Giving patients high-quality care is the most satisfying thing about being a physician, according to a RAND Corporation study sponsored by the American Medical Association. The study, "Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health
Systems, and Health Policy," identifies electronic health records (EHRs) as a prime source of stress and dissatisfaction.
based their findings on information gathered from 30 physician practices across
the country, including a family medicine practice in Pflugerville. The
practices included a wide assortment of medical specialties and organizational
models. AMA sponsored the study to identify factors influencing physicians'
researchers said that while physicians acknowledge some advantages of EHRs, they
complain they are cumbersome to operate and are an important contributor to
their dissatisfaction. "Many
things affect physician professional satisfaction, but a common theme is that
physicians describe feeling stressed and unhappy when they see barriers
preventing them from providing quality care," said Mark Friedberg, MD, the
study's lead author.
findings of the study include physicians' concern that current EHR technology
interferes with face-to-face discussions with patients, requires them to spend
too much time performing clerical work, and degrades the accuracy of medical
records by encouraging template-generated notes. They also worry that the technology
costs more than expected and that different types of EHRs cannot "talk" to
each other, preventing the sharing of critical patient medical information when
it is needed.
findings from the study include:
productivity quotas and limitations on the 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
describe the cumulative burden of rules and regulations as overwhelming,
draining time and resources from patient care.
of collegiality, fairness, and respect are key factors affecting whether
physicians are satisfied. Within the practices studied, frequent meetings with
other doctors and other health professionals fostered greater collegiality and
say that physicians report being more satisfied when their practices give them
more autonomy in structuring clinical activities, as well as more control over
the pace and content of patient care. Doctors in physician-owned practices or
partnerships are more likely to be satisfied than are those in practices owned by hospitals or
study's recommendations are:
practices need a knowledge base and resources for internal improvement.
physician practices affiliate with large hospitals and health systems, paying
attention to professional satisfaction may improve patient care and health
implementing new and different payment methodologies, the predictability and
perceived fairness of physician incomes will affect professional satisfaction.
EHR usability should be an industrywide priority and a precondition for EHR
the cumulative burden of rules and regulations may improve professional
satisfaction and enhance physicians' ability to focus on patient care.
did not identify health care reforms as having prominent effects on physician
satisfaction, either positive or negative. Most physicians and practice
administrators are uncertain about how the Affordable Care Act will affect
physician satisfaction and practice finances. It was clear, they said, that a
common response to health care reform is for physician practices to seek economic
security by growing in size or affiliating with hospitals or larger delivery
Action, Oct. 15, 2013