Last week when we wrote about the US’s exorbitant healthcare expenditures we mentioned that spending on physicians constitutes only about 10% of the nation’s healthcare spending. We also noted that the U.S. has only 2.4 practicing physicians per 1,000 population—putting us significantly below the OECD average of 3.1.
A recent Vox interview with Dr. Sandeep Jauhar, author of the book Doctored: The Disillusionment of an American Physician, takes a look at the effects these numbers are having on America’s physicians. The title of the interview—Only 6 percent of doctors are happy with their jobs—sites a 2008 survey of 12,000 physicians that asked whether the doctors would describe their morale as positive. In addition, eighty-four percent of the doctors said that their incomes were constant or decreasing. Most said they didn’t have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether.
In a recent Wall Street Journal article, Dr. Jauhar added, “More recent surveys have shown that 30% to 40% of practicing physicians wouldn’t choose to enter the medical profession if they were deciding on a career again—and an even higher percentage wouldn’t encourage their children to pursue a medical career.”
30% to 40% of practicing physicians wouldn’t choose to enter the medical profession if they were deciding on a career again—and an even higher percentage wouldn’t encourage their children to pursue a medical career.
Among the reasons cited: An overwhelming patient load and financial insecurity. “There’s no question that doctors earn healthy incomes,” Jauhar says, “[But] what they have to do to earn that income is often appalling. To earn a $150,000 to $200,000 salary, which is a healthy salary that primary-care doctors make, you have to run on a treadmill. You’re seeing 25 to 30 patients a day. These figures don’t include the educational debt that some of my colleagues have, which can be nearly $500,000. The amount of pressure and risk that you take seeing patients for eight to 10 minutes per session, the educational debt, the fear of getting sued, all of that has created a climate of dissatisfaction.”
In the Wall Street Journal article he elaborated, “In 1970, the average inflation-adjusted income of general practitioners was $185,000. In 2010, it was $161,000, despite a near doubling of the number of patients that doctors see a day,” and cited a 2002 article in the journal Academic Medicine that suggested the return on educational investment for primary-care physicians, adjusted for differences in number of hours worked, is just under $6 per hour, as compared with $11 for lawyers.
The return on educational investment for primary-care physicians, adjusted for differences in number of hours worked, is just under $6 per hour, as compared with $11 for lawyers.
We’ve also previously written that the US is the world leader in administrative healthcare costs—an estimated 36% of the approximately $3 trillion we spend on healthcare goes toward administrative overhead for payers and providers. According to Dr. Jauhar, this has a negative impact on both physicians and patients:
Other factors in our profession’s woes include a labyrinthine payer bureaucracy. U.S. doctors spend almost an hour on average each day, and $83,000 a year—four times their Canadian counterparts—dealing with the paperwork of insurance companies. Their office staffs spend more than seven hours a day.
…The growing discontent has serious consequences for patients. One is a looming shortage of doctors, especially in primary care, which has the lowest reimbursement of all the medical specialties and probably has the most dissatisfied practitioners. Try getting a timely appointment with your family doctor; in some parts of the country, it is next to impossible.
… Perhaps the most serious downside, however, is that unhappy doctors make for unhappy patients. Patients today are increasingly disenchanted with a medical system that is often indifferent to their needs. People used to talk about “my doctor.” Now, in a given year, Medicare patients see on average two different primary care physicians and five specialists working in four separate practices. For many of us, it is rare to find a primary physician who can remember us from visit to visit, let alone come to know us in depth or with any meaning or relevancy.
Perhaps the most serious downside, however, is that unhappy doctors make for unhappy patients. Patients today are increasingly disenchanted with a medical system that is often indifferent to their needs.
But what can be done? Last week we suggested that in order to decrease total expense and improve quality of care, administrative overhead payments need to become provider payments. The dishearteningly low morale of American physicians supports this notion. If targeted payments were tied to lightweight metrics on chronic disease management, the end result would likely be reduced costs, improved provider satisfaction, and better health outcomes.
A 30% increase in physician payments could improve the U.S. average from 2.4 physicians for 1,000 patients to the OECD average of 3.1. This would allow doctors to spend more time with each patient, but would represent a shift of only 3% of our total healthcare spending.
Dr. Jauhar concurs:
We also need to replace the current fee-for-service system with payment methods such as bundled payment, in which doctors on a case are paid a lump sum to divide among themselves, or pay for performance, which offers incentives for good health outcomes. We need systems that don’t simply reward high-volume care but also help restore the humanism in doctor-patient relationships that have been weakened by business considerations, corporate directives and third-party intrusions.