Declining Morale Leaves Docs Questioning Their Career Choice

Edition: July 2002 - Vol 10 Number 07
Article#: 1271
Author: Laura Thill

Are your customers starting to smile less and complain more? If so, don't take it personally – at least not yet.

Excessive demands, waning respect for the medical profession and limited financial rewards have contributed to faltering morale among physicians, according to the Kaiser Family Foundation. In its March 2002 National Survey of Physicians, Part III: Doctors' Opinions About Their Professions, it appears that doctors' attitudes about their profession and, especially about managed care, have become more negative since 1999.

Their number one complaint about managed care is that it has led to increased paperwork, decreased time with patients, and restrictions in patient access to specialists. In spite of this, many doctors continue to recommend the medical profession to newcomers, and those doctors who work primarily in managed care environments tend to be more positive about the effect it has on healthcare.

Following are some general findings showing how physicians feel about the medical profession:
• Morale has declined. Eighty-seven percent of physicians say overall physician morale has dropped in the last five years. Fifty-eight percent claim their own enthusiasm has decreased as well.
• More doctors than not (53 percent) would still recommend their profession to young people.
• Most doctors are satisfied with continuity of care, professional challenges and the income provided by their practice. They are frustrated, however, by the lack of time they have for patients or outside interests, as well as by their limited autonomy and low potential for an increase in income.
• Physicians overall are negative about the role of managed care in healthcare. Ninety-five percent feel managed care has increased the amount of paperwork required: 88 percent believe it has restricted the amount of time they spend with patients; 83 percent say it has increased their overhead costs; 78 percent believe it has restricted patients from getting necessary prescription drugs; and 73 percent think managed care has decreased the quality of healthcare in general. Forty-one percent of physicians believe that managed care has increased healthcare costs.
• Physicians debate whether managed care has actually reduced patients' use of inappropriate services. Forty-four percent say it has had no effect; 29 percent believe it has been successful in decreasing use of inappropriate services; 26 percent think it has actually increased patients' use of these services.
• Some doctors believe managed care is responsible for some improvements in healthcare. Sixty-three percent say that managed care has led to greater use of practice guidelines and disease management protocols. Forty-two percent of doctors say that managed care has enabled patients to take greater advantage of preventive services. (Thirty-one percent say managed care has had no effect here, and 26 percent think it actually has decreased patients' use of preventive services.)
• Physicians affiliated primarily with a single managed care organization are a bit more positive about the influence of managed care than other physicians. The following chart compares the two groups of doctors (See chart below.)

 Doctors Affiliated with Single Managed Care Plan Other Doctors
Percent who believe that managed care has increased overhead costs for practices.60 percent87 percent
Percent who believe that managed care has decreased the quality of care for patients.63 percent75 percent
Percent who believe that managed care has increased their paperwork.86 percent96 percent
Percent who believe that managed care has decreased the ability of patients to see specialists.76 percent84 percent
Percent who believe that managed care has interfered with patients' ability to get prescription drugs.69 percent80 percent

Similarly, physicians associated with a single managed care plan are more likely than others to say that managed care has decreased the use of inappropriate services (40 percent vs. 27 percent), or increased the use of practice guidelines (70 percent vs. 62 percent).

Physicians have some priorities for Congress to address, notes the Kaiser Family Foundation. For one, 59 percent would like to see Medicare become more financially stable for future beneficiaries. Fifty-seven percent are hopeful that more Americans will be insured in the future. And, 55 percent would like Congress to offer more protection of patients' rights in health plans.