The President’s Podium: Unhappy Doctors?

by Ronald Dunlap, M.D., President, Massachusetts Medical Society 

The headline shouted the news – 60% of Docs Wouldn’t Recommend Their Profession as a Career – recounting the sentiments of a nationwide survey of nearly 3,500 physicians. And while we may parse the responses – Is it a generational thing? Does specialty matter? – it’s likely most physicians aren’t surprised at the result. Changes to our profession have been fast and extensive in recent years, and we’re constantly adjusting to new demands.

When six out of ten doctors, however, suggest they’re unhappy, it prompts some key questions. What might patients think of this? Are discontented doctors affecting the physician-patient relationship? Or are survey respondents just blowing off steam out of frustration?  I think that it’s an important issue. Here’s my take on the reasons behind the survey results:

Mounting administrative and mandated requirements. Prior authorizations, certifications, complex billing, and the myriad of administrative tasks before us all steal time from the thing we most love to do: engagement in patient care. Ever-expanding oversight (though some, we’ll agree, is good and necessary) through more and more rules and mandates from insurers, legislators, and regulators, some duplicating the others, steal more time, and chip away at the control we have over how we practice medicine.

The imposition of information technology. Advocates say IT will lead to better quality care, but for many physicians, it’s been more of a disruption than an improvement to medical practice. Big investments of money and time, without appreciable return, along with lack of interoperability among systems, have soured many on computers, despite financial incentives. Computers have provided some benefits and may yet prove to improve health care, but the evidence so far is limited, and the transition is not complete.

The cost of educating physicians. Many young doctors avoid primary care or public health positions in favor of higher-paying specialties that may offer a more flexible lifestyle. It’s easy to understand why, when they’re coming out of medical school with hundreds of thousands of dollars in debt. The extraordinary cost and years of training are raising questions about the return on their investment of time and money.

Other issues weigh on our perspective. These include declining and changing reimbursements, the specter of liability, the uncertainty of reform, and imperfect rating systems from a host of sources telling us how well (or not) we practice medicine.

These are legitimate concerns. I suggest, however, that our discontent is not with the practice of medicine, but rather with the business of medicine – a fact borne out by the survey that prompted this post. I suspect, as those who conducted the survey do, that the disenchantment was prompted in part by colleagues letting off steam.

As my fellow MMS members and I work to fix what’s wrong, I remind myself that “physician” remains at the top of every poll ever taken of most admired professions and that, in the words of Dr. William Osler, we are distinguished from all other vocations by our unique ability to do good. I hope my patients feel the same way.

The President’s Podium is a new feature that will appear regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   

 

 

  1. Paul A. Carpentier, MD, CFCMC says:

    Thank you Dr. Dunlap. Well said.
    We feel the same way: We love the practice of medicine. It is the business of medicine that gets us down.
    We recently received a memo from a prominent third party reimburser which announced, “… we will look at the doctor’s prescription and we will decide whether the patient (thier subscriber) needs that medicine or not.”
    We physicians realize that that has been occuring for decades, but to see it so boldly written in a public document was disheartening. To braisenly state that these administrators, so far removed from the patient’s suffering, symptomatology, grief and life scenario, will decide our patient’s fate, should be a wake up call to all who pay health insurance premiums.
    Thank you for your leadership.

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