In October, Geneia revealed the Physician Misery Index, a tool the company established to measure national physician satisfaction, had increased to 3.94 out of 5, and in response, invited health information technology companies to join together to restore the Joy of Medicine.
Why did Geneia create the Physician Misery Index?
Geneia conducted its first national survey of physicians in January 2015. The results stunned us.
The majority of physicians were dissatisfied with the practice of medicine – 87 percent said the “business and regulation of healthcare” had changed the practice of medicine for the worse – and two-thirds of physicians knew a doctor who was likely to stop practicing medicine in the next five years, as the result of physician burnout.
We created the Physician Misery Index – the aggregate results of a six-question survey – to call attention to the issue of physician dissatisfaction and to enable physicians to quickly gauge their own level of dissatisfaction in relation to the national average.
What is the Physician Misery Index?
Physicians were asked how strongly they agree or disagree with six statements, which are:
- I frequently feel rushed when seeing patients.
- It happens more and more often that I talk about my work in a negative way.
- Implementation of practice standards has diminished my autonomy and ability to choose the right treatments for my patients.
- It’s often difficult to manage the amount of work required of me.
- The “business and regulation of healthcare” has changed the practice of medicine for the worse.
- The heightened demand for data reporting to support quality metrics and the business-side of healthcare has diminished my joy in practicing medicine.
The 2018 Physician Misery Index is 3.94 out of 5, up from 3.78 in 2015, indicating physicians are even more miserable than they were three and a half years ago.
Broadly speaking, why does physician satisfaction matter?
As a nation, we’re consuming more healthcare. Each day, 10,000 people turn 65, what many call the Silver Tsunami, and we know people tend to need more healthcare as they age. In addition, 50 percent of employees have one or more chronic conditions and 84 million American adults – more than 1 in 3 – have prediabetes and are unknowingly on the road to becoming diabetic.
Physician dissatisfaction is likely to exacerbate the projected physician shortage. An Association of American Medical Colleges study predicts a shortage of between 42,600 and 121,300 physicians by 2030. Burned out physicians are more likely to leave clinical practice in advance of retirement. In fact, in our survey, 70 percent of physicians said they know a physician who is likely to stop practicing medicine in the next few years, as a result of physician burnout.
Research shows physician burnout doubles the odds of a patient safety incident. It’s also associated with poorer care and lower patient satisfaction.
Cost of physician turnover
As the internist and writer Abraham Verghese wrote recently in the New York Times magazine:
“The total cost of recruiting a physician can be nearly $90,000, but the lost revenue per physician who leaves is between $500,000 and $1 million, even more in high-paying specialties. Turnover begets more turnover because those left behind feel more stress. Physicians who are burned out make medical errors, and burnout can be infectious, spreading to other members of the team.”
Nearly all physicians (96 percent) report they have personally witnessed or personally experience negative impacts as a result of physician burnout such as cynicism (78 percent), dissatisfied patients (66 percent), severe stress (65 percent) and lower empathy for patients (64 percent).
What’s changed between Geneia’s 2015 physician survey and the 2018 survey?
Not much and not nearly enough.
- 66 percent say the challenges of practicing medicine in today’s environment have caused them to consider career options outside of clinical practice, an 11 percent increase compared to Geneia’s inaugural survey in January 2015.
- 89 percent say the “business and regulation of healthcare” has changed the practice of medicine for the worse. The intensity of agreement has increased over time; today, 57 percent strongly agree, up from 48 percent in 2015.
- There was a notable shift in attitudes among female physicians who now express higher levels of dissatisfaction and awareness of burnout, compared to their male peers. Female survey respondents are more likely to know a physician who is likely to stop practicing medicine due to burnout, consider options outside clinical practice at a higher rate, and feel more at risk for burnout.
- In 2015, we thought it would be easier for physicians to answer the question, “Do you know a physician who is likely to stop practicing medicine in the next five years, as the result of physician burnout?” Two-thirds (67 percent) said yes.
- In 2018, we asked a more pointed question, “Given the current environment, do you personally feel at risk for burnout at some point in your career?” Eighty percent said yes.
Why do you think physician satisfaction has continued to decline?
In short, there has been little-to-no improvement in EHRs, which for most physicians is their number one pain point, and the demands associated with quality reporting have steadily increased.
- According to an Annals of Internal Medicine study, physicians spend two hours on EHRs and desk work for every one hour with patients.
- Physicians spend 21 percent of their time on non-clinical paperwork – the equivalent of 168,000 physician FTEs
- The average physician practice spends 15.1 hours per week processing quality metrics, which translates to $40,069 per year
What is the physician burnout gender gap and why do you think there is one?
Female physicians, in particular, are frustrated by the challenges of practicing medicine and expressed greater dissatisfaction than their male counterparts. Female survey respondents are more likely to know a physician who is likely to stop practicing medicine due to burnout, consider options outside clinical practice at a higher rate, and feel more at risk for burnout.
- 72 percent of female doctors have experienced or witnessed lower empathy for patients compared to 59 percent of their male peers, a gender gap of 13 percentage points.
- 57 percent of female doctors have experienced or witnessed depression compared to 43 percent of male doctors, a gender gap of 14 percentage points.
While our survey did not probe why female physicians are more dissatisfied than their male peers, I suspect some of the reasons are:
- We know for most physicians the ability to create meaningful relationships with their patients and truly impact health outcomes is why they entered the practice of medicine in the first place, and is critical to experiencing joy in their work. We also know from our survey that 84 percent of physicians feel the amount of quality time doctors are able to spend with patients has decreased in the last 10 years. It’s quite possible that difficulty in creating meaningful relationships with patients impacts female physicians more than male doctors.
- The wage gap. In Medscape’s Physician Compensation Report 2018, male primary care physicians reported average earnings of $239,000 compared with $203,000 for female respondents. The earnings gap is even greater among specialists; male specialists earned $358,000 on average compared to women specialists who earned $263,000.
- The out-of-office demands of child-rearing. For example, one of the physicians we worked closely with during the Joy of Medicine Challenge in 2015 was pregnant twice during her residency.
Is there anything in this year’s survey that makes you feel hopeful about physician satisfaction?
Across the board, physicians, particularly the younger generation, accept the potential of and the need for data tools, and share some positive views on the possibilities offered by advanced analytics.
- 68 percent of physicians say the data collected by EHRs isn’t being used and analyzed to its full potential
- 96 percent believe it’s important for EHRs to be better designed so they seamlessly integrate with technology systems used by their office and insurers
How is Geneia remedying physician burnout?
We know that which gets measured gets done.
Geneia is committed to measuring the satisfaction of physicians as a part of onboarding new clients for our analytics and insights platform. Even more importantly, we will survey the physicians who use our products annually to gauge changes in sentiment and work with those doctors to remedy their technology and analytics pain points.
We’re calling on all health IT companies to involve physicians in the design and implementation of health technology products and to measure physician satisfaction. We’re sharing the survey and will be making other resources available to make it easier for health IT companies to involve physicians.
Do you really think what Geneia is doing can remedy physician burnout?
No, not alone. But we believe our efforts – along with those of other organizations like the AMA, the Mayo Clinic, Medscape, CMS and other health IT companies – offer the possibility to improve physician satisfaction. We believe there’s a role for all in the healthcare industry to help restore the Joy of Medicine, and are calling on others to join us.
How can Geneia encourage other health IT companies to join the effort to restore the Joy of Medicine?
Perhaps the single best way would be for health IT buyers to ask vendors how they’ve involved physicians in the design and implementation of their products. Equally important is measuring physician satisfaction before a health IT implementation and at regular, post-implementation intervals, and then incorporating this information into product development and product enhancement processes.
Geneia is committed to sharing resources such as the Physician Health IT Satisfaction Survey with health IT companies to make it easier to involve physicians in the design and implementation of health technology products and to measure and address physician satisfaction.
Given Geneia’s work in this area, what else do you think will improve physician satisfaction?
At Geneia, we believe:
- Physicians are a highly-valued, limited resource;
- The central tenant to design of workflows and tasks that involve physicians must be to minimize the overall effort expended by physicians;
- To the greatest extent possible, everything that can be done by someone other than a physician, in fact, should be;
- That other administrative and care team members are perfectly equipped, if given the right information and tools, to identify risk, coordinate care, manage open care opportunities, close care and coding gaps, motivate and engage patients, and perform recordkeeping to maximize a return on quality, cost and revenue; and
- We must reserve physicians’ time for improving the patient relationship, diagnosis and treatment.
We try to infuse our product design, client relations and more with these beliefs, and believe physicians would be more satisfied if the healthcare industry as a whole did the same.
We know physicians long to be asked for their feedback and heard, valued for their expertise and education, understood and given a say in changes that impact them.
Can you elaborate on the survey details?
It was an online survey of 300 physicians who have been practicing post-residency medicine for more than four years conducted July 5-13, 2018 by ELR Research/Quest Opinions. Each region of the country – Northeast, Midwest, South and West – represents 25 percent of the total respondents. The margin of error is +/- 5.7 percentage points at the 95 percent level.