Article from HealthLeaders Media posted July 11, 2013
The administrative burden of being a physician continues to fuel discontent among doctors. More than a third report having a negative outlook for the profession, and the majority would not recommend it as a career choice.
Nearly 60% of physicians wouldn’t recommend the profession to young people, a survey shows.
The various sources of the doctors’ discontent include decreased autonomy, lower reimbursements, administrative and regulatory hassles, corporate medicine, litigation fears, and longer work hours, much of which has meant that they’re spending too much time away from patients.
Looking ahead, 36% of the 3,456 physicians who responded to a survey conducted this spring by Atlanta-based physician staffers Jackson & Coker reported a negative outlook for the profession, while 16% were favorable and 48% cautious.
“What we have begun to find is that pretty much across the board the physicians are becoming a little disenchanted with the business of medicine,” says Edward McEachern, vice president of marketing Jackson & Coker.
“Not the practice of medicine, but the business of medicine, because of this overwhelming administrative burden that is very difficult for them to work through and still practice good patient care medicine. It’s to the point where we ask ‘would you be willing to recommend the medical career as a position to the younger generation’ and for the first time we’ve really begun seeing them not recommend it.”
“They are saying ‘with all the investment I have to have in my education and all of that is the outcome really worth it?’ They are telling these young people ‘Hey this isn’t the place to go. Stay in healthcare. It’s a great industry. Just don’t become a physician.’
If you look at (Certified Registered Nurse Anesthetists) versus anesthesiologists the money is almost the same, but the risk for the CRNA is dramatically less in terms of liability, the cost of the education, etc. So all of a sudden when you are looking at the balance you think ‘I will just become a CRNA and I won’t have those sleepless nights, but I am making a large percentage of what the doctor is making.'”
McEachern says the movement toward employed physicians may ease some of the concerns about paperwork and haggling with insurers, but that it also creates its own sets of problems.
“One of the motivations for physician relocation at one point was dealing with immediate income versus potential income,” he says. “What happened is 20 years ago, when we did this survey, potential income was among the highest ranking motivators. Now it is immediate income and the reason is doctors aren’t building equity in a practice anymore like someone building equity in a home they plan to sell in 20 years from now. Even though employment model has less overhead and risk, you also aren’t building any equity in your own future. So you have to take all the money on the table now as opposed to building a practice.”
Scott M. Manning, director of HR/Provider Recruiting at District Medical Group, the largest physician group in Phoenix, AZ, with more than 300 providers, says he senses a lot of job dissatisfaction among physicians although the levels cited by the Jackson & Coker survey “sound a little high to me.”
“But I am not at all surprised that there are a percentage of docs who don’t see medicine to be as good a career today as they did 20 or 30 years ago,” says Manning, who is also president of the Association of Staff Physician Recruiters.
“It is kind of a generational thing. If you were to talk to docs who came out of training 25 or 30 years ago the vast majority of them would go out and join a small group of two or three docs, they would hang a shingle and open their own practice. For those folks things like Obamacare and expanded Medicaid or more government rules are a definite source of contention. They result in lower rates of reimbursements. They also result in less control over how you decide to run your practice. But it is not like it is any one thing such as Obamacare. This has been going on for many years. If you went back a few years, you’d see the same thing although the percentage wouldn’t be this high but that is probably true of the docs who are older and heading towards retirement age.”
Manning says dissatisfaction among older physicians will not necessarily affect the decisions of younger people to enter medicine.
“The folks who are coming into the business today know what they are getting into,” he says. “Most of them tend to lean towards employment instead of being out on their own. You see the numbers of physicians who prefer to have someone else run the business so they don’t have to worry about the overhead.”
Even with all the carping by physicians, Manning says it remains a good living. The key is to ensure that would-be doctors understand what they are undertaking from the onset.
“You have to educate the people on what the career is today, not what it was 30 years ago, and emphasize the positive things about being a doctor today which are still very much what they were before,” he says. “If you are going into the business because you want to take care of people and make a difference it is still a great business. If you are going into it because you want to make a good living it’s still a great business. Will you make as big a percentage difference over the norm than maybe you did 30 years ago? Maybe not. Maybe the gap is closer. But physicians still make a very nice living.”
McEachern acknowledges that disgruntled physicians could be more inclined to answer questions about happiness and job satisfaction and that their responses could be a way of venting the frustration and uncertainty that comes with healthcare reform and other fundamental shifts in care delivery, employment, and reimbursement models.
“That is the blowing off steam part. That is our theory. There seems like a lot of frustration tied to that uncertainty,” he says. “What we have found is that autonomy and satisfaction seem very closely linked. What does that mean? We really don’t know the answer yet. We are still waiting to get a few years down the road to see. As more and more doctors choose employment they are still going to relinquish some autonomy. Are we going to see an increase in satisfaction and employed physicians over the years or is it going to flame out just like it has with private practice doctors?”