medicine to care for patients. When there are so many road- blocks in the way of rules, regulations, and what amounts to busy work, it gets in the way of physicians providing care to their patients, which is what all of us would rather spend our time doing,” Dr. Philip said. EHRs emerged as a prime source of stress and dissatisfac- tion among physicians who participated in the study. Dr. Philip, like many physicians, recognizes the potential of EHRs to im- prove patient care, but says they increase physicians’ workload and drive a wedge between them and patients. Dr. Brotherton says the RAND study unveils a pervasive feeling of resentment among physicians. “Physicians undergo years of extensive training and educa- tion only to be relegated to the level of a clerk. The study tells us physicians are spending way too much time inputting data in EHRs, dealing with insurance company hassles, and han- dling other administrative duties.”
The beauty of the RAND study is that it’s physician-centered
and presents an objective examination of real-world problems practices currently face, Dr. Bias says. “Adequately addressing the problems detailed in the report
will result in happier physicians and patients. Organized medi- cine can use the information from the study to focus on advo- cacy efforts and policy development that could reduce early retirement and burnout among physicians,” he said. AMA plans to develop resources to help physicians improve practice effectiveness, efficiency, sustainability, and profession- al satisfaction by using study findings and input from other sources, including its members and experts in physician prac- tice design. To read the full study, visit
http://bit.ly/1abJoav.
Canary in the coal mine F. Jay Crosson, MD, vice president of the AMA’s Division of
Professional Satisfaction, Care Delivery and Payment, was an architect of the study. “AMA wanted to have an in-depth, scientifically robust anal- ysis done to reveal the exact sources of physicians’ unhappi- ness so that the organization can develop solutions that foster professional fulfillment while promoting economically sustain- able practice models,” Dr. Crosson said.
Practices participating in the study first completed a ques-
tionnaire assessing their organizational structure, EHR use and capabilities, and participation in innovative payment models. RAND researchers then interviewed 220 participants (108 practicing physicians and 112 practice leaders and clinical staff) in person. They sent a final survey to 656 physicians in all 30 practices and received 447 responses.
RAND analyzed information collected on the dimensions
of professional satisfaction and factors that might influence professional satisfaction. Joseph P. Annis, MD, of Austin, a member of the AMA
Board of Trustees, says the study indicates politics, profits, and economics propel physician dissatisfaction. “Physician dissatisfaction could be the canary in the coal mine regarding quality of care. It would behoove hospitals,
payers, and EHR vendors to work to eliminate unnecessary hassles that contribute to dissatisfaction among physicians,” Dr. Annis said. Susan Rudd Bailey, MD, of Fort Worth, vice speaker of the
AMA House of Delegates and a past TMA president, says the study’s findings show that “medical practices need help now. I believe this first-of-its-kind study on satisfaction provides hard data that will help jump-start efforts to solve the problems identified.”
The study concludes that:
• Physician practices need resources for internal improve- ment.
• As physician practices affiliate with large hospitals and health systems, paying attention to professional satisfaction may improve patient care and health system sustainability.
• When implementing new payment methodologies, the pre- dictability and perceived fairness of physician incomes will affect professional satisfaction.
• Better EHR usability should be an industry-wide priority and a precondition for EHR certification.
• Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physi- cians’ ability to focus on patient care.
Armed with sound data, AMA can work with EHR vendors, government leaders, and other stakeholders to help physicians overcome obstacles to providing quality patient care, Dr. Bailey says.
In addition to AMA, specialty societies, TMA, and county medical societies work to defend the patient-physician rela- tionship. Dr. Annis encourages Texas physicians to support these and other organizations that protect physicians and the practice of medicine.
Under pressure
RAND selected a variety of practice sizes and ownership mod- els for the study and included single subspecialty, primary care, and multispecialty practices. Dr. Bias thinks researchers chose Parkway Primary Care because it’s a small, privately owned primary care group, a setup he says is becoming a rarity. In fact, the study found that leaders of smaller, independent prac- tices describe feeling pressure to join larger systems, sensing that it may become more difficult in the future to remain inde- pendent from these systems as a consequence of health system reform. Dr. Bias affirms that concern, worrying the personal touch
patients relish from practices like Parkway Primary Care may one day disappear as economic pressure to join larger entities mounts.
“Our patients enjoy the one-on-one attention they get from
our group, and we enjoy the autonomy and control involved in being part of a small practice. But administrative and regula- tory hassles combined with growing patient volumes threaten the viability of setups like ours,” he said. Dr. Keller says small groups are on shaky ground, especially
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