| 1. |
Morale is a strange entity to try to measure. Dealing with new faculty in an academic department is difficult because of unmet expectations which is partly a generational issue. The red tape is huge and lack of appreciation of physician expertise or value by administrators (lack of respect, whether intentional or not) is the biggest key in morale. Little things go a long way but when the docs don't see any leadership in the halls, the wards, near the OR or in the lounges, they feel like a widget. Medical management or managers ( which is different from leadership) generally don't get it when it comes to dealing with docs, especially in an academic setting. |
| 2. |
It seems to be getting more and more difficult for primary care physicians to "hang in there" and continue to do what they've been trained to do. Between the low(er) pay and the frequent lack of appreciation on the part of patients for the job that we do, it's hard to continue to be enthusiastic about practicing primary care in the future. |
| 3. |
Physicians are caught in the middle of it all. Our expenses continue to climb, our income drops, patients are noncompliant and yet we are suppose to provide expert care 24/7 and be perfect 100% of the time. If we are concerned about money then we are "bad doctors" because everyone knows that all doctors are rich. Right! |
| 4. |
I HAVE BEEN RETIRED FOR 10 YEARS FROM MEDICAL PRACTICE. JVC |
| 5. |
Stress re med-malpractice always hanging over physicians- medicine less enjoyable when having to order tests just to cover all bases as no tolerance for misses in this society. |
| 6. |
It seems impossible to continue to practice with the workflows of the past. Perhaps we need to spend 5% of our time thinking about how we work. |
| 7. |
We have forgotten why we exist - to help - the patient - not financial folder, not the system. I see patients at the end - when they have recieved everything thier insurance allowed, but thier probelm has never been cared for. All I can do is shake me head and try to help. |
| 8. |
my biggest morale problems have been with lack of understanding of administration of the challenges of clinical medicine. No support for me in primary care, little funding of needed technological advances ( e.g. EMR), no recognition of how hard it is to provide quality education of residents. |
| 9. |
Significant lack of respect is also an issue |
| 10. |
This survey is inadequate, seeking to link morale issues to behavioral health outcomes. Low morale affects the practice of medicine in so many other ways that are not "pathologic". |
| 11. |
Financial issues and politics drive the shape of healthcare. Medical science and the integration of well-documented clinical care guidelines into practice have not had the highest priority even among physicians. Technology has the potential to address many problems with quality of care and decision-making but is the exception in clinical settings. "Independence" of individual physicians is likely to continue to impede appropriate evolution of the practice of medicine and the provision of care sufficiently to result in external forces overwhelming the professional prerogatives that brought us to medicine originally. Physicians have abrogated our responsibility to be engaged in the overall healthcare system. We have been too busy protecting narrow interests without a realistic perspective on the landscape in which we spend our lives. The result is poor quality of care and population health status below all other industrialized nations. And at an outrageous cost. Our work is cut out for us. |
| 12. |
It is both a uniquely personal and collective problem that is driven primarily by the work environment. The most sensible solution is to take control as best you can. This seems to translate into leaving medicine, going into private (solo or small group) where problems still exist but you can better control. However, most physicians I know including myself seem to stay out of a sense of pride in our profession and because after a "risk/benefit, pro/con" analysis the lesser of two evils mentality prevails. |
| 13. |
interference with the doctor/patient relationship by insurance companies is another cause of low physician morale; as is feelings of inadequate reimbursement for the education and the time involved in being a physician. Primary care physicians constantly feel undervalued relative to specialists and underpaid. |
| 14. |
Physician morale issues are perhaps more common in older physicians, who tend to be working with an 'autonomy' model and haven't adapted to the changing healtcare environment, don't like to interface with computers, and struggle to keep up with increasing patient workloads. Younger physicians have different priorities, work fewer hours, and are increasingly being trained in an environment which emphasizes teamwork. Poor morale is perhaps a 'generational thing'. |
| 15. |
we offer same day access with too few physcians working too few hours leading to long hours of unscheduled work. this lowers morale. solutions are planned, but slow roll out lowers morale. |
| 16. |
Apathy is pervasive. Much of the collegiality and connection that MDs used to share has eroded. It is hard to get MDs to come together esp after hours for gatherings such as medical society meetings. I also find that many are more likely to gripe (or simply turn inward) rather than to work toward reasonable solutions and mutual supportiveness. Seems to me that the "heart" of medicine in the USA is growing cold -- most MDs are overly focused on survival and darn few seem to be thriving! |
| 17. |
There appears to be no consideration of physician morale in health care policy making bodies. Also physicians are not unified to resolve or help themselves in this regard. |
| 18. |
Physicians have always been able to do anything they want at anytime. When looked at carefully and critically many are found to have large knowledge gaps and behavioral problems. These things are not tolerated in any other industry. The physician community needs to be trained more broadly in terms of medicine, behavior and business as it relates to the community, not just their own private world. |
| 19. |
In the VA, we expect physicians to constantly adapt. Their morale remains high because they work in a system that is acknowledged daily as the best in the world. Your entire survey seems biased towards self-serving private practice docs. PS: I used to be one. |
| 20. |
Morale is a daily challenge for all. The key for me has been in finding a greater calling in my work. I have a very spiritual outlook about my work and the trials I experience. It is uplifting and sutaining but such approaches, for me a "faith-full" one, do not evolve overnight. We need mentors and there are few... The key to finding a way to be renewed and motivated should start in medical school or before. |
| 21. |
Government unfunded mandates are a major contributor to the decline of physician (and hospital) morale. |
| 22. |
There is no single biggest factor to lower physician morale. It is a combination of all the factors noted in the question. In addition, I practice in the New Orleans area and the morale is incredibly low here as a result of Hurricaine Katrina. Many physicians are leaving the area. The lack of enough physicians is placing more work and stress on the remaining physicians that in turn is creating an additude that "I won't be the last to leave." |
| 23. |
There are stong differences between primary care and the surgical specialties and the sub specialties who are have other "ancillary" mechanisms to generate income, to off set the bureacratic and costly overhead expenses. |
| 24. |
Professional Autonmy is critical |
| 25. |
Working with payors such as Carefirst who are engaged in an aggressive effort to lower reimbursements....and who lobby state gov'ts to do so...and who lobby and incentivize hospitals to pressure physicians in this effort...places physicians in a unique isolated and devalued environment and makes physicians question their committment to the practice of medicine. |
| 26. |
I left practice in what should have been my prime clinical practice years over this issue(s) |
| 27. |
Until a systems approach successfully modifies the modes of care, until the political rhetoric ends, until physicians can once again serve as patient advocates in an environment of trust, physician morale will continue to deteroriate with the concommitant findings of burnout, fatigue, depression, and disruption of marital, family and other aspects of their personal life outside of their professional activities. |
| 28. |
Physicians age 45 and over have gone through a very demoralizing career. My peak earning capacity occured in the 8th year of my 23 year career so far. We have physicians around age 60 who are having to leave practice or find some outside source of income because their overhead is so high in comparison to their ability to generate an adequate income practicing medicine. This leads to high frustration in addition to all of the problems listed in the survey. |
| 29. |
Mandates, guidelines, budgets, JCAHO, IHI, EHRs everything around us changes but we are still stuck with the 15-20 minute office visit in which to cram in all this STUFF!!! We need major systems overall in this country in the delivery of health care |
| 30. |
As long as the US can recruit foreign med graduates from countries that need them more than we do, the control of decision making, and the hassles will not improve. Despite these foreign recruits, I see dark clouds on the horizon between 2011 and 2020. |
| 31. |
I believe there is a real dicotomy between the specialist who has reasonable reimbursement versus the Ob/Gyn and primary care where the reimbursement is poor. I see medicare is making some changes in this area. |
| 32. |
The general public is not very aware of the low morale among physicians, efforts should be made by organized medicine to make the public aware of the severity of this problem, certainly does not contribute to better communications with family, staff, colleagues,patient and patient's families nor it helps with better patient care. |
| 33. |
As a hospital based physician (chief pathologist-lab director), my problems are somewhat different than many of my colleagues. My principal issue is trying to convince adminstrators to give me enough personnel and physical resources to perform my departmental tasks for the benefit of clinicians and patients, in a very difficult reimbursement environment. A corollary to this is maintaining my staff morale so that we can continue to be patient-centered. Diminished pathology revenues, down about 25% over 5 years with constant-to-increasing volume, is also an issue. As for my clinical colleagues, I think that lowered reimbursements have led physicians to run faster to stay in place. This, coupled with more burdensome rules, defensive medical practices, more administrative demands, have all led to a greater level of overall frustration. I still feel fortunate to be able to practice medicine, however. One gets to help people, it's intellectually challenging, still fundamentally collegial, and continues to be appreciated by patients, families, and society at large. Vastly preferable to being in law, politics, or certain business sectors where the rule of the jungle is still the norm. |
| 34. |
There are many ups and downs and without a stable and rewarding personal life it is harder to function and maintain balance. Often jobs in medicine is so demanding that is is almost impossible to succeed at work and have the time. More than is reasonable is expected or each individual (by their leaders or by themselves) and this adds to the stress. Often an individual feels unseccessful by their own measure when all objective data says they are doing great. They then drive themselves harder and yet can't ever satisfy themselves. As they do this their personal life and perspective can be lost. This issue is one of the most important ones facing medicine and yet there is little formal help to solve it in the work place |
| 35. |
I think that young physicians expectaions are not being met and that some of their expectations are unrealistic. There has been a degaradation in professionalism and dedication that manifests itself in decreased morale and satisfation. Some do not even like their pateints or feel their patients are too demanding. No one wants to take call and the needs of the physican are put above the needs of patients. |
| 36. |
External agencies have promoted loss of autonomy. There is also a loss of respect for the profession. Both lead to poor morale. |
| 37. |
Until physicians are considered important contributors to the health care industry and not just a bothersome necessity, morale will continue to be an issue. Physicians must have some say so in the how the health care system will be structured and its future direction. |
| 38. |
I beleive that it is more difficult to gauge the ability to "do good work" in an administrative opportunity. I do, however, believe that I can make things easier for the practicing physician through my intervention. |
| 39. |
As an academic anesthesiologist, our pay for Medicare cases is below cost. My practice has seen a 10% rise in Medicare patients this past year. We all took a $5000 pay cut due to financial losses. It is difficult to see how we can teach the next generation of physicians and maintain reasonable (40% below private practice incomes). My partners are discouraged. The physician I know who left practice was an OB/Gyn discouraged over malpractice. |
| 40. |
If I did not have obligations to my family I would leave my private practice (which is very healthy) in a nanosecond. I would probably opt for a position in a non-profit organization or a charitable organization or with the government, State Dept. etc. I am not naive enough to think these organizations are without problems, but the for-profit health care system in this country is a quagmire of greed, beaurocracy, inefficiencies, and is consuming way too much of our national resources. |
| 41. |
I was the medical director of a large multispecialty group practie, and took a leave of absence when I adopted a child. I did not fully realize how burned out I was physically and emotionally until I had that down time. I could not make myself return to practice until financial strains forced me to do so 2&1/2 years later. I must say, medical practice has not improved in that period of time. I am no longer in administration, just doing clinical work...it amazes me how anyone makes a life-long career of mediine anymore. The demands, paperwork and patient load have worsened. The much-touted EMR has done little to assist the clinician that I can see. Medical records, laboratory, attorneys yes. I cannot see where the patient benefits much either. When the power goes out as it has three times this month in our clinic...nothing can be done. |
| 42. |
I really think the biggest factor leading to stress and burnout is the COMBINATION of the factor listed. Any one of them is stressful, but add them all together and you get some nasty synergy. |
| 43. |
I feel that many physician/physician families set unrealistic financial expectations and loose sight of other aspects of successes. This leads to a tremendous focus on financial success to drive their own self-esteem and often their spousses. |
| 44. |
The changes in reimbursement have forced physicians to take short-cuts and see a higher volume of patients to break even. This results in not having time to do the reading and follow up on individual cases that is essential to staying up to date, and being effective. This yields personal dissatisfaction and potential for mistakes. With the current environment of law-suits, that can be the end of a career. The risk and demands are no longer worth the rewards. Either personal or monetary. |
| 45. |
The dedication to the physician career is quickly disappearing. Patient care becomes more fragmented and the quality of care suffers. |
| 46. |
One of the major sources of stress seems to be more the pace and amount of work and balancing that with your life outside of work. With the technology available today, you can essentially have the ability to always be connected to your work responsibilities. I know of more physicians now finishing their documentation and checking their emails at home after they have completed a long day of seeing patients. We need to make a conscious effort to "end the day" at some point and put as much effort into our personal lives and time. |
| 47. |
Many complain about the high cost of doing business, so now they want to be employed by a health facility, rather than be on their own. |
| 48. |
The sheer emotional/time demands of caring for ill people over a number of years is tiring. I believe any job that requires an individual to listen to complaints for years on end is unhealthy. Especially for non surgical docs, the relentless negative input and limited positive feedback wear you down. |
| 49. |
survey doesn't cover those who left the practice of medicine only those considering it |
| 50. |
Physicians are being asked to act and think in ways considerably different than what got us in to medicine in the first place - this is confusing and frustrating. Showing how the current features of medicine (e.g., 100,000 Lives Campaign) need high quality individual physician sffort is essential. |
| 51. |
Both in the hospital setting and in managed care, the priorities and workloads for physisians are controlled by the non-physician executives. |
| 52. |
I think that our patients deserve more time from us to address their medical needs and wishes. We seem to be rushing all the time. We seem to be have inadequate time to do the careful job we need to do and want to do. Medical care is still the most satisfying career. Thank you. |
| 53. |
Practice environment has taken Medicine from a profession to skilled trade. Governmental encrouchment on Medicine has led to multiple rules/guidelines/regulations encumbering the actual practice of medicine. |
| 54. |
Challenges seems a better word than morale: 1. Learning to neutralize a negative experience effecting patient outcome directly related to independent decisions made by uninformed nursing personnel while still maintaining appropriate level of empathy. |
| 55. |
Multifactorial, resulting in feeling that no matter what I do or how hard I work, there is no relief in sight. All the issues (cost of medical care, medmal, acces to care, reimbursement) seem to be made into "the doctors' problems", and extremely little real help is coming from the parties who have a large part of the control--payors, government, regulators. |
| 56. |
It is important to be intouch with yourself so you can make changes when situations and expectations change. It is important to be true to yourself. |
| 57. |
Most of the physicians I know work hard, some enjoy very difficult cases. most are happy and would not leave medicine. Some that have moments of "low morale" experience this because of there own personality traits not because of medicine. |
| 58. |
Physicians got to their medical careers by being curious, creative, passionate, and thinking for themselves. Today's environment in the health care industry does not reward those key attributes of happiness and well being. Top it off with the malpractice environment, and it's no wonder morale needs a boost! |
| 59. |
I used to be in dministrative medicine and returned to private practice. I love seeing the patients and love my practice. I love where I live. But I will be closing the practice and moving before this year ends because the reimbursement rates for primary care do not allow me to spend time with my patients and give them the care they need. I decided to file for bankrupcy this week. |
| 60. |
Problem is especially acute in adult primary care (IM,FP) |
| 61. |
Low reimbursement, red tape,loss of respect, loss of autonomy, medical malpractice, manage care...all contribute to very poor morale on most physicians I have worked with or talk to over the last 7-10 years. More and more of the "easy work" is taken over by "Allied Health Professionals" and the difficult(and low reimbursement VS time invested) case left for the Physician with no further compensation. Physicians always "score high" in salary survey; but most of the others we are compared to don't work 60-70 hours/week + call schedule + work at night and weekend.We also,in general, don't take as many vacation time as other professionals. It is not surprising that so many of us are looking for ...something else. |
| 62. |
Discussions at all physician gatherings include dissatisfaction with declining reimbursement for primary care providers, question of the viability of primary care specialties due to low income contrasted to work load. Even a discussion with the director of a large (36 residents) primary care residency included pointed questions about my opinion of the future of family medicine in US healthcare. |
| 63. |
It is a problem that is going to worsen over time. The system is fucked up. The respect and reimbursement for the "technician" doctors like endoscopists and cardiac cath. performers is way out of proportion compared to the real physicians. |
| 64. |
Current position - Medical Director of a health plan. Prior position - Residency Director |
| 65. |
Phiysicians, in general, are too busy to keep up with the "non-medical" aspects of medicine, such as HIPAA, Natl Safety Initiatives, etc. When mandated changes occur, they fight thms, don't understand them, and waste a lot of time and effort. They they conclude that they "lost autonomy", which in reality, they never had. |
| 66. |
Physicians are being "hit" from all sides - the public expects perfection 100% of the time and have for the most part shirked their responsiblity for their own health, insurers and Medicare expect to pay the least amount as possible for the greatest amount of work at the same time the cost of practice continues to climb. At some point - you can't continue to see more and more patients without something going wrong or you physically/mentally burning out - Hate to say this but patients have no problem paying 100$ for a pair of sneaker or 100$ to see a professional athlete play with a ball but somehow "forget" a 10$ co pay or complain that a 50$ office charge is "too much". Some of my worse deadbeat patients - who can't seem to manage to pay my bill - have no problem chatting on a cell phone while waiting to be seen in my office. I wonder if the cell phone company is as compassionate as I am. Lastly - one of the reasons I left full time practice was that I was simply burned out trying to care for patients more interested in their own agendas than with addressing their health problems and realizing that I could be liable if something happened. Medicine in the US is in a sad state - God help us if there is a pandemic - because the system will break |
| 67. |
Physician feel set upon by all sides with increased work load and lack of family/personal time. While we are haranged to be more in touch with our patients human feelings, physicians are treated in a completely dehumanized way, never allowed to be wrong, sick, grouchy or have any personal needs. I know very few physicians who are planning to continue practicing after age 55-60. |
| 68. |
It is hard to specifically get my hands around it but is a miz of increasing demands on time, with concomitant reduction in positive feedback on doing a good job. |
| 69. |
The requirements for documentation re: compliance were what tipped me over the edge. Getting top notch training, providing excellent care and documenting that isn't enough to be paid- one has to also document garbage that CMS requires (i.e., * 10 systems, family history, etc.) that is totally irrelevant. Finally I said enough... |
| 70. |
The mainstay of morale appears to be low reimbursement rates for the extensive tasks being done. This then leads to excessive hours to be worked to complete the bureacratic red tape to make ends meet and therefore burnout. The primary care sector is hit hard by this because of the markedly undervalued E & M service coupled with the majority of the administrative-unreimbursed tasks as compared to specialist work. |
