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Physicians: Systemic Discontent

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For more analysis and a look at the complete survey results from all sectors, please visit our HealthLeaders Media Industry Survey 2009 Web page, which features downloadable reports covering CEOs, finance, technology, quality, marketing, health plan, physician, and community and rural leaders.

That our survey of physician leaders would turn up some dissatisfaction with the healthcare system isn't all that surprising. But it's the gap between doctors and other healthcare leaders that suggests a much greater depth to physicians' discontent.

Not that they were unhappy with their own jobs. In fact, most of our readers were satisfied with their careers, including roughly 85% of physician leaders. But when we tried to measure satisfaction with the overall healthcare system with a question about whether the respondent would encourage his or her child to enter the field, differences started to emerge. The split was about 80/20 for most healthcare leaders—80% said yes, they would encourage a child to follow in their footsteps, and 20% said no. Nearly 40% of physician leaders, however, fell into the latter category.

"The significant number of physicians who wouldn't recommend their children to enter this field was very discouraging," says Erin Tracy, MD, MPH, an OB/GYN at Boston's Massachusetts General Hospital. "Physician burnout and lack of satisfaction are two incredibly important issues for the profession to address."

However, addressing physician frustration requires first understanding it, and physicians are far from a monolithic group. We saw stark differences in physician opinion by age and gender, for instance. As expected, work-life balance plays a role in physician dissatisfaction and was cited as being most important to career satisfaction overall. However, this sentiment came primarily from mid-career physicians—more than half of doctors 46-55 rated work-life balance as most important. Younger physicians, on the other hand, were more likely to cite autonomy to make decisions, and physicians older than 56 ranked being respected by peers and patients higher than their younger colleagues. Similarly, female physicians were slightly more likely to value work-life balance; male physicians, compensation.

So what solutions do our readers see on the horizon? When we asked what they would do if granted one wish to improve healthcare, most physicians didn't wish for better reimbursement or an alleviation of shortages, although there was some of that. The most common answer was some form of universal coverage. Although they differed on the method—another question found an even split between government-funded and government-mandated insurance—covering the uninsured seemed to be a top priority for big-picture change.

When we asked about the best way to improve relationships between physicians and payers, more than half said increasing reimbursement rates was the answer. The other popular responses—speeding up claims processing and giving doctors more autonomy over care—were equally physician-centric. In the short term, physician leaders are doing what they can to deal with the financial environment—more than half predict either negative or no financial growth in the next year. The most popular strategy for coping is adding ancillary services, which more than half plan on doing in the next three years.

Others are looking for new opportunities through mergers with another facility or by entering into a joint venture.

The dissatisfaction with the healthcare system we see in this year's survey could either worsen or fade in subsequent years. It depends largely on whether the environment improves and whether physicians can adapt if it doesn't.

But a sizeable minority is dissatisfied enough to stop accepting new Medicare and Medicaid patients (12%) or stop taking call (16%). If overall physician frustration with the healthcare system continues to grow, we may see more of these strategies in surveys down the road.

For the next HealthLeaders magazine story in this package, visit www.healthleadersmedia.com/industry_survey/finance. For complete, detailed survey results, visit www.healthleadersmedia.com/industry_survey.

—Elyas Bakhtiari

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