August 2016
Unhappy Doctors Make for Unhappy Patients

 So writes Sandeep Jauhar in his 2014 book "Doctored: The Disillusionment of an American Physician." And, physicians are unhappy. A survey of nearly 12,000 physicians conducted in 2008 for The Physicians' Foundation by Merritt Hawkins and Associates revealed o nly 6% of physicians described the professional morale of their colleagues as "positive" and 42% of physicians said the professional morale of their colleagues was either "poor" or "very low." Seventy-eight percent of physicians said medicine is either "no longer rewarding" or "less rewarding." "Patient relationships" ranked highest on the list of things physicians find satisfying about medicine, while "reimbursement issues" and "managed care issues" ranked highest on the list of issues physicians find unsatisfying about medicine. Ninety-four percent of physicians said the time they devote to non-clinical paperwork in the last three years had increased, and 63% said that the same paperwork had caused them to spend less time per patient. Sixty percent of doctors would not recommend medicine as a career to young people. By all accounts, things have only gotten worse since 2008.

 In the Doctors' Lounge section of the July issue of Louisville Medicine, Dr. Larry Griffin, a highly respected obstetrician in our community, wrote of the "rapid deterioration of the practice of medicine in this country." In his article, Dr. Griffin raged against corporate medicine's focus on RVUs, the electronic health record programs that rob physicians of precious time with their patients, and corporate greed. Dr. Griffin's article has generated a lot of discussion both inside and outside doctors' lounges in this city. While "the views expressed in the Doctors' Lounge... are not those of the Greater Louisville Medical Society or Louisville Medicine" hospital administrators, leaders of health care systems, and employers of physicians should not interpret Dr. Griffin's sentiments as the rantings of a doctor from another era. These sentiments are pervasive in our physician community, in all age groups, and in all health systems.

 Why is this issue important? It's because unhappy doctors make for unhappy patients! And unhappy patients can affect the bottom lines of the physicians' practices and the health care system. Moreover, unhappy doctors are more prone to making medical errors, to document their care inappropriately, and to show their frustrations to patients,  leading to reduced patient confidence and compliance. These affect the quality and safety of health care and can lead to malpractice suits. Finally, unhappy doctors are more likely to show signs of burnout leading to early retirement, physical and mental illness, alcoholism and substance abuse, and suicide.

 Are the leaders of hospitals and health care systems hearing this message? Many physicians in our community think not. More cynical physicians believe the hospital leaders know that physicians are unhappy but just don't care. These cynics feel that the hospital administrators are in control and, with non-compete and dismissal-without-cause clauses in the contracts, can do what they wish with little regard to physician satisfaction.

 What happened to the promise of the Physician Executive? Remember the call for physicians to learn leadership skills and earn an MBA so that physicians could lead our health care system and thereby stand up for the patients' interests and our profession? Has the promise of ph ysician leadership been largely unfulfilled? It is commonly stated in doctors' lounges that those physician leaders, having now found themselves in leadership roles, seem to have drunk too much of the corporate Kool-Aid. Many physicians have expressed the feeling that these physician leaders have sold out and no longer watch out for the patients or the doctors. And, while these physicians understand the concept of "no margin, no mission," they feel the margin has become the mission for these physician leaders.

 In Dr. Griffin's article he asked, "Do I have an answer?" and answered, "I fear not."

 I'd like to think the answer lies in improving dialogue between and among physicians and the leadership of hospitals and health systems. We, physicians and administrators alike, work during a difficult time in the evolution of our health care system. I believe that we, physicians and administrators alike, are good people who aspire to provide high-quality, safe and effective care to the men, women and children of our community.

 Historically, rich dialogue occurred among doctors and between doctors and administrators in doctors' lounges and on medical staff committees. But that was when the medical staffs were made up of independent practitioners and when primary care physicians in the community frequented the hospitals. The character of the doctors' lounges and the medical staff committees have changed over the years, and these longstanding lines of communication have suffered. Doctors' lounges and medical staff committees are now populated mostly by hospital-based and employed physicians. Are these physicians, with non-compete and dismissal-without-cause clauses in their contracts, free to tell the emperor he has no clothes? Are the administrators getting the message they need to get? Who is the voice for the employed physicians?  Who is the voice for the independent practitioners who no longer go to the hospitals yet continue to refer their patients to the employed hospitalists?

 GLMS can be the voice of these and all physicians in our community. GLMS has proven itself effective in addressing and resolving conflicts among physician practices and insurance companies through the GLMS Insurance Issues Resolutions Committees. Perhaps it is time for us to consider a similar model to improve communication between physicians and our health care administrators. 
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Greater Louisville Medical Society Mission Statement:
  • Promote the science, art and profession of medicine
  • Protect the integrity of the patient-physician relationship
  • Advocate for the health and well-being of the community
  • Unite physicians regardless of practice setting to achieve these ends