findings are not surprising when you look at them like a psychologist. What makes people happy at work? A sense of control, feeling like they are doing something important, etc.

      But there is plenty of evidence people often don’t do what makes them happy. Economists prefer to study revealed preferences and the revealed preferences of doctors is often “whatever makes me more money,” not what is good for the patient. The AMA long held up physician supply to inflate wages, they still support heavy regulation of PAs and NPs, and they flip out when machines encroach on their work like managing anesthesia drugs during colonoscopies most recently )long article in the WSJ).

      • You are being disingenuous and a hypocrite. You blast doctors for fighting PAs but your own psychology organizations are fighting tooth and nail to keep MSWs and “lesser” trained mental health providers from taking over psychology.

    • It is not reform that is a problem at least for me, rather: 1) the feared reduction in the quality of care provided by the ACA 2), the ACA reliance upon programs that have yet been proven to work such as EHR’s. 3) the time that such programs take from the physician’s face to face contact with the patient, 4) the ACA’s regulatory environment which is based upon more government involvement not less. There are other reasons, but I wanted to limit myself to the things mentioned above.

    • I run a practice at a hospital on the wrong side of the tracks. People could make more and work less if they just went to another practice within 50 miles. They could make a lot more if they went to another state. Still, I manage to recruit from the Ivy league schools and from the other big name programs from Duke to the Cleveland Clinic. I think a lot of this is because we let people practice the way they want, but insist on high quality. I tell people they will need to use everything they learned in training, then learn more. It seems to work. I do miss out on a bunch of people who tell me they dont want to work that hard, but I am happy with who I get. Also, people like to work with other people whom they perceive to be of good quality.