Six Biggest Gripes of Employed Doctors

Kenneth J. Terry, MA

Disclosures

March 02, 2011

In This Article

5. Lack of Clinical Autonomy

As hospitals and medical groups alike put more emphasis on quality improvement and measurement, many employed physicians feel like they're losing their clinical autonomy. And the problem is compounded if quality scores determine a significant part of their compensation, Matthews says.

"That's part of the loss of autonomy that bothers doctors even more than the business side. Most of them hate it. They say, 'I do a good job, I take good care of my patients.' Now they've got to meet certain metrics. And often, those metrics are part of their compensation plan."

LaPenna isn't sympathetic to these complaints. "Electronic health records and evidence-based medicine are coming to everyone. I think the doctors who don't realize that are dinosaurs who've stepped on their last eggs. They've walked the earth, and they're sort of in charge, but they don't realize their species is extinct."

Nevertheless, say physician recruiters, major changes in how doctors work, such as how they document visits or how they coordinate care, can make them unhappy and increase their inclination to change jobs. For example, researchers studied a "patient-centered access" program at Group Health Cooperative, a Seattle-based group-model HMO. They found that while patients liked open-access scheduling and the additional work that their doctors did to keep in touch with them between visits, the primary care physicians were getting burnt out.

Said one primary care doctor, "The professional model for physicians always involved giving extra, and I don't begrudge that. It's just I can't do it every day all the time. It has been a couple of years since I've had lunch. I eat at my computer while I'm doing my charting or looking through my results or other in-basket functions, and that's pretty much the way it goes."

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