AMA Focuses on Physician Satisfaction

Soon after the American Medical Association (AMA) announced last year its plan to enhance physician satisfaction and practice sustainability, AMA chief executive officer James Madara, MD, received complaints from outside the medical profession that the organization was being self-serving.

During a speech at the AMA annual meeting in June, Dr. Madara recalled that leaders in other industries even told him that “no one cares if physicians are satisfied,” although he said they admitted that they were concerned about patient, nursing, and nonphysician staff satisfaction.

To Dr. Madara and other physicians, now is the ideal time to focus on ensuring physicians are content. Next year, approximately 30 million additional people are expected to have health insurance due to the introduction of insurance exchanges and the expansion of Medicaid. Physicians are going to be held accountable for providing quality care, will be working in teams, may have their compensation cut, and will face other challenges.

“It is not self-serving to say physician satisfaction is important,” Dr. Madara said. “It is self-evident to say so. And anyone who denies this is simply being foolish. Physician satisfaction does matter.”

According to a recent survey from the Deloitte Center for Health Solutions, nearly 70% of physicians in the United States are satisfied with their jobs, including 67% of nonsurgical specialists, 63% of surgical specialists, and 59% of primary care providers. Physicians from 25 to 39 years of age were more satisfied than their older counterparts, while physicians with ≤10 years of experience were more satisfied than their more experienced colleagues.

However, the study’s authors wrote that “physicians are pessimistic about the future of medicine.” They noted that 57% said “the practice of medicine is in jeopardy,” while 62% said physicians will retire and 55% will decrease their practice hours because of the way medicine is changing. Only 31% reported a favorable grade when asked about the performance of the healthcare system. Further, 40% said their take-home pay decreased from 2011 to 2012 and 51% said they thought physician incomes would “fall dramatically” in the next 1 to 3 years.

The survey included a random sample from the AMA Physician Masterfile, and 613 respondents completed the online questionnaire.

With the introduction of accountable care organizations (ACOs) and other delivery models, physicians are being asked to collaborate more and report data that will be analyzed to determine if they will receive increased or reduced compensation. Of the physicians surveyed, 37% said ACOs would be successful at introducing performance reporting and benchmarks, 28% said ACOs would be successful at better identifying and managing high-risk patients, 21% said ACOs would be successful at improving population health, and 21% said ACOs would be successful at using lower-cost treatment settings and providers.

Some of the issues that physicians have may be rooted in their training. Dr. Madara noted that medical students receive most of their education in individual environments in spite of physicians increasingly working in teams, a trend that is expected to continue for the foreseeable future. In addition, medical students usually work in in-patient settings during their schooling. However, Dr. Madara said that there are 300 outpatient visits in the United States for every person admitted to the hospital.

Glenn D. Steele, Jr., MD, PhD, chief executive officer of Geisinger Health System, has said it takes up to 2 years for medical students to adapt to working as a physician, according to Dr. Madara. Dr. Madara added that leaders from Scott & White Memorial Hospital, Virginia Mason Medical Center, and the Mayo Clinic have had similar observations.

In June, the AMA announced it would provide $1 million to 11 medical schools over 5 years to fund research on how to best train students. More than 80% of accredited schools submitted proposals to receive the funding.

In addition, to help improve the morale of physicians and prepare them for the future, the AMA has partnered with the RAND Corporation, a nonprofit institution. Dr. Madara said RAND will conduct research on 30 physician practices in 6 states, analyze the best practices, and publish and promote the most successful delivery and payment models in the private and public sector.

In a May blog post on the Health Affairs website, Francis J. Cosson, MD, and Lawrence Casalino, MD, wrote that there has been little research on the relationship between physician satisfaction, quality and cost of care, and patient experience. They noted a cross-sectional survey in 2000 that found that patients of satisfied physicians may be more satisfied with their care [J Gen Intern Med. 2000;15:122–128].

However, the authors in that study said further research was needed to evaluate the factors that determined the relationship between physician and patient satisfaction. Another study from the RAND Corporation in 1993 found physician job satisfaction correlated to general adherence among patients with diabetes, hypertension, and heart disease [Health Psychol. 1993;12(2):93-102].

Drs. Cosson and Casalino mentioned that physicians are key stakeholders in efforts to reduce costs and improve quality of care. They suggested physicians should have more influence on delivering care and have “reasonable financial stability” so they can pay off the high costs of medical school and afford new technology such as electronic medical records.

“Taking physician satisfaction seriously does not mean giving physicians anything they want,” Drs. Cosson and Casalino wrote. “But it should mean creating an environment where physicians are always able to put patients first. More research is needed to understand the most effective interventions to create that environment.”