The relationship between hospital executives and physicians has always been fraught. They need each other, but that doesn't mean they have to like each other. It'll be interesting to see how that changes as younger physicians opt out of private practice and go to work directly for hospitals and as more physicians move into hospital management ranks. I suspect there will always be plenty of issues to keep the tension levels high.
One hot potato that might become a real scorcher as baby boomers hit their 60s and 70s is the idea of a mandatory retirement age for physicians. An article last fall in the Annals of Emergency Medicine compared medicine with other high-risk professions like aviation, which require their practitioners to step down at a specific age.
Short of mandatory retirement, patient safety leaders insist we at least need a standardized way to assess physicians' practice skills that goes beyond periodic recertification, which older doctors in certain specialties can avoid through grandfathering. ''There has to be some real experience testing, not just pencil and paper knowledge tests, but the ability to examine a patient and diagnose a patient," says Lisa McGiffert, director of the Safe Patient Project at Consumers' Union.
Diane Pinakiewicz, executive director of the National Patient Safety Foundation, points out that pilots undergo ongoing simulator training, as well as periodic observation by another pilot while they are flying an aircraft. Even then, commercial airline pilots must retire from active service at 65.
Need any more reasons to fret about your medical staff? A pair of surveys released earlier this month provides them.
According to Physician Wellness Services, nearly half of mid-career physicians with 11 to 20 years experience say they're ''very stressed," and physicians' stress levels peak in their 40s, level off in their 50s and decline somewhat in their 60s. For the 40- and 50-year-olds, increased pressures from their children and aging parents may be a factor. Another: they're squeezed between older doctors slowing down as they near retirement and today's young physicians who are limiting their workloads and hours so they can balance career and home life.
Something else that may be stressing some doctors out: Nearly 40 percent of those in active practice say they have minimal to no savings, according to the Medscape Physician Lifestyle Report 2012. That, the report says, reflects ''the more difficult economic climate for the younger generation of physicians."
The Medscape report also notes that nearly 40 percent of physicians are overweight or obese. Some hospital leaders worry that could impact their docs' work, the cost of their health coverage and the healthful public image of the organization where they practice.
Last but not least are the results of a survey published in February in Health Affairs showing that some physicians are not always open or honest with patients. ''Open, transparent and bidirectional communication between patients and physicians is the foundation of patient-centered care," the authors write.
The vast majority of respondents ''completely agreed that physicians should fully inform patients about the risks and benefits of interventions, never tell a patient something that is not true, and never disclose confidential information to unauthorized persons."
However, within the previous year, more than a 10th of respondents said they'd told an adult patient or a child's guardian something that wasn't true; almost a fifth hadn't fully disclosed mistakes to patients for fear of being sued; more than a quarter had revealed unauthorized health information about a patient; and more than half had described a prognosis more positively than the facts warranted.
In a March 27 op ed piece in the New York Times, Danielle Ofri, associate professor at New York University School of Medicine, wrote, ''I don't think that doctors are generally a dishonest bunch … I suspect that the dishonesty that is being uncovered … reveals more about the diagnosis of being human than anything else."
In other words, when the news is grim, physicians' emotions sometimes get in the way of giving patients the whole truth and nothing but. ''Doctors can't — and shouldn't — eradicate emotions that grease the wheels of patient care," Ofri wrote, ''But being alert to them can help us minimize where we fall short, and maximize where we succeed."
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