Blog | Thursday, August 17, 2017

Is the search for employed physician job satisfaction fool's gold?

Discussion about physician job satisfaction and burnout is all too common within medical circles. Every doctor at the moment knows what a huge issue this is, and how the numbers seem to be getting worse (some statistics suggest a burnout rate well over 50%). It's also no small secret that this depressing trend coincides with the huge loss of autonomy and independence suffered by physicians over the last couple of decades. As more and more doctors seek the safety of employment by large healthcare organizations instead of owning their own practices (as they previously used to, but is now made almost impossible from a bureaucratic standpoint), the feeling of a loss of control over their own destiny becomes more entrenched.

I grew up in England, and after going to medical school, worked briefly in the National Health Service (NHS) before moving to the United States. I therefore still have lots of friends and former colleagues over there, and it's been interesting to see exactly the same phenomenon of physician burnout and dissatisfaction play out in the United Kingdom as well—albeit for different reasons (heavily centralized big government control with excessive interference in work patterns and pay scales).

Since being in the United States, I've witnessed at close quarters the dwindling of private practice groups and the proliferation of big corporate medicine. In my travels up and down the East Coast, I've had the privilege and honor of working with so many fine colleagues, and heard many differing perspectives about what life is like for doctors and the challenges we face practicing medicine in this era. The consolidation of health care organizations, the widespread disruption to physician practice caused by policies such as Meaningful Use, all against the backdrop of an increasingly rancorous political debate, has taken its toll.

This may seem almost defeatist to say—and I hope I'm proved wrong—but I have come to a simple conclusion: there may unfortunately be no long-term physician job satisfaction for full-time physician employees. The loss of autonomy and control suffered in a controlled corporate environment, is directly related to physician dissatisfaction. The happiest doctors I ever saw were the ones who owned their own practices and essentially ran their own small businesses. Although they nearly always worked harder and longer hours, they did so “as their own brand” and on their own terms. They were not told by non-clinical administrators what they could or couldn't do, enjoyed long term relationships with their patients, and always seemed to go the extra mile. If you worked hard as an independent doctor, you were rewarded appropriately. In a corporate environment, would any physician really want to go the extra mile knowing that the rewards will be going to the CEO and other executives?!

The employee mindset that is human nature in any industry, works against physicians and will eventually make them miserable and their job unsustainable. It's only a matter of time before employed physicians will have some sort of negative experience or administrative clash that will make them not like their work and seek something different. Are there exceptions to this? Absolutely, there always are. But that's my basic observation. The only happily employed physicians practicing clinical medicine I see these days are broadly in the following three categories:
1. Physicians who are in academia, devote their career to research or working in a teaching hospital, and are okay with sacrificing salary for academic medicine
2. Physicians who are working towards something else, like an MBA or another non-clinical route, with that end-goal in mind
3. Physicians who work only part-time, with or without other creative ventures or entrepreneurial activities the rest of their time. Similarly for locums or moonlighting physicians, who can work somewhere and not be as “tied” to the organization with all of the associated administrative headaches and heartache.

When I think of all the hours of studying, sleepless nights, sweat and toil it took to become an Attending physician, it really has been an astonishing amount of work. This is not to say that medicine in not an immensely rewarding career, or that I have any regrets doing it (because I certainly don't and really do enjoy my work as a physician and everyday patient interactions)—but merely to state that the inevitable push towards having 100 percent employed physicians will have consequences for a group of professionals as smart and creative as doctors are.

I would love to live in a world where physicians, administrators and big corporate health care would all get on well and look out for each other with the patients' best interests at heart, but that seems like something of a fantasy right now, with so many conflicting interests and incompatibilities.

As much as I hate to say it, if the goal is long-term employed physician job satisfaction, it may be akin to searching for fool's gold.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.