You and your physician have something in common: As a patient, the things that make you happy about your health care are the same things that please your doctor; likewise, the same situations frustrate you both. It all boils down to time together focused on your care ― versus obstacles to that shared time.
A new study of physician attitudes shows doctors who feel they give their patients quality care are most satisfied in their work. And most often that happens when they get to spend time with their patients ― just what patients seem to want as well. So it follows that obstacles to a quality relationship and quality care trample that satisfaction for doctors.
Texas Medical Association's (TMA's) Texas Medicine magazine highlights the yearlong RAND Corp. study of physician professional satisfaction, ending September 2013. "Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy" highlights information gathered from 30 physician practices in Texas and five other states (Colorado, Massachusetts, North Carolina, Washington, and Wisconsin). The American Medical Association sponsored the study.
"To put it simply, if physicians feel they're giving high-quality care to their patients, they have a high level of satisfaction," said TMA President Stephen L. Brotherton, MD. He says the RAND study exposes a pervasive feeling of resentment among physicians over the barriers to providing quality care. That can happen if the doctor does not have a stake in practice management and business decisions, the practice lacks economic sustainability, or the doctor does not enjoy a personal rapport with patients.
RAND surveyed 30 medical practices in six states, using questionnaires, one-on-one interviews, and full surveys. RAND asked the practices about their organizational structure, electronic health record (EHR) use and capabilities, and participation in innovative payment models.
What RAND found was that physicians' greatest frustrations stem from administrative and financial burdens insurance companies place on physicians, including when payers hinder the quality of care they provide due either to denying medically necessary services or to requiring preauthorizations; and EHRs because they increase physicians' workload and drive a wedge between them and patients. (Any patient who has described symptoms to the doctor while he or she types on the computer instead of making eye contact, can relate.)
"Physicians undergo years of extensive training and education only to be relegated to the level of a clerk," said Dr. Brotherton. "The study tells us physicians are spending way too much time inputting data in EHRs, dealing with insurance company hassles, and handling other administrative duties."
"Often, [health insurance] regulations interfere with my ability to provide what I feel is quality care for my patients," said Tina Philip, DO, one of three doctors in a small Pflugerville, Texas, primary care practice. "Obtaining approvals for imaging studies or prior authorizations for medications is an inefficient use of time for me and my office staff and further delays care for the patient."
Many physician respondents are upset at the emphasis that their health plans' pay structure places on volume of care rather than quality, although some physicians indicate satisfaction with that setup.
Among the RAND study's conclusions:
- Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians' ability to focus on patient care;
- Excessive productivity quotas and limits on time spent with each patient are major sources of physician dissatisfaction. The cumulative pressures associated with workload were described as a "treadmill" and as being "relentless," sentiments especially common among primary care physicians;
- Physicians describe the cumulative burden of rules and regulations as overwhelming, draining time and resources from patient care; and
- Better EHR usability should be an industry-wide priority and a precondition for EHR certification.
Travis Bias, DO, Dr. Philip's practice partner, is hopeful this study can improve care for patients and professional satisfaction for their physicians. "Adequately addressing the problems detailed in the report will result in happier physicians and patients. Organized medicine can use the information from the study to focus on advocacy efforts and policy development that could reduce early retirement and burnout among physicians," he said.
"Ultimately, most physicians went into medicine to care for patients. When there are so many roadblocks in the way of rules, regulations, and what amounts to busy work, it gets in the way of physicians providing care to their patients, which is what all of us would rather spend our time doing," Dr. Philip said.
Maybe physicians ― and patients ― have cause to be optimistic. Doctors surveyed said they still experience moments of joy when spending time interacting with their patients, but they also want to influence the practice environment and care decisions, and a stable revenue stream.
TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 112 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.