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.


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