From physician frustration to physician satisfaction

A message to all physicians from Steven J. Stack, MD, chair of the AMA Board of Trustees.

By — Posted Sept. 10, 2012.

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The lyrics and intense energy of this well-known song (I bet many of you can hear it in your head now) capture the message I want to convey this month.

I’m frustrated. More than that, I’m downright angry at times.

I have managed multiple emergency departments in two states, am currently practicing emergency medicine in central Kentucky and am married to a board-certified pediatric allergist in private practice. I can’t possibly imagine being more engaged on the “front lines.” And, more often than I’d like, the front lines aren’t so much fun.

In an emergency department like mine, the pressure to do it faster, do it with less and “don’t make anyone upset” can be maddening.

I’m very supportive of prompt and efficient care, but prevalent “30-minute” emergency department promises are often inconsistent with staffing levels, insufficient ancillary support, patient emergencies and a host of other issues. By comparison, I wait longer than 30 minutes to walk 100 feet through airport security at O’Hare airport on a regular basis.

I am openly supportive of electronic health record adoption and health information exchanges. I firmly believe we could provide better quality at lower cost if we can make more effective use of all the data we currently have. That having been said, I become exasperated with one-size-fits-all approaches to forcing health IT adoption upon physicians. Even more infuriating are the arbitrary PASS/FAIL, carrot-and-stick incentive programs in which anything less than 100% is a FAIL no matter how ill-suited the design is to the clinical situation.

Our broken medical liability system, unfair government and private payer payment (and payment denial) schemes, flawed patient “satisfaction” surveys and eroding respect for the value of physician education and training are other things that cause me angst.

For these and many other reasons, I often want to shout out that I’m “not gonna take it anymore!”

Yet it seems to me that, in our shared frustration, we sometimes confuse an expression of outrage with constructive engagement and attainable results. Beyond a temporary moment of release, the outrage doesn’t really help anything.

And there is a better way.

With its rich, 165-year tradition of advocacy on behalf of physicians in service to our patients, the AMA is an obvious vehicle for channeling a more constructive approach to physician frustration — one that can make a difference.

The AMA’s new strategic plan boldly takes on this challenge in three critical areas:

  • Improving health outcomes.
  • Accelerating change in medical education.
  • Enhancing physician satisfaction and practice sustainability by shaping delivery and payment reform.

It is the third of these, enhancing physician satisfaction, which is most relevant to the feelings of outrage and lack of control that I, like too many other physicians, struggle with in my clinical work.

Americans care deeply about their health, their personal safety in the hospital or a doctor’s office, and the unaffordable and escalating costs of health care. To the extent that we as physicians can find ways to restore health, ensure safety and provide high-quality care at an affordable cost, we have a much better opportunity to be relevant and to find partners who will take the time to care about our concerns as well.

Research shows that when physicians are satisfied with their practice environment, their patients are more satisfied.

But what kind of environment leads to satisfied physicians?

Finding the answer to that question is why the AMA has determined to forge a unique role as the analyst that explores delivery models across the spectrum of physician practices and provides solutions that promote practice sustainability for physicians.

Our aim is to help physicians navigate the transformations taking place in health care delivery and payment systems by identifying and promoting models that work. These are and will be models that enable physicians to deliver high-quality care in a way that affords professional satisfaction and sustains the physicians’ practices.

Fundamental to any “better system” will be:

  • Best practices that improve patient health, increase productivity, and save lives and money.
  • Payment policies that reflect the diversity of physician services, levels of clinical integration, and risk.
  • An availability of options that allow physicians to choose models that fit their mode of practice.

Right now, the AMA is working with physician groups and other organizations to identify effective delivery models that provide both high-quality patient care and physician satisfaction — and the common characteristics they share.

Through this unique and important undertaking, the AMA will translate those satisfaction-creating elements into model care delivery and payment options that can be implemented by physician practices of many different sizes and sorts to attract and retain the best doctors, improve the practice experience and deliver the best patient care. Additionally, looking at such successful models can help physicians determine if they wish to belong to or create a care delivery organization and if so, what sort of organization.

These are lofty goals, but they are firmly based on the AMA’s legacy. Done well, they will help physicians to have a fulfilling profession in service to patients, and they will position the AMA for a robust future.

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