Physician satisfaction: Adapt to the system or break free?

With new challenges seemingly at every turn, it's easy to get caught up in lamenting problems. But if you look at most situations a different way, you can usually just as many potential solutions as problems. The difficulty, of course, is determining whether a solution is truly a cure or a harbinger of yet more problems.

A recent blog post from Health Affairs hones in on one problem that is perhaps both a symptom of and lynchpin binding the rest: physician dissatisfaction.

Unhappy physicians aren't only a threat to the success of individual practices, but also to the healthcare system in general, contend authors Francis J. Crosson, M.D., group vice president of Physician Satisfaction: Care Delivery and Payment with the American Medical Association, and Lawrence Casalino, M.D., Ph.D., of Weill Cornell Medical College.

"As the country adapts to the opportunities accelerated by the Affordable Care Act, physician dissatisfaction threatens the success of care delivery and payment reforms," they wrote. "The Commonwealth Fund Commission on a High Performance Health System recently listed 10 strategies to improve healthcare services and save $2 trillion over the next decade. At least seven of these strategies will require the close involvement of practicing physicians in order to succeed."

Increasing physician satisfaction, the post continues, relies on two major issues: Physicians' sense of control and their financial stability.

Based on our FiercePracticeManagement coverage to date, I'd have to agree. As we reported back in December, many physicians who have felt forced to join larger entities to survive have grieved over the loss of autonomy in how they practice medicine.  

But fortunately, evidence exists that doctors don't have to surrender as much control as they may fear. For starters, there are several strategies practices can use to stay independent, either by adopting looser alignment models or embracing an alternative practice structure, such as the direct-care model, discussed in this week's issue.

We also bring you another story today that points out employment and physician engagement don't have to be mutually exclusive. Organizations that have demonstrated success in managing physician groups thus far place a priority on involving physicians in committees, decisions, recruitment and policy-making, noted Tommy Bohannon, senior director of recruitment and development training for Merritt Hawkins & Associates.

This is an important take-home point for hospitals, as well as doctors and groups evaluating alignment opportunities. For doctors to perform, financial incentives and penalties aren't enough. They need support and a sense of partnership. As a story from Medscape Today noted, employed doctors become frustrated with being told what to do by administrators and managers who don't listen to them in turn.

Remarks from one physician who spoke to Medscape anonymously nicely tie the control issue to the other biggie--finances:

"The toughest transition is that the provider no longer has the final say in decisions affecting the logistics of practice," he said. "I now have to deal with the human resources department, and unmotivated and sometimes less-than-competent employees. They work for the institution and not me. It is exasperating, but at the end of the month the paycheck shows up. I am no longer the last to get paid."

Again, when it comes to avoiding the very real fear of financial devastation, doctors generally fall into one of two camps. They either embrace updates in the healthcare system, such as accountable care organizations, medical homes and performance-based reimbursement models, or they eschew the red tape and go back to collecting their income directly from patients.

Some concierge doctors, such as Natasha Deonarain, the founder of The Health Conscious Movement, have gone so far as to say doctors should get rid of the term "patients" altogether when referring to the business transactions that take place with their clients.

In a recent post for KevinMD, Deonarian makes some bold statements about how physicians can reclaim their value in the marketplace. A key element of doing so, she wrote, is for physicians to promote their own perceived value, in part by raising their prices. "Once you have created your customized program for clients (no longer to be called patients), you double your prices," she wrote. "If you don't, your clients will downgrade your value. They will not perceive you as being worth a higher price."

Deonarian acknowledges that adopting this mindset will "take some gumption," but insists the payoff is worthwhile. "But once you get used to reclaiming your personal perceived value, your bank account will begin to show you exactly how much you believe you're worth, doctor," she concluded.

As the saying goes, there's more than one way to skin a cat. As we can see here, wildly different opinions exist as to the best way for physicians to find satisfaction through a sense of control and financial stability. Between these extremes, of course, are principles of basic revenue-cycle tightening and efficiency we didn't even touch on here.

But I'm curious to hear what you think. Is physician satisfaction possible within our current, albeit evolving, healthcare system--or is going rogue the only sure path to happiness? - Deb(@PracticeMgt)

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