Physician Satisfaction Characterized

The AMA asked RAND Health to characterize the factors that lead to physician satisfaction.  You know, because they care so much.  So RAND gathered data from 30 physician practices in six states, using a combination of surveys and semistructured interviews and found the following:

1. The Importance of Delivering High-Quality Care
   • When physicians perceived themselves as providing high-quality care or their practices as facilitating their delivery of such care, they reported better professional satisfaction.
   • Obstacles to such care could originate within the practice (e.g., a practice leadership unsupportive of quality improvement ideas) or could be imposed externally (e.g., payers refusing to cover necessary medical services).
2. The Pros and Cons of Electronic Health Records
   • Physicians approved of EHRs in concept and appreciated having better ability to remotely access patient information and improvements in quality of care.
   • However, for many physicians, the current state of EHR technology significantly worsened professional satisfaction in multiple ways.
   • Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.
3. The Value of Income Stability and Fairness
   • Few physicians reported dissatisfaction with their current levels of income.
   • However, physicians reported that income stability was an important contributor to overall professional satisfaction.
   • Payment arrangements that were perceived as fair, transparent, and aligned with good patient care enhanced professional satisfaction.
4. The Cumulative Burden of Regulations
   • Physicians and practice managers described the cumulative burden of externally imposed rules and regulations as having predominantly negative effects on professional satisfaction.
   • At the time of the study, “meaningful use” rules for EHRs were the regulations most commonly singled out by physicians and practice leaders.

Their Recommendations:

• Physician practices need a knowledge base and resources for internal improvement.
• As physician practices affiliate with large hospitals and health systems, paying attention to professional satisfaction may improve patient care and health system sustainability.
• When implementing new and different payment methodologies, the predictability and perceived fairness of physician incomes will affect professional satisfaction.
• Better EHR usability should be an industrywide priority and a precondition for EHR certification.
• Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians’ ability to focus on patient care.

My Thoughts:

1. WTF?  – Are their recommendations reflecting anything in the real world?  Are they even recommendations because I don’t see solutions listed. 
2. Quality is a self-perceived marker and should not be judged by useless, unproven quality indicators.
3. EHRs drive doctors crazy and this is being ignored.
4. Bureaucratic drag is alive and well and driving doctors out of the profession.