What's Troubling Physicians?

Editor's Note: I first drafted this article in 2008 and have since made a few minor modifications or edits to reflect current situations in practice. However, the key elements of the writing is unchanged in eight years. Think about that... 

Why aren’t physicians happy?

An open letter to hospital executives and healthcare leaders.

I’m writing this letter because of a comment relayed to me and attributed to the CEO of a large health system when he heard that a physician wanted to leave practice to enter administration. It was a simple comment, but a telling one. He said, “What’s wrong with him isn’t practicing medicine good enough?” 

For more than 10-years I’ve counseled and advised physicians about career dealing with frustrations and most often implementing career transitions – that is leaving clinical practice. I have consulted with and or assessed more than 1,000 physicians nationwide - and some outside the U.S. Yes, it's interesting, physician frustration is a global issue. What began as a skunk-works within an executive outplacement business nearly a dozen years ago has grown to be, arguably, the largest physician-only career consulting and career transition business in the United States, third_Evolution.

My practice has followed an interesting progression. My first clients were physicians leaving medicine due to age and disability. Most didn’t want to leave practice, but they had no option. However, they still wanted to use their medical knowledge and years of clinical experience in some natural and beneficial way. The next step in our corporate transition evolved slowly towards younger physicians. First we saw those in their mid-50s, many of whom had planned for much of their careers to “retire” in their mid-50s, so meeting with us was a natural next step. However, some weren’t following a pre-determined plan; some believed medicine had changed so much from their early years they didn’t want to continue down what they saw as a slippery slop that ended with the “business-types” dictating the terms of patient care, and too many patients eagerly seeking to “cash out” via a malpractice suit.

In short time paralleling our own corporate growth, our client base became younger, into their 40’s and then 30’s. This group often believed they’d been sold a bogus dream. Their  youthful ideals of medical practice were never realized, and they didn’t believe they ever would. Finally, and recently, my phone rings constantly from medical students and residents seeking an alternative – an alternative to the hours, the risk (real or perceived), and to the maltreatment from instructors, attendings, administrators and patients - and now, Obamacare.

That’s their story. Interestingly hospital and other healthcare executives and leaders don’t seem to be listening. Why not? First, it’s a difficult message to hear – difficult because they don’t want to hear it and difficult because physicians are not likely to let them hear it.

We hear what we want to hear. The first job of healthcare administration each year seems to focus more and more on financial management. And the unintended result of this fact is that while top administrators may see themselves as only working to provide the environment for quality patient care, in reality, they are setting the standards of appropriate behavior for everyone else in their organizations. Major policy is always a top down flow and staff will always follow deeds over words.

So while CEOs preach patient-centered care and treating physicians like customers, staff too often see only the bean counting. I know the demands for CEO and other executive time have greatly increased over the years, but if staying in touch with the “customers” is a goal, it simply can’t be done second and third handed. And with customers, the same adage is true, actions speak louder than words. Are your physicians smiling when they’re in your facility, engaging staff, talking, sharing stories with you or with colleagues or are they stern, focused, just “getting the job done?”

Don’t ask, don’t tell might well be the credo of physician dissatisfaction. A financial planner friend of mine once told me, “I have hundreds of physician clients, and I don’t know of a single one who wants to leave practice.” He was right, he didn’t know, and his clients weren’t about to tell him. Further, there aren’t many people a physician will tell of a true desire to pursue other career goals. Why? From our practice, this is what we’ve learned.

My word, you’re a doctor… Being a physician is seen as a calling, as a well-paying well-respected career providing practitioners with a rewarding and satisfying work environment. How could anyone not want to be a physician?

A traitor to your profession...  Family and colleagues consider any disparaging talk as demeaning to the profession. It’s taken very seriously, and physicians who truly complain (criticism of administrators, payors and malpractice rates is considered more cussing the enemy than complaining about medical practice) are often seen as “having a problem” or weak in some way.

If I say it, it will happen... Physician practice is based on a combination of the confidence physicians have in themselves and the confidence they can instill in others. Seriously discussing leaving practice shows and gains a lack of confidence. Absent one’s confidence, patients will leave, referral sources will dry up and physicians will loose their practices, by default.

What will my family think... So many spouses, parents and even children have their identities inextricably linked to their physician relatives,’ they become codependent supporters of unhappy practices.

What else could I possibly do... Most physicians have followed a well defined roadmap their entire careers. Beginning with their first elective educational course they focused on the sciences, and then followed clearly marked road signs for schools, programs, and relationships that led them to and through medical school, residency and practice. Now, dissatisfied, frustrated and confused, they no longer have a defined path to follow.

The reality is that many physicians are unhappy. A survey conducted by Merritt Hawkins and Associates showed that nearly 25% of residents would not choose medicine if they could restart their educational careers. A California Medical Association survey showed:

  • 43% of surveyed physicians plan to leave medical practice in the next 3 years. Another 12% will reduce their time spent in patient care.
  • More than 1/4 of physicians would no longer choose medicine as a career if starting over today…
  • 2/3 of physicians are not advising their children to practice medicine.

So what can you do to better support, and possibly retain, your medical staff?

Don’t treat them like the very need for change is a problem. Learn to talk with your physicians about not just their practices, but their careers. Are they happy with patients, how their practices run, their staffs? Physicians usually aren’t skilled administrators, and sometimes you can provide valuable administrative expertise and insights that can turn a practice and a practitioner around.

Support changes in practice. One of our clients, a general surgeon, was suffering under the weight of group problems, rising malpractice and a variety of other practice related issues. He left his practice and started an outpatient endoscopy center. While you may see that example as creating a new competitor to your hospital’s outpatient services, many physicians could be happy in practice if their practices better reflected a combination of their needs and their interests. Sometimes practicing in a more focused way can solve many problems. However, this change doesn’t carry with it a road map for success. You can help create a positive and mutually beneficial road map.

Recognize the value of a medical education. While MBA candidates were pulling all-nighters working on a simulation game with their work team, fueled by beer and pizza, the MD resident was pulling an all-nighter in an ER dragging a victim of the local knife and gun club back from the brink of death. Making significant decisions with imperfect information is the mainstay of medical practice. It just needs to be retuned and refocused a bit to become an administrative asset.

Treat them like any colleague who has decided to take on a new career challenge. If your COO walked in one day and said he was going to buy a Harley Davidson franchise, you’d probably be envious, wish him well, and tell everyone how this great fellow was following a dream. Need I say more?

From my practice, I have found that more than 99-plus percent of our clients “should” be physicians. That is to say, behaviorally and functionally they fit well in the practice of medicine. However, something has happened to alter their view of practice. And like dealing with almost any pathology, early detection and intervention leads to the least drastic remedy. If someone had taken early steps to help physicians be happier and more rewarded in practice, fewer of my clients would be seeking non-clinical careers. What are you doing to support and understand your physicians?