Physician practice innovation

Friday, November 01, 2013 12:27 PM
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RAND releases results from study of efficient delivery and payment models

Chet Seward, Senior Director, Health Care Policy

Physician job satisfaction is primarily driven by the ability to provide high quality care and things that get in the way of providing that high quality care are sources of stress for doctors.

These seemingly simple findings from a recent study by the RAND Corporation in collaboration with the American Medical Association (AMA) highlight many of the vexing problems that physicians in Colorado and across the nation currently face. The study also points the way to areas where solutions have the potential to markedly improve health care quality and safety, while enhancing the joy of medicine for physicians.

The AMA and RAND teamed up to study models of practice that have been shown to improve practice sustainability and physician satisfaction. Thirty physician practices across the nation participated – five in Colorado – representing a broad spectrum of specialties and practice settings.

Researchers began collecting data in December 2012 through three methods: a questionnaire for administrative and clinical leaders to examine the staffing, finances and overall structure of the practice; on-site visits for facility tours to observe staff meetings and to conduct in-person interviews with administrative leaders, clinicians and staff members; and a clinician experience survey. Customized individual and aggregate reports will be released to the practices soon so they can better understand the key steps and behaviors their peers are using to successfully transform the way care is delivered.
The Colorado Medical Society supported the study because we are keenly interested in finding ways to help physicians better cope with and lead changes in how care is organized, delivered and paid for in the future.

The findings suggest that the factors contributing to physician dissatisfaction could serve as early warnings of deeper quality problems developing in the health care system. “Many things affect physician professional satisfaction, but a common theme is that physicians describe feeling stressed and unhappy when they see barriers preventing them from providing quality care,” said Mark Friedberg, MD, the study’s lead author and a scientist at RAND, in an AMA press release. “If their perceptions about quality are correct, then solving these problems will be good for both patients and physicians.”

“Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts,” Friedberg said in the release. “But at the same time, they report that electronic systems are deeply problematic in several ways.”

Among the key findings of the study was how electronic health records have affected physician professional satisfaction. Those surveyed expressed concern that current electronic health record technology interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and degrades the accuracy of medical records by encouraging template-generated notes. In addition, doctors worry that the technology has been more costly than expected and different types of electronic health records are unable to “talk” to each other, preventing the transmission of patient medical information when it is needed.

To reduce physician frustration, some practices employ extra staff members to perform many of the tasks involved in using electronic records, helping doctors focus on activities requiring a physician’s training.

Researchers said that physicians reported being more satisfied when their practice gave them more autonomy in structuring clinical activities, as well as more control over the pace and content of patient care. Doctors in physician-owned practices or partnerships were more likely to be satisfied than those owned by hospitals or corporations.

The study did not identify recent health reforms as having prominent effects on physician satisfaction, either positive or negative. Most physicians and practice administrators were uncertain about how health reform would affect physician satisfaction and practice finances. It was clear, however, that a common response to health reform was for physician practices to seek economic security by growing in size or affiliating with hospitals or larger delivery systems.

The report, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy,” is available at

Posted in: Colorado Medicine | Practice Evolution | Initiatives | Physician Wellness


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