Physicians have to fight for every dollar. Plumbers and attorneys do not have to call a third party to verify that they will be paid when they fix leaky faucets or draw up wills. Primary-care physicians’ share of the U.S. health-care dollar is only 7 cents. If payers cut reimbursement for physician services by 25 percent, the average annual rate of medical inflation would only decrease to 5.7 percent from 6.2 percent. However, primary-care doctors control 80 cents of the health-care dollar by sending their patients to hospitals, referring them to specialists and handing out prescriptions.
This outsize influence extends to patient perceptions. Nurses, pharmacists and physicians annually occupy the top three spots in the annual Gallup survey of how Americans gauge honesty and ethics among professions. Gallup has polled on public trust in professionals since 1976. In its 2012 survey, nurses scored the highest, at 85 percent on “honesty and ethical standards,” followed by pharmacists at 80 percent and physicians at 70 percent.
More than 3 out of 4 Americans say their physicians put patients’ interests ahead of their own, according to a Kaiser Family Foundation poll.
About 4 out of 10 Americans say they are confident in the U.S. health-care system, but more than 8 out of 10 say the health care they receive personally is good or excellent. Physicians are seen as heroes who help people when they are sick, not as cogs in an impersonal economic sector.
Cardiologist Rick Snyder, former president of the Dallas County Medical Society, says physicians do not advocate on their own behalf and fail to use their considerable influence.
“By being an advocate you can treat a whole state or country, not just one patient,” Snyder said. “What are the most credible professions? Nurses and doctors. (Republican pollster) Frank Luntz once said, ‘You doctors are God and the law.’ “
Stanford University professors Victor Fuchs and Arnold Milstein agree. They wrote in the New England Journal of Medicine, “…Physicians are the most influential element in health care. The public’s trust in them makes physicians the only plausible catalyst of policies to accelerate diffusion of cost-effective care. Are U.S. physicians sufficiently visionary, public-minded and well led to respond to this national fiscal and ethical imperative?”
Unfortunately, the annual battle to avoid reimbursement cuts because of Medicare’s sustainable growth rate has absorbed physicians’ attention in the political arena. All other issues pale by comparison.
Only 15 percent of U.S. primary-care physicians believe the nation’s health-care system works well. More than half are frustrated by the difficulty many of their patients face in paying for care.
Burnout is pervasive
According to a large study in 2012, nearly half of U.S. physicians struggle with job burnout. They said they either were emotionally exhausted or felt a high degree of cynicism or “depersonalization” toward their patients.
The researchers used a questionnaire called the Maslach Burnout Inventory, considered the best measure of job burnout. Burnout was especially prevalent among physicians on the front lines of medicine, such as those who staff emergency rooms or family practices.
On average, physicians worked about 10 hours a week more than other professionals—50 hours vs. the standard 40—and more than 1 out of 3 worked more than 60 hours a week. More than 4 out of 10 expressed dissatisfaction with their work-life balance, almost double the rate of non-physicians.
The study’s authors struck this disheartening note: “Unfortunately, little evidence exists about how to address this problem. Policymakers and health-care organizations must address the problem of burnout for the sake of physicians and their patients.”
A separate survey found that 86 percent of physicians are moderately to severely stressed. Respondents said their top four stress factors were the economy, health-care reform, Medicare and Medicaid policies, and patients without the means to pay for their care.
Physicians have the highest suicide rate of any profession, for distinctive reasons. Non-physicians are more likely to have had a specific traumatic event, such as a personal crisis or death of a loved one. Physicians are more likely to have on-the-job stress or a specific professional problem. They also are less likely to undergo mental-health treatment.
A study of surgeons with work-home conflicts found they were more likely to fall prey to alcohol abuse and depression because of poor work-life balance. The average surgeon works 60 hours a week, spends 16 of those hours in the operating room and is on call two nights a week. About half who reported work-life conflicts showed signs of depression while more than 1 out of 6 of those showed signs of alcohol abuse or dependency.
Physician burnout starts early. Nearly half of medical students become burned out during their training. Students are overworked, fearful of making mistakes and encouraged to tamp down emotions such as grief and self-doubt.
It is troubling that the nation’s health is in the hands of a profession that displays such pervasive signs of disaffection, disenfranchisement and hopelessness.
Even young physicians exhibit a high degree of pessimism. An April 2012 Physicians Foundation survey of physicians under 40 found that more than half were pessimistic about the future of the U.S. health-care system, while 22 percent were optimistic.
Those physicians who are satisfied with their profession tend to display an evangelist’s zeal for practicing medicine, and enjoy addressing conditions such as obesity and nicotine or alcohol dependence. Their empathy also translates into better patient outcomes. Academic Medicine researchers used a Jefferson Scale of Empathy (JSE), designed in 2001 to measure empathy in a medical setting. They found a direct association between a positive physician JSE score and better control of patients’ hemoglobin A1c and cholesterol levels.
Pure and simple, physician satisfaction translates into better patient health.
A survey of hospital executives and practice managers by physician recruiting firm Merritt Hawkins underscores the sharp contrast in the outlook of health-care executives compared with that of physicians. Merritt Hawkins surveyed U.S. physicians for the Physicians Foundation in 2012.
- More than 9 out of 10 executives say they feel positive about being in health-care management, compared with 1 out of 3 physicians who say they feel positive about being in medicine.
- Nearly 9 out of 10 executives say their morale is positive and they would recommend health-care management as a career, compared with about 4 out of 10 physicians who would make such a recommendation.
Travis Singleton, a Merritt Hawkins’ senior vice president, said in a statement, “For health-care facility managers, the glass appears to be half full. For physicians, it appears to be half empty.”
According to a survey by locum tenens staffing firm Staff Care, virtually all nurse practitioners said they had positive feelings about being an N.P., and 98 percent said they were optimistic about the future of their profession. In the Physicians Foundation survey, only 13 percent of physicians felt optimistic about the future of medicine.
Marcus Welby took joy in his work. But he also did not face the obstacles and pressures today’s physicians must endure.