Internist Ann Cordum, MD, belongs to a seemingly endangered species of primary care doctors—those who enjoy their work and look forward to coming to the office every day.
It hasn’t always been that way for Cordum. She spent the first quarter century of her career in clinical and administrative positions with large healthcare systems, where she found herself growing increasingly frustrated with bureaucracy, too-short patient visits, and answering to managers who were MBAs rather than MDs.
So in 2015, Cordum decided to strike out on her own. She and another internist opened a direct primary care practice in Boise, Idaho, with the goal, she says, of “having no intermediary between myself and the patient.” The result has been exactly what she hoped for in terms of her approach to practicing medicine. “Now it really is joyful,” she says. “I like going to work and even when I’m not at work, I’m always available. I feel like it’s my pleasure to help the patients with their needs.”
Burnout, alienation increase
Doctors’ use of terms like “joyful” and “pleasure” when talking about medical practice has grown increasingly rare in the last decade or so. Studies and surveys consistently show rising levels of burnout and alienation within the medical profession. For example, in the Physicians Foundation’s 2016 Survey of American Physicians, 54 percent of respondents rated their morale as “somewhat or very negative,” and 49 percent said they “often or always experience feelings of burnout.” Only 37 percent said they harbored positive feelings about the future of the medical profession.
The reasons behind these feelings have been well documented. They range from frustration with EHRs and time spent obtaining prior authorizations to anger over government mandates and payers’ “take it or leave it” attitude in contract negotiations.
Carving out more patient time
And yet, in spite of all the obstacles, it is still possible for doctors to enjoy their work. The key, according to practice consultants, psychologists, and physicians, is spending more time doing what doctors are trained to do and gives them pleasure: treating patients.
While that sounds obvious, the challenge lies in finding the time for it. To start with, many doctors—particularly those working for hospitals and hospital systems—usually have little control over their schedule or working conditions and often must wrestle with the system’s bureaucracy to get patients the care they need.
But even doctors in independent practice often find it difficult to carve out more time for patients, given the range of administrative tasks and quantity of paperwork pulling them away from the exam room.
“A lot of what’s driving doctor unhappiness is that more and more is being expected of them than in the past, and this has compressed the amount of time they have to spend with patients, while the documentation burden has gone up,” says Cynthia “Daisy” Smith, MD, FACP, vice president of clinical programs for the American College of Physicians and part of the ACP’s Physician Well-being and Professional Satisfaction initiative.
Smith cites a 2016 study in Annals of Internal Medicine that found that for every hour doctors spend in face-to-face clinical time with patients, they spend nearly two hours on “EHR and desk work in the office,” according to the authors, and another one to two hours of personal time on computer and clerical work.
Rethinking approaches to medical practice
But the barriers to finding, or rediscovering, joy in medicine aren’t all external, experts say. Sometimes it requires physicians to rethink how they approach their work, says Gail Gazelle, MD, FACP, a former hospice physician who now coaches doctors on issues of professional satisfaction and work-life balance.
Gazelle notes, for example, that many physicians are perfectionists, a personality attribute that is important for success in medical education and training but can contribute to frustration and anxiety as a practitioner. “If you spend hours [on patient notes] perfect because you believe that every note has to be, but you only have so many hours in a day, you can see how the math doesn’t add up, and helps to explain why so many physicians struggle to keep up with documentation demands,” Gazelle says.
That drive for perfectionism, Gazelle adds, goes hand-in-hand with how many doctors learn to deal with problems they encounter in their practice: by working harder. “Many of us were taught that to be a good doctor you just power through, and don’t pay attention to your own needs,” she says. “And we know, given the high levels of burnout in front-line specialties, that is not an effective strategy in the long run.”
Another impediment to professional satisfaction doctors sometimes face—especially older physicians—lies in the attitude of supreme authority instilled during their education. “When I was in medical school 40 years ago, there wasn’t a lot of emphasis on team care,” says Louis Snitkoff, MD, FACP, chief medical officer of Community Care Physicians, a multi-specialty practice in the Albany, N.Y. region. “You were trained that everything the patient needs, or happens to the patient, is your responsibility, and it’s a tremendous burden.”