Quality care linked to physician satisfaction

A new study suggests that physicians are most satisfied with their jobs when they believe they are providing high-quality care. Researchers said obstacles to such care can diminish physicians' satisfaction and point to hidden problems in the health care system.

The RAND Corp. survey also found that physicians are eagerly awaiting improvements in the operation of electronic health record (EHR) systems, saying that while they support the promise this technology has to improve clinical care, the inherent problems with user interface, data entry, and reduction of face-to-face interaction with patients represent significant obstacles to professional satisfaction.

The study, sponsored by the American Medical Association and released this week, surveyed 447 physicians in six states. While acknowledging that it was a relatively small sample size and not designed to represent practices on a national basis, the researchers said it did include voices from a wide number of practice types.

The study found that physicians generally have accepted the clinical and professional benefits of EHRs in their practices, with only one in five expressing an interest in staying with or returning to paper-only practices. But they continue to have serious misgivings about the current limitations of many EHRs. For instance, they complained that EHRs are frequently difficult to use, require too much time commitment for entering data, often don't share information with other EHR products, and result in less useful clinical documentation. Also, some practices continue to find the price tag for switching to an EHRs prohibitive.

While waiting for improvements, practices are trying to fix some of those problems themselves, including employing new or existing non-physician staff for data entry or to interact with the EHR while the physician focuses on direct patient care. The researchers recommended that federal authorities include improved usability as a key requirement for EHR certification.

Other findings included respondents saying that health care reform in general hasn't yet affected physician professional satisfaction in either direction, other than producing uncertainty. Several practices said they've responded to the economic uncertainty by joining a hospital or other large delivery system or, at least, are considering it.

Some other recent regulations, however, are having an effect, most notably the meaningful-use rules tied to EHR implementation. Respondents said the rules require too much time and paperwork for compliance.

As for primary care physicians in particular, the survey found some respondents complaining of physicians in other specialties treating them or their staff as inferior. They also said that their level of job satisfaction suffered when the pressure to provide more services to more people limited the amount of time and attention they could spend with individual patients. They also found that physicians of all kinds tend to get more satisfaction when they enjoy greater autonomy and control over the pace and content of their clinical work.

Respondents across the spectrum of health care also said they expected primary care physicians to see an increase in relative income in the future at the expense of sub-specialists.