Most physicians entered the medical field believing that hard work and dedication would lead to a happy, successful, satisfying career in the practice of medicine. The sacrifices made through the added years of education and training required to develop their unique skills were well worth it in their quest to deliver the best possible care to their patients. All seemed to be going well until the mid-1980s.
Growing concerns about health care costs and quality, and noted variations in diagnosis, treatment and clinical outcomes of care, raised concerns about the appropriateness, efficiency and effectiveness of different practice patterns and their impact on cost and quality of care. The era of external surveillance and accountability was born.
The initial payer response was to simply change provider reimbursement from the traditional fee-for-service system to more of a payment system based on fixed-priced, per-case, per-diem or capitation models. Any remaining fee-for-service payments were significantly discounted through a variety of managed care contracts.
The second phase of concern occurred in the early 2000s with the release of an IOM Report (“To Err Is Human”) that highlighted the large number of preventable medical deaths that occur each year as an unintended outcome of medical interventions.
As the era of health care reform begins, there’s an increasing emphasis on looking at medicine as a business, with more external monitoring and interference telling doctors what we can and cannot do and paying us less for doing it. Adding fuel to the fire of growing physician concerns about autonomy, authority and loss of control is the increasing complexity of the healthcare environment and the difficulties of managing a medical practice.
No wonder we’re seeing increased levels of anger, frustration and dissatisfaction as physicians grapple with the growing pressures around them. In some physicians, these factors have progressed into burnout and exhaustion, and even bouts of depression, substance abuse and/or suicidal ideation.
A recent article in The Annals of Surgery reported that 40% of surgeons reported being burned out and 30% screened positive for symptoms of depression. Burnout ratings were the greatest predictor of career satisfaction. Several reports suggest that many of these problems may actually begin during the medical school years and residency training programs. One study reported a 50% burnout rate in medical students with 10% experiencing suicidal thoughts. Similar findings are noted in primary care physicians, as well.
Besides the toll they take on personal life and work satisfaction, there is a growing body of literature that links practice dissatisfaction, work/life stress, burnout and fatigue with behaviors that are known to adversely affect staff relationships and performance efficiency, which can seriously compromise patient safety and quality of care, increase the occurrence of adverse events and/or medical errors, and increase the likelihood of litigation.
With the growing shortage of physicians, we need to look at physicians as being a precious resource and work with them in an effort to reduce stress, improve overall satisfaction and help them adjust to the changing environment.
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