In a perfect world, physicians could devote ample time to providing quality care to every patient in an environment free of regulatory and administrative hassles. During office visits, they could talk directly to patients without the intrusion of electronic health records (EHRs), and they could fully focus their attention on practicing medicine in their patients’ best interest. Regrettably, the current health care landscape is far from perfect. Physicians have long
voiced concern about the state of medical practice and made no secret of their growing dis- content with government mandates and insurance regulations. Now they have scientifically valid data to support their dissatisfaction.
T
he American Medical Association sponsored a yearlong RAND Corp. study of physician professional satisfaction ending in September 2013. The study, “Factors Affecting Physician Professional Satisfaction and Their Implica- tions for Patient Care, Health Systems, and Health Policy,” highlights information gathered from 30 physician practices in Texas, Colorado, Massachusetts, North Carolina, Washington, and Wisconsin. Last year, AMA convened an advisory committee of rep-
resentatives from government, academia, medical practice, and business to discuss the research project, its design, and its implementation.
The study emphasizes the importance of delivering quality
care in determining physician satisfaction. “To put it simply, if physicians feel they’re giving high-qual-
ity care to their patients, they have a high level of satisfaction. We’ve always known this, but the study shows quality care is tied to physicians’ ability to have a stake in practice man- agement and business decisions, to the practice’s economic sustainability, to professional collegiality and respect, and to
a personal rapport with patients,” said Texas Medical Associa- tion President Stephen L. Brotherton, MD. In Texas, RAND chose family physicians practicing at
Parkway Primary Care near Austin to participate in the study. RAND researchers visited Parkway’s two Pflugerville clinics last spring and interviewed practice owner Shane Keller, MD, and his partners, Tina Philip, DO, and Travis Bias, DO, about factors that influence their professional satisfaction. Dr. Philip primarily discussed professional autonomy with
the researchers. She says she chose a small, physician-owned practice because it allows her to set her own schedule and practice medicine the way she desires. “I do not feel micro- managed or that I have to adhere to practice guidelines I do not agree with.”
Instead, her frustrations stem from administrative and fi- nancial burdens insurance companies place on physicians. “The rules and regulations of insurance … severely limit and
control the way I practice medicine. Often, these regulations interfere with my ability to provide what I feel is quality care for my patients. Obtaining approvals for imaging studies or prior authorizations for medications is an inefficient use of time for me and my office staff and further delays care for the patient,” she said.
The irritations Dr. Philip cites surfaced in
Stephen L. Brotherton, MD
Joseph P. Annis, MD 16 TEXAS MEDICINE January 2014
Susan Rudd Bailey, MD
David Fleeger, MD
the RAND study. The physicians surveyed commonly expressed dissatisfaction when payers hindered the quality of care they pro- vided, due either to not covering medically necessary services or to preauthorization requirements. “Ultimately, most physicians went into
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