No one feels sorry for American doctors. They are some of the highest-paid in the world and spend their lives in the country with the highest nominal GDP in the world. But why is it so hard to find any doctors who actually like their job? Why do so many dream of walking away? Here are five reasons why.
The electronic medical record (EMR)
Technology is amazing, and the EMR is no exception. Gone are the days of hunting down old paper records, and access to patient-related data is at an all-time high. So what’s the problem? There are a few.
To start, as the one taking care of an individual patient, the quantity of data is unimportant—quality and relevance are key. Trying to find what you need in a bulky EMR that hasn’t been optimized for user experience is a battle.
Along the same lines, reading the notes of other providers is equally grueling. Such notes are filled with auto-populated information, and identifying human insight regarding the patient (if any exists) can be like finding a needle in a haystack. To compound matters, these notes are often copied from one encounter to the next, making the scavenger hunt a regular exercise.
Finally, writing your own notes, assuming you want them to be useful, takes time. Dictation and typing are required, and when repeated up to 30 times a day, the hours accumulate. It’s no wonder older physicians still pine for the days of pen and paper. It’s also no wonder that the use of the EMR is strongly associated with physician burnout.
The RVU situation
When physicians work for health care systems, they are often paid by an RVU (relative value unit) system. Everything they do is assigned a given number of RVUs, and they are paid a certain rate per RVU.
For example, 3 RVUs x $50/RVU = $150. (Obviously, the health care system is paid more than $150 for the work and pockets the difference.)
As patient care is a huge revenue generator for health care systems, physicians are encouraged to generate a lot of RVUs. No big deal. Capitalism at work.
But here’s the concern. Physician A generates 5,000 RVUs per year, taking meticulous care of their patients and earning the trust of families and colleagues alike. Physician B generates 6,000 RVUs per year, providing marginal care and ensuring that no colleague would place a family member under their care. In the eyes of the health care system, Physician B is the superior employee. Physician A is unmotivated at best and a liability at worst.
The tone-deaf administration
Doctors, like all other employees, have a tendency to whine. In this case, the whining is directed toward administrators—the ones who sit in those boardrooms and eat Panera Bread all day. The conversation typically goes something like this.
Physician: I’m not sure I can keep up this pace. Anyone can work this hard for six months, maybe a year, maybe even five years. But to think I’m going to be doing this for the next 30 years is hard to imagine.
Administrator: I totally understand. Tell you what—go ahead and work harder. We’ll just have a Physician Appreciation Day. We’ll get cookies, keychains, and maybe even those reusable bags you can take to the grocery store. It’ll be great.
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The PA/NP phenomenon
As health care systems look to provide care to the populations they serve, they have turned to physician assistants (PAs) and nurse practitioners (NPs).
First, such providers fill a void that cannot be filled by the current number of physicians.
Second, these providers can often deliver the same work as a physician at a lower cost to the system.
The issue that gets raised is not one of competence but rather one of embarrassment.
Most physicians in the U.S. must spend 11 to 15 years after high school before being able to practice independently, landing them in their 30s. During that window, six-figure student loans and unimpressive wages are the norm. If unhappy with specialty choice, a physician must obtain training in another specialty, a process that usually takes at least two years.
In the case of a PA, the post-high-school period lasts about six years, meaning less student loans and an earning potential that starts much earlier. If unhappy with specialty choice, a PA can change fields the next day.
These discrepancies have left many physicians feeling like … suckers.
The mindfulness thing
With the above stressors in play, emphasis has been placed on so-called mindfulness. While no one actually knows what that means, on the surface, the concept seems relatively benign. Unfortunately, its practical application translates into additional meetings or online activities—some of which are mandatory—to get in touch with your feelings.
In other words, you are asked to devote more hours to work in order to feel better about it.
Most would argue that simply working less would be a more logical approach.
With all this said, there is no reason to feel bad for American doctors. Much of the world is dealing with far worse problems. In fact, many would advise doctors to simply suck it up. And that’s actually fine. Just don’t expect them to enjoy—or continue—their work.
Amol Shrikhande is a nephrologist.
