By Joe Bormel
In this blog I often address stories about improving healthcare delivery through the use of information technology from my standpoint as a physician and software vendor. Although we always start with the intent to do something for the care provider to make their work 1) faster, 2) easier, 3) better, and 4) help keep them out of trouble; we also risk achieving the exact opposites.
The non-clinical hassles around caring for patients—administrative, technological and workload combined with compensation issues—are causing many physicians to re-examine their career paths.
The Challenge
Should physicians stay in clinical practice full-time, part-time, or not at all? Those are the questions several hundred docs were asking during the October Skills, Education, Achievement, and Knowledge (SEAK) conference in Chicago, where I served once again as an official mentor.
Attendees spent more than $2,000 of their personal funds, and two or more days of their time, to sort out these important questions. And, that figure doesn't include the potential lost income from not being able to provide patient care.
I had the privilege to work with all of these physicians from the stage, as well as meet and work individually with about 70 of them. Their stories were remarkably similar. All said something along the lines of, “I love patient care. It is everything around patient care that I don't like.” Most added, “I don’t see clinical practice as desirable or sustainable over the next five to 10 years.”
The Causes of Physician Dissatisfaction
There was a broad, homogeneous sampling of physicians in attendance—men, women, all ages—including primary care, surgery, radiology, and all specialties. Most were employed, although there were a significant number of independent physicians in solo or small group practices. All had experience with electronic health records and, for the most part, that experience was very positive.
Of the docs I talked with, there was a universal sense that their incomes would be declining. And that decline was set against a backdrop of longer hours, progressively less autonomy, and frustration with their reduced ability to ensure their patients receive the best care. No surprises in this paragraph to anyone with friends or family in the practice of medicine. On one hand, the economy is changing life for us all. But on the other, the cheese actually has been moved.
Optimism Combined with Sadness
Every time I share these observations with colleagues, both non-clinical and clinical, the reaction is uniform. No one wants to see their doctor or docs as a whole dissatisfied with their profession. And we are angry, or at least disappointed, when the doctor we trust becomes unavailable to us. This is happening even now as the shortage of physicians to replace them—along with a shortage of nurses and pharmacists compounding the dilemma—increases nationwide.
The other dimension that everyone seems to pick up on is the profound apparent waste when physicians leave active clinical practice. Most of us have, on a personal basis, seen the positive results that stem from the skills and experience of caring doctors. It is uniquely transcendent. I know this from personal experience.
As a patient, I had long-term, intermittently excruciating stomach pain. When my doctor Joanne identified it, and my surgeon Gil subsequently removed my gall bladder to end it, I've remained grateful for decades. Emotionally, seeing doctors choose to leave clinical practice is indeed sad. But in certain instances, as with other professions, this is sometimes a necessity.
My Advice
For all of us, periodic self-reassessment is essential. So is receiving coaching and mentoring. Taking an inventory of our options—including reading descriptions of positions available and talking with recruiters—are essential steps to grounding oneself. This requires discipline to make sure we take a few hours to perform these tasks on a quarterly basis even when our “day jobs” are rewarding. When they're not, I’m sure most of us can find time each week to work on improving our situation.
I assembled my specific guidance for physicians in a 2009 SEAK presentation, with an extended version specific to the software vendor positions for physicians I presented to AMIA here. Note that in a general sense, the information therein may prove of value across a spectrum of career choices.
Closing Thoughts
Health and healthcare delivery are changing, and that's happening in concert with broad payment reform. This is happening with rapidly increasing transparency on quality, safety, and consumerism, characterized by a heightened focus on consumer convenience. More on that last item in my next blog about self-service and the patient experience.
All of these changes require new planning and execution. Physicians are best equipped in terms of talent, skill, knowledge and tenacity to contribute to getting a significant part of that right. This is especially true for those aspects that involve the diagnosis and treatment of complex, sick patients. There are other professionals who excel at wellness care, where physicians are often untrained, inefficient, or both. Taking another tack, you can’t realistically ask a chef to effectively tend bar or catch the tuna for lunch any more than you can expect Peyton Manning to play linebacker or punt returner!
Should physicians stay in clinical practice? If we restructure care delivery appropriately (find out more about STEEEP here) most physicians would want to stay right where they are, as happy, active and productive clinical contributors. That’s what the majority told me at SEAK, and I believe them.
So how are things going with your career?
Joseph I. Bormel, MD, MPH
CMO and Vice President
QuadraMed Corporation