From Modern Healthcare:

We live in challenging times for physicians, who are required to do things that are wearing them out and making them feel bad about their jobs.

Surveys showing large percentages of doctors burned out, dissatisfied with their work or regretting their career choice point to something deeply psychological that is happening to many doctors—something that should make all of us very concerned.

The things happening to them are clear—their work is a daily treadmill of truncated, rapid-fire patient visits and cookbook medicine; they have too many administrative and infrastructure requirements placed under their responsibility; they must collect, document, and report performance-related minutiae; they have been forced to use information technology in heavy-handed ways; they must lead “teams” while at the same time caring for individual patients on a full-time basis; and they work under their employers' assumption that they have to be watched to know if they are doing their job correctly.

All of these dynamics are magnified for the large number of salaried employees working in more-controlling corporate work settings.

Making things worse is the move to “value-based payment” schemes, particularly through the recent Medicare Access and CHIP Reauthorization Act rolled out late last year. If you spend hundreds of pages, as the MACRA final rule does, spelling out how someone is going to get paid, in this case physicians, don't expect that someone to believe that you have their best interests at heart.

You also may want to read up on the science of human motivation. That science, and my own research and observations over time, show that most doctors are indeed driven primarily by intrinsic desires, i.e., things such as the personal meaning in their work, strong interpersonal relationships with patients and the emotional rewards they get from helping people. A system based on extrinsic motivators and external oversight, inherent in MACRA and other pay-for-performance programs, further erodes doctors' ability to pursue these intrinsic rewards.

Read the full post on Modern Healthcare (free subscription required to login).

Timothy Hoff

Professor of Management, Healthcare Systems, and Health Policy; Visiting Associate Fellow, Oxford University