CHICAGO — With all the pressures bearing down on their profession — from payment reform to the loss of independence and the introduction of difficult-to-master electronic tools — docs are a sometimes disillusioned and dissatisfied bunch. One recent study by The Doctors Company found that nine out of 10 physicians surveyed wouldn't recommend health care as a profession worth pursuing.
The American Medical Association commissioned a survey of 30 physician practices in six states last year, looking to get to the bottom of this dissatisfaction. The results were released in October and, now, the nation's largest physicians group is figuring out how it can turn these dissatisfiers in the other direction. AMA officials detailed the findings and discussed their call to action at the association's annual meeting, which kicked off on Friday here in the Windy City.
One of the biggest determinants of doctors' satisfaction was whether they felt they were able to deliver high-quality care, Jay Crosson, M.D., a group vice president at the AMA who focuses on professional satisfaction, said. Recent data, he said, have shown that some physicians are spending half of their workday on administrative duties.
"We've had comments from some physicians saying, 'I went into medicine to practice medicine and now I'm a data entry clerk,' " Crosson said. "It's not simply the electronic health record, but the burden of reporting to payers, managing the payment process and reporting quality. Each of these things, many of them reasonable in their own right, can end up for a physician as death by a thousand cuts."
So, the AMA is now working to develop 12 proven interventions that doctors can make in their practice to shift their time away from administrative duties and back toward the bedside. Those include pre-visit planning and lab tests, expanded use of office staff, systematizing the process of refilling prescriptions and improving the usability of EHRs.
The latter has drawn particular ire, as the AMA study, which was conducted by RAND Corp., found, only 35 percent of docs believe that their EHR improves job satisfaction, and 43 percent said their EHR slowed them down when administering care. The AMA has formed an EHR usability committee, and is now drafting a report to put pressure on the tech companies.
"We have decided to take on the vendor industry directly and collectively on behalf of physicians, and to raise, either gently or not so gently, the issue with the EHR industry that physician usability and practice efficiency need to be brought to the head of the line of the strategic direction of these organizations, and they have not been traditionally," Crosson said.
All sorts of experiments are taking place across the country with respect to how physicians are paid — be it capitation, shared savings, bundled payment, concierge medicine or pay for performance — but no one is really tracking all these disparate models to see which ones are producing the most promising results, Crosson said. So, the AMA is working with RAND to produce another report, to determine definitively which payment models work.
And finally, as docs continue to migrate to hospitals — Crosson said one study estimated that 70 percent of new docs will work in a hospital setting — the AMA is aiming to better define the relationship. The association held its first joint meeting with the American Hospital Association in 35 years in October, hoping to determine how the two sides can better collaborate.
The meeting produced a clear call for more and broader leadership roles for physicians in hospital and health systems, regardless of whether they're employed or independent. The AMA and AHA are now in the process of drafting yet another report, spelling out the ideal doc-hospital relationship, where physicians are equal to the leaders of the hospital and have a joint management role in running the organization.