Physician dissatisfaction is at an all-time and the timing could not be worse. “The lack of an adequate primary-care infrastructure in the U.S. is a high obstacle to creating a high-performing healthcare system,” says David Bluementhal, President of the Commonwealth Fund, a healthcare research foundation. The Association of American Medical Colleges estimates the United States will be short 45,000 primary-care doctors in 2020, compared to 9,000 today. All this just when thirty million additional patients are entering the healthcare space through Obamacare.

A good friend of mine, a Pulmonary Care Physician, predicted this problem recently at a dinner party. In his words, “Whether you like nationalized healthcare or not, the current infrastructure is not adequate to provide for the additional patients that will be entering the marketplace.” Fact is, the American healthcare system is already over-stressed resulting in a high level of dissatisfaction among physicians with serious implications for the system.

In 2012 an Urban Institute study of 500 primary-care physicians found that 30% of those aged 35-49 planned to leave their practice within 5 years. The rate jumped to 52% for those over 50. A more recent survey by The Physicians Foundation revealed the following:

• More than 60 percent of physicians would retire today if they had the means.
• Physicians see 16.6 percent fewer patients per day than they did in 2008, a decline that could lead to millions of fewer patients seen per year.
• More than 52 percent limit Medicare patients’ access to their practices or plan to do so.
• More than 26 percent have closed their practices to Medicaid patients.
• Physicians spend more than 22 percent of their time on nonclinical paperwork, resulting in a loss of some 165,000 full-time equivalent (FTE) physicians.

A recent survey by Medscape/Web M.D., also shows dissatisfaction among doctors on the rise. In an online questionnaire of 24,000 docs representing 25 specialties, only 54% said they would choose medicine again as a career.

A Jackson Healthcare survey of 3,456 physicians echoes the same results, 42% of physicians are dissatisfied with their job.

Does It Matter If Physicians are Satisfied?

The implications of physician dissatisfaction are myriad. Physician turnover is greater in organizations with high levels of physician dissatisfaction impacting consistent patient care and delivery costs. High levels of dissatisfaction decrease physician commitment to the practice setting and lead to mental strain and burnout. Published high levels of dissatisfaction within the career can lead to fewer medical school applicants – further exacerbating what is already a serious shortage of physicians

In the words of Erik Swenson, Chief Medical Officer for Capella Healthcare:

“There have been many studies on how dissatisfaction on the job leads to poor work habits and a poor work environment. Healthcare is no different and recent healthcare studies have shown this. Dissatisfied physicians have worse relationships with their patients, staff, and colleagues. Behavioral issues are more common as physicians feel (and act) more stressed. Patient care quality is diminished, generally ends up costing more, and patients are less loyal. All of this leads to more complaints and more malpractice suits filed against these physicians, thereby further increasing dissatisfaction.”

Causes of Dissatisfaction

Although the ranking may be different from one study to another, the top five causes of physician dissatisfaction are as follows:

• Low reimbursement – While this has obvious significance for a private practice, it is also the driver behind the emphasis on RVUs and mammoth case load requirements in employed settings. Providers who only survived by the proper mix of Medicare patients and privately-insured patients are now finding that commercial insurance rates are now equivalent to Medicare.
• Loss of autonomy – While many physicians have retreated to employed positions to escape the business pressures of private practice, the trade-off is loss of clinical autonomy.  Insurers, government regulations, and hospital “formularies” are just a few of the things that dictate how a physician can treat a patient,” according to Richard Jackson, CEO of Jackson Healthcare, “If we continue to devalue the experience and skills of our physicians, they will become the most expensive data entry clerks in the nation. “
• Administrative hassels – Administrative work now consumes more than 16% of physician time weekly. Electronic Medical Records have not provided any relief, particularly for primary care physicians who are more likely to spend time taking full medical histories.
• Patient overload – Focus on patient-centered care. A patient-centered care focus also scored an average of 8.5 out of 10 for physician importance. Even though the majority of hospitals and health systems believe they are a patient-centered organization, physician satisfaction with their organization’s focus on this aspect was just 7 out of 10. The formula for failure is simple – more patients, less patient time, and lots more patients.
• Loss of respect – Howard Forman, a professor at the Yale School of Management who researches diagnostic radiology, health policy and healthcare leadership says, “The transformation of the field from independence and professionalism to being commoditized and feeling like you’re just another worker is disheartening.” Many physicians fear that clinical decisions will be determined primarily by policy and untrained clerks making their training and expertise superfluous.

The Solution to Physician Dissatisfaction

Suffice it to say that one size does not fit all, neither can one solution be the panacea to a serious “industry-wide” dilemma. However, many physicians are finding satisfaction in a unique practice setting, the Military Treatment Facility (MTF).

Here are some reasons providers enjoy working in a military environment:

• Strict schedules – the military has a propensity of starting and ending on time. Most positions are M-F, 0730-1630.
• Professional working environment – strong emphasis on quality patient care working alongside motivated professionals at the top of their field with access to the most advanced resources
• No insurance or back office issues – everyone is covered by Tricare, making paperwork a matter of the software learning curve (no coding, billing, collections)
• No malpractice worries – medical malpractice is covered by an Act of Congress, Title 10
• Manageable Caseload – Primary Care Physicians, for example, typically see one patient every 20 minutes.
• Respect – Where else in this country will you be called “Yessir” or “Yesmam”? In addition, no pre-authorization for consults is required.

KurzSolutions specializes in placing physicians in all specialties in military civilian roles. We expect to place over 400 physicians in 2015, in patient-centered military treatment facilities where the training, skill, and expertise of physicians is valued and respected. Why not give us a call to discuss your options?

Endnotes:

1. http://kaiserhealthnews.org/news/doctor-burnout/  http://www.washingtonpost.com/national/health-science/a-growing-number-of-primary-care-doctors-are-burning-out-how-does-this-affect-patients/2014/03/31/2e8bce24-a951-11e3-b61e-8051b8b52d06_story.html
2. http://www.forbes.com/sites/susanadams/2012/04/27/why-do-so-many-doctors-regret-their-job-choice/
3. http://www.locumtenens.com/physician-recruitment/physician-dissatisfaction-growing.aspx
4. http://www.beckershospitalreview.com/hospital-physician-relationships/survey-42-of-physicians-are-dissatisfied.html
5. http://www.capellahealth.com/wp-content/uploads/2012/01/ClinicalConnections_MayJune2012_HR.pdf

Prescription-DrugsFor all its promise, MTM failed miserably as a supplemental revenue stream for pharmacies suffering under reduced Medicare payments and as a venue for a more professional direction for retail pharmacists. The “still birth,” which was largely the result of unclear and inadequate reimbursement guidelines, was more than disappointing – it left the major gap in patient care, safety, and quality – Medication Therapy Management – unaddressed.

The severity of the problem can be illustrated by my recent visit to Camp Lejeune, Marine Base in North Carolina where several marines have died from drug interactions. The few, the proud, the brave often receive prescription meds both on and off base from physicians who are not linked and do not communicate with each other in any way. Add to this the overuse of prescription drugs (often up to seven different medications at once) in treatment of combat trauma, and the failure of the naval hospital to require relinquishment of unused medications when new prescriptions are given, and you have the tragic result, dead marines.

The good news is that progress is being made. Thanks to dedicated professionals such as Linda Strand, VP of Medication Management Systems, policy and legislation are currently being crafted that will give Medication Therapy Management a second life. Check out this webinar hosted by the Center for Medicare and Medicaid Innovation to get fully up to speed on this important renaissance.

Read the tragic result of this failure at these links:

http://www.jdnews.com/news/hospital-78400-lawyer-abuse.html

http://www.nytimes.com/2011/02/13/us/13drugs.html?pagewanted=all

http://www.marinecorpstimes.com/news/2010/06/military_drug_deaths_060710w/