Untitled Document

Secrets of Physician Satisfaction
by Richard J. Bogue, PhD, John G. Guarneri, MD, Monica Reed, MD, Kenneth Bradley and Jay Hughes, MD

Survey Result 101-200 — Back 100 Results <

101.

Work in Emergency Services. We are stretched too thin.

102.

Medicine is no longer controled by physicians. As a direct result of this, patients do not receive quality care. Managed care plans are dictating what diagnostic tests are appropriate and what medication a patient should be taking. There is an ever increasing burden of paperwork that takes significant amounts of time and resources by the physician, which takes away from time that could be spent with patients. Physicians are not reimbursed for this time.

103.

Clearly the push for productivity combined with a push for access, as left many exhausted during a time there has been a surge in the requirement to improve coding and documentation by electronic methods. In other words multiple forces have been impacting physicians with flat compensation for added performance.

104.

The conditioning we all expereience in becoming physicians is very de-humanizing. If we struggle taking care of ourselves--how can we expect to provide a quality of care to help others in a significant manner?

105.

Deflated re-imbursement for the same work over the past decade is a real disincentive to stay in the practise of medicine along with the burgening 'paper' work.

106.

I have never seen it this low and it seems to be continuing on a downhill trend.

107.

The real answer to question 3 is all of the above. I think that any one--taken alone--would not affect morale that much. It is the load of all concurrently that is so bothersome. The affect on quality of life is tremendous. The other factor that is not really on there are the "loss of boundaries" for patients in seeking medical care. We have become a 24/7 society in many ways and patients are imposing a 24/7 mentality on physicians that are 12 hrs a day, Monday through Friday. Health care as an industry has not really moved to a 24/7 service yet, although it has changed radically in the last 15 years. And the fact that it takes at least 8 years from the decision to be a doctor to actually practicing means that the expectations on new graduates are already very different that what they were expecting when they started the journey.

108.

If you had numbered the questions above, it would have made making comments easier.... I think some of these questions should have included "N/A" or "Don't know" as an answer choice. Not including that option will skew your conclusions, I believe. Did you beta test this survey?

109.

Physicians tend to forget their primary focus, i.e. providing the best care possible for the patients they are privileged to care for. I have had positions as a surgeon, addiction professional, and administrative person, and have always believed that we are rewarded commensurate with the level of our dedication to patient care. I am appalled at the "whining" I hear from professioanl people. We have brought on ourselves all of problems which seem to concern us more than patient care. Going back to the onset of Medicare I know of no constructive alternatives to this program which were offered by our own AMA. And now we have invited the public and government to regulate the quality of care we give because we have been unwilling to police ourselves. The stress we perceive is self induced because we have forgotten the Hippocratic oath. I hope the ACPE will foster programs at national meetings to confront these self induced problems of our profession.

110.

Have found some encouragement in exploring short term mission medicine in underserved, foreign settings.

111.

Difficult to find management as female physician. Pay is the same as it has been for years- no increases to compnsate for increase in prices. Insurance co do not pay despite legislation. Oversight from government and failure of Medicare to pay drove me out of privat4e practice.

112.

Many older physicians are finding that they cannot keep up with the pace of medicine physically. They would like to cut back but cannot for financial reasons; either prsonally or because they cannot run their office without working full time. They find it hard to recruit young physicians to join them. They would like to take on an elder statesman role but feel that they have been betrayed by the system and are very bitter.

113.

There is no single stressor that can take full responsibility for the change in attitude by what can only be considered trementously-dedicated people. The onslaught from several different angles leave many physicians feeling that the light at the end of the tunnel is flickering. Our dedication to patients keeps us going, but how long that can last and what effect it will have on future would-be physicians is a real concern.

114.

All the physicians that I know discourage their relatives to NOT go into medicine as a profession because of malpractice, excessive government control, and poor reimbursement compared to other professions such as financial management.

115.

This country is going to get what it's asking for: Health care delivered by algorithm and technicians. The finest health care system the world has ever known is being destroyed by people whose avarice is exceeded only by their arrogance and ignorance. I wouldn't care, except that this will affect me and my family as well as those who created this debacle. No wonder physicians are fed up.

116.

it is the combination of loss of autonomy, increasing bureaucracy, declining reimbursement, increasing scrutiny, distrust, and litigation, and the escalating rate of change that all combine to lower morale, enthusiasm, and the enjoyment of being a physician.

117.

my family, particularly my wife wants me out, I still fope to make it and look to administrative alturnitives to allow me to extend my career.

118.

The few remaining members in high risk specialties can't recruit due to the ridiculous malpractice insurance rates and can't keave due to the prohibitive "tails" that the completely unsupervised insurance companies charge--typically 2.5 to 3 times the yearly rate, or $350,000 to $750,000. How anyone could or should come up with that outrageous figure simply as a condition to change jobs is beyond understandaable. We are like sharecroppers who can't afford to leave and the professional societies do nothing to shed light on this insurance/legal system abuse.

119.

It is very easy to get discouraged because of all the possible problems that have been listed in the survey, however, if we just sit back and think about why we are in the profession of Medicine to begin with, it is not very difficult to put those depressing, discouraging feelings aside and feel good about what we do as physicians. I feel that every industry, work place, organization, job sector and so on has gone through tremendous changes over the years. We just know more about the profession of medicine, because we are right in the middle of it. Just think of the people who have lost jobs or have been demoted because of collapse of the computer/software/IT industry, or loss of jobs overseas, or automation in work place or any other reason. The antidote to depression/discouraging attitude is exercise, stress management practices and good diet. While we may remember 100 patients who did not thank us or appreciate our help, few who do appreciate will compensate for the negatives anytime.

120.

Morale is the lowest I have seen in 35 years due to multiple factors including loss of autonomy, lower reimbursement, increased demands and expectations, increased work load, intentional shifting of higher work and lower reimbursement patients to specialty care, nursing shortage, increased competition from institutional medicine, decreased competence and inadequate training of new physician recruits

121.

Pogo said years ago "We met the enemey and the enemy is us". If we ever learn to collaborate for the sake of the patients we supposedly took an oath to care for and get beyond our self interests we might regain our leadship position.

122.

Physicians who are involved in their communities and have been involved in improving patient care practices and patient safety electronic records etc. are much happier than ones who are employeed and living in the past.

123.

It is easy to point to many external forces that can lower morale, when in fact the precipitating factors may be internal. I find that younger physicians have a greater acceptance of the external forces, and they have higher morale, and I believe the two are related.

124.

Being a doc is not working in a coal mine, but many of us have lived sheltered and privileged lives, esp as children, thus making it more difficult to appreciate how fortunate we are......

125.

Physician morale problems are occuring due to many factors but the most important are low reimbursement, lack of respect and loss of autonomy. I do not see any solutions on the horizon but there certainly will be a primary care crisis over the next 10 to 15 years.

126.

127.

I have been chief of surgery at an active hospital(4 years) andCEO/ president of a large neurosurgery group practice (currently). There are many issues, that make medicine a difficult profession. Amoung them are the difficult medical-legal climate, lowering reimbursement and increaseing uncompensated care, as well as the concept of medicine as a "right" and not a shared project/ responibility. I have worked very hard all my life and am as burned out as it gets. I shortened my retirement horizon by 10 years from 62 to 52. I am luckey I can. I like neurosurgery, but not like this.

128.

Although I wrote financial compensation as number one on the survey the others on the list are almost all factors. The only one I didn't feel was pertinent was loss of respect. Time spent in activities that are not productive in the care of patiens and not compensated require a great deal of time and is one of the major factors. Insurance forms, prior authorizing meds etc.

129.

Worst problem is in primary care

130.

Was this survey vetted by ACPE. Several poorly designed questions.

131.

all the factors listed apply

132.

The paperwork component was already at a difficult level (I have 80% geriatric and diabetic) when Medicare Part D came along. It has added an hour/day to each physician's schedule, and an hour/day to our nurses' schedules. Another component is the crisis approach to the diminishing capacity of elderly patients - we have on average one emergency admission/solve my parents' problems today, do the paperwork and make sure someone will pay. We not prepared for aging!

133.

I don't see morale great in any industry in this country right now

134.

I love medicine, just don't like this job with the work overload. I've never been sorry I became a physician. In 4 years I'll be able to retire and work as a physician part-time, and still have time and energy for a life. But as a Preventive Medicine doc, my options have been limited. And I've been essentially a single parent since 1989, so that's added stress. And now my memory isn't as great as it used to be, and I can't juggle 5 things like I used to.

135.

Morale problems are not just reimbursement - your question above is a poor one since you allow only one answer. Malpractice (I am in Illinois), arguing with utilization review organizations and insurance companies, coupled with terrible - and declining - reimbursement make for a bad environment.

136.

All previous problems drove me into administration, when I should still be at my prime as an experienced Surgeon. I deal with many YOUNG Surgeons contemplating leaving completely.

137.

Low morale is due to all the factors mentioned in the first question. Bottom line is that we are working harder for less (less money, less respect, less autonomy, etc.) and it is wearing us down.

138.

Most of us do not look at change as a positive force in our lives. We seem to feel that once we have a position we have "arrived" and have earned future respect and security. Yet change in the status of our subspecialties, income potential, working arrangements has come to be the norm rather than the exception. So, we need to be sure that the next generation that chooses medicine has realistic expectations of what is involved or we can expect to continue to have serious morale problems.

139.

I think there is an overall sense of helplessness among physicians conerning their inability to change the health care system which is controlled by government and the insurance industry both of which care only about controlling costs.

140.

Stress is a huge problem. ACPE should create a stress management section where physicians can explore various stress reduction modalities. For me, meditation works great. Others may find another method more suitable for them.

141.

The scarey parts are the limited options available for me and, more importantly, how this phenomenon will affect the next generation of physicians and as a result who or what will provide care for my children!

142.

My main disillusionment with medicine is due to trying to see too many patients in too little time and the lack of respect I feel from a significant minority of my patients.

143.

it is the single most common topic of discussion in the lounge these days.

144.

Some of your options should allow more than 1 answer. I am President of a 130 doctor group, Medical Director of a PHO, and a practicing physician.

145.

It is disheartening to know that I work in a "profession" that cannot set its reimbursement and cannot control some of the largest expenses(ie. malpractice insurance and the expected requirement of EMR). I also feel trapped in this profession. I would have to make a substantial change in lifestyle to leave medicine. I devoted my life to this and it is not rewarding. Many patients are very disrespectful.

146.

Doctors are cultivated to have very high performance expectations and a very low tolerance for errors. In an era of insufficient direct support for meeting those expectations, all kinds of significant reactions and defense mechanisms kick in, including those in your list. Furthermore, even for people with feet in both camps there is a dreadful clash of values in resolving clinical models of care with business models...

147.

We practice every day getting less and less reimbursement and being held to the highest standards, worried that any patient could sue you, I get frustrated when the heavy macinery worker in my town makes more money than I do per hour and has no night call has a union gets health benefits paid and not worried about malpractice. He may be worth that but did he go to school for 8 years with 4 years of residency and have loans and 50% overhead of running a smalll business??

148.

Low morale is merely a symptom in the San Francisco Bay Area where HMO managed care accounts for 50% of the market, PPO managed care accounts for another 30%, and Kaiser has 50% of the commercially insured market. It is a symptom of co-dependent behavior in which the physicians classically see themselves as helpless, some hopeless, victims who have lost their autonomy and quality of life to managed care and significantly reduced reimbursement. They are almost all addicted to money now, pathologically greedy. By definition, if physicians have suffered a loss of autonomy and feel helpless, if not hopeless, they have passed the stage of being addicted to power within the system, which was the common addiction until 15 years ago. Local physicians regularly change roles, switching from victim to helpless rescuer to angry persecutor who wants to quit with child-like visions of being missed or of inflicting his/her hurt on the community that has voted with its pocketbook. Our whole health system in California is co-dependent in this sense. Judging from the listserve postings for the AAP, this is not unique to CA. My personal observation of these processes comes from the vantage points of having managed a 13 provider group practice, being an IPA Board member, being a principal in a medical accounts receivable and practice management company, and being an innovator in entrepreneurial medical ventures. Finally, I would like to observe that many physicians have so dumbed down their job just to triage work to another financial risk bearer, that they are not intellectually challenged, bored and no longer feel the pride of a competent professional who makes any substantive difference in the lives/well-being of his/her patients.

149.

There seems to be a total feeling of helplessnes and loss of control. In addition, the low re-imbursement and the increased workload with sicker and older patients, coupled with lack of respect we now face from our surgical colegues and the hospital administrations have taken the fun out of doing our work. I've always enjoyed my profession, but as of late, I look foward to finding a way to do something else.

150.

Physicians don't appreciate how good they have it. The highest paid occupation, on average, doing very important work that is highly valued by patients and society, very interesting some or most of the time. They long for the good old days, that weren't very good for quality, and were a crack in time, until health care costs and concerns about quality came to the fore.

151.

I think physicians are suffering in the midst of our country's change to an interdependent model of health care delivery: physicians will be a vital part of that new model, but they will not necessarily be at the center of it.

152.

I believe that physicians feel "boxed in" by payors, regulations, managed care, lack of ability to care for patients as they see fit, colleagues who are involved in denial of care, colleagues who are unreasonable during peer review (turncoats)

153.

I left a position of Medical Director of a group practice, that was part of a national corporation. As a middle manager, I had all the responsibility but none of the freedom. Matters as trivial as where to store charts and whether I could leave 15 minutes early were determined by offsite supervisors. None of the staff reported to me, but to offsite supervisors. Professionals need the freedom to determine how they will accomplish goals. This company treated physicians as the lowest level technicians, expected to perform the duties as directed, no questions asked.

154.

loss of autonomy, loss of respect, declining reimbursement with increased documentation and oversite requirements creating a perfect storm

155.

low moral among physicians is multifactoral. Low payment, lack of autonomy,. malpractice concerns, more demands placed upon them. It is imperative that there is assistance for phycicians in the development of systems and supports to assist with their medical management, that allows docs to get back to the fun part of delivering medical care.

156.

the single most important coping mechanism is not to isolate yourself. Seek help. Develop another identify outside of work.

157.

i was going to fill this in but am from Canada so cannot comment on the morale of US physicians.

158.

the assaults on your time and the emotional aspects of taking care of other people's problems or other people who are a problem is one thing. Insurance, government and malpractice all make life bad at some point. If they take the money out of it they will take the sane out of it

159.

I see it more as a problem with primary care providers who are increasingly asked to do more at each visit and get paid less. They are the lowest on the totem pole and as we have a harder time recruiting PCPs, it will only get worse.

160.

Physician morale is a major concern and should be addressed by all professional medical organizations.

161.

I believe it is also related to specialty.

162.

Other major cause of poor morale is poor communications between physicians leading to "dumping" on internists, hospitalist and ER and that leads to loss of collegiality

163.

The practice of medicine has become so fragmented and encroached upon by midlevel providers, non-clinical managers, and bureaucrats to the point that the practice of medicine by and large is a hassle for everyone, and transcends specialty and locale. Patients complain about their physicians until they see them walk through the emergency room door in the middle of night--then they're delighted with their physicians. No one else--nurse practitioner, physician assistant, bureaucrat, or "manager"--wants that part of my job.

164.

Generally fair, depending on the specialty. Massachusetts has a very low Practice Environment Index, and declining, well below the national mean, as reported by the Massachusetts Medical Society.

165.

I expect that I will not be a practicing physician within the next 12 months.

166.

Patients have some legitimate demands and expectations, but many are unrealistic. Push/pull marketing of advertisiers for health care help set-up unrealistic expectations. Asked to do more and more with less and less and the Suit Time if the patient thinks there was a problem that THEY certainly will take no responsiblity for - it is always someone else's fault. Time for a benevolent dictator to set expectations correctly and tell those that think otherwise that there are international travel agencies that can serve their goal. pNote: I have not been sued in my 32 practice years - so not sour grapes, there.] Time for reimbursement to be commensurate with service. Time for the House of Medicine to police those among us who abuse their degree and license and milk the patient and the system for all it is worth rather than doing what is right - medicatoins, treaments, procedures, etc. Scienifically - great strides; reputationally - greed, morals, and socail ignorance have taken Medicine (and science, for that matter) into a terrible tail spin. {And some naively wonder why Chiropractors, health food stores, etc. are making a good showing - they listen and provide service - how refreshing.} Thanks - I feel better.

167.

Don't forget lack of excercise, poor diet, poor sleep patterns that come with being a middle aged physician juggling demands of practice and family.

168.

It is difficult to choose only one answer for question #3. Several of these choices are very significant, and I believe it might be a better idea to rank them.

169.

in a HMO/insurance environment, there is little respect for the physician, and the physician is quite often blamed for the problems of the health plan.

170.

Unfulfilled expectations for many middle career physicians.

171.

Physicians I have supervised have commented about the lack of control over their schedule and how many patients need to be seen to reach MGMA benchmarks. They relate less joy in practicing because it is difficult to develop the relationships with their patients in a limited encounter with time constraints.

172.

1) Malpractice environment oppressive 2) Lower reimbursement (with cost of living increses) 3) Feeling of frustration with increasing regulatory oversight 4) No evidence of relief (from above issues) in sight

173.

I have no direct reports

174.

I don't think there is a single stressor- there are multiple factors from patient over load, low reimbursment, highly litiginous society and understaffed hospital facilities with too few nurses taking care of extremely ill patients.

175.

It is generally poor to fair and worsens as physicians are longer in clinical practice.

176.

Perfect storm of loss of autonomy, reimbursement, litigation, beurocracy, resident work hour issues, respect. Social Contract of arduous traing with long hours and low pay that would be offset by delayed gratification of very reasonable life style, community trust and respect, and autonomy, has been shattered.

177.

There are many problems and some errors in medicine, but all have been exaggerated to such an extent that many patients have lost their trust in doctors and hospitals. The second concern I have has been the criminalization of the practice of medicine. Wrong codes=upcoding=fraud=criminal charges. In Texas they are talking about the possibility of charging physicians who perform certain abortions with murder under certain statutes. (I am personally opposed to abortion.) The third concern has been the consumer model of healthcare where if I want it (CT scan, MRI), I should have it. If we order it, we overutilize, if we don't we have poor patient satisfaction scores. It is a good thing nurse practioners wnat to practice medicine, because we are approaching a time when less and less intelligent physicians want to.

178.

As CEO, the progressive general dissatisfaction with the everyday hassles of practice and the decreasing reimbursement for more and more work was a big issue for the practicing physicians. They were very tired of jumping through hoops to meet the requirement of the different agencies. I felt some of the same frustrations as a CEO being required to enforce them.

179.

In some ways phhsyicians (including myself) need to put some perspective on our "plight". We are still better off than the vast majority of people in the world,

180.

I left practice 17 years ago. I thoroughly enjoy the business side of medicine. It is disheartening, however, to witness the decline in morale that those in the clinical side of the profession are experiencing.

181.

Difficult to see any resolution.

182.

The American health care crisis will never be solved as long as the powerful industries/lobbies with a vested interest in maintaining the status quo are not forcibly overridden.

183.

Last 2 questions were left blank because I am currently unemployed. I have been looking for employement OUTSIDE the field of healthcare, but find it frustrating because of the specific type of education and experience gained in medicine. Most all physicians I know would leave medicine IF they could transition to an alternative career in another field. The sentiment is that NO OTHER CAREER is saddled with the regulations now imposed on healthcare. To have the value of a physician's services determined by the government or an insurance company is deflating for most physicians.

184.

In my 15 years of experience, MD dissatisfaction is widespread and growing in Emergency Medicine..It's multifactorial, but really exacerbated by beaurecratic micro management and policy decrees..Prime offenders seem to be JCAHO, State DOH, EMTALA, etc..Many younger MDs have reduced ED shifts and hours. Half of my staff is working 1/2 to 2/3 time. We have also experienced regular staff turn over, most looking for greener pastures...I think that every EM physician who can afford to will be working reduced hours within three to five years, and expecting full Healthcare coverage with pro-rated benefits. I don't think future workforce needs projections are taking this phenomenon fully into account.

185.

there is system failiur and that need to be fixed soon........

186.

a more coolgial attitude and less emphasis on financial constraints of our sickness care business would boost moale

187.

SINGLE biggest factor for low morale I chose low reimburstment but medical malpractice environment is a VERY close second!!!

188.

Many physicians can't recognize that they are burned out and tend to work harder as a result of their unhappiness. Younger physicians seem to be more in touch with life / work balance issues and seem to meet these head-on. I think that it is important for physicians to adapt to a changing environment that they live and work in, and to seeek alternatives to traditional practice, like Medical Informatics (my choice), administrative, teaching, research, or performance improvemment areas, if they feel "hemmed in".

189.

I do not believe legislators (local, state and federal) care about how the increased levels of indegent and non-paying patients is destroying our safety net of emergency care. I am an emergency physician and have contemplated suicide. One of my classmates murdered her children just before committing suicide. Do we really need to die because the legislators have their own agenda! I became a doctor to help people, but I need to have a healthy mind to do so. I am close to filing bankruptcy, selling my house, telling my daughter I cannot afford her college tuition! I am working every day, sometimes double shifts multiple days of the month just to keep up with the bills. HELP!!!

190.

There is not a single biggest causal factor for low moral - its the interaction of overwhelming demand with less and less time to spend with each patient and falling reimbursement for each encounter. I think among physicians'practices the factors might vary by specialty

191.

Morale problems arise from tw sources: 1. The stress associated with clinical work. 2. The fact that most of the stessors in practice arise from an unfavorable business climate where there has been a loss of control

192.

Most importantly we must strive to provide a supportive environment for all physicians.

193.

As near as I can understand, physician morale is at an all time low. The physicians that I talk to over coffee or lunch talk about how the government, medicare/medicade, lawyers and agencies such as JCAHO make the practice of medicine so difficult; helping the patient isn't fun anymore, nor is keeping the trial attorny at bay. Perhaps we should leave the practice of medicine to the nurse-practioners and the PA's, they seem to know more than we do.

194.

For many of us in my generation, we see the changes occurring with the newer residents coming out----9 to 5 mentality, decreased availability to patients, demanding less call, decreased organizational loyalty despite being an employee.

195.

The landscape is changing radically in that young physicians are seeking more of a "9 to 5" practice environment and one that minimizes patient responsibility and continuity of care.

196.

Physician morale is affected by many things. The most important is patient physician relations. This can be the most satisfying part of medicine. Unfortunately there can be external forces that can have an adverse effect on this. Certainly long hours with poor reimbursement can be a factor. Fewer physicians go into primary care because of this. Managed care has created morale problems for some physicians.

197.

Huge issue for me is number of "pre-authorizations" for medications for Medicare Part D and insurance carrier drug plans, as well as pre authorizing needed radiological tests.

198.

You should have allowed us to list any and all factors that lower physician morale rather than just one.

199.

Age Cohort... very significant..call/EMTALA...hospital /administration relationships..competition with employed physicians..unrealistic patient expectations..all play a role

200.

Physicians tend to believe that they are not in control of their own destiny due to the various changes in the environment, including reimbursement issues, hospital pressures, patients' expectations and liability.

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