Juliette Mullin, senior editor
If I had one takeaway from this year's physician compensation survey from Medscape Medical News, it's that doctors are making more money than ever—but they're also more dissatisfied than ever about their career choices.
Survey breakdown: Two physician specialties saw compensation drop last year
In recent years, doctors have consistently reported dissatisfaction with their choice of specialty and practice setting. In the most recent iteration of Medscape's survey, which included 19,500 physicians polled between December 2014 and March 2015, the majority of doctors (64%) said they would choose medicine as a career if given the chance for a life do-over. But just 45% of them would pick the same specialty, and just 24% of would choose the same practice setting.
For some specialties, the dissatisfaction is even more evident. For example, just 25% of internal medicine doctors said they would pick the same specialty again, compared with 73% of dermatologists.
It's clear that David Bornstein was on to something when he wrote in the New York Times in 2013 that "[m]edicine is facing a crisis, but it's not just about money; it's about meaning," Bornstein writes.
So what's driving this burnout and disengagement among this critical part of the health care workforce?
According to Advisory Board senior analyst Cassie Dormond, the key drivers of physician engagement are autonomy and decision input. "For example, physicians want their organizations to be open and responsive to their input, and they want executive decisions to reflect clinician priorities," she says.
Dormond notes that changes in the health care landscape may be worsening physician disengagement and burnout. "You can imagine that the rapid pace of change in health care, particularly in the past five or so years, coupled with an ever-greater emphasis on standardization, has put physician engagement increasingly at risk."
Dormond is currently working on an Advisory Board study on the issue. She says, "our members attached to the idea that, often, when we talk about 'burnout' we are actually talking about 'change fatigue.'"
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Another key component in engagement is recognition. Preliminary findings from an Advisory Board survey of 3,711 physicians found that only 46% thought they were recognized by their organization for a job well done. This is especially troublesome when you consider that physicians in the Medscape survey identified "being good at what I do" as the No. 2 most rewarding aspect of their jobs, behind only "relationships with patients."
What can leaders do?
For organizational leaders, identifying the problem is an important first step. Dormond warns that while the root causes of disengagement and burnout are similar, their manifestation can be very different.
- Disengagement: "Our members generally see disengagement manifest either through direct physician complaints or through physicians' unwillingness to change the way they practice or manage their practice despite health system or medical group needs," Dormond says.
- Burnout: "Burnout is a mental health designation. While disengagement would pop as one symptom of burnout, other symptoms such as exhaustion, absenteeism, and loss of empathy would also be present," Dormond explains.
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Dormond and her team say that any effort to improve physician engagement should include efforts to involve physicians in change initiatives.
Dormond explains, "This means looping physician leaders into the process of deciding how a new initiative or change should be implemented." Then, leaders must thoughtfully plan communication to explain the change and its implications for individual providers within the organization.
How engaged are your clinicians?
Engagement can lead to better margin performance and more satisfied patients. See how health care engagement compares across vital service lines and clinical roles. Get the infographic.