When you consider a few of the stories in this quarter's issue, you've got to wonder how physicians do it. And I thought journalists had it tough.
The lead story in this issue's Staffing section reports on a study that appeared recently in the Journal of the American Medical Association regarding the mental and physical impairments of overworked medical residents. The study, according to reporter Andis Robeznieks, says residents who worked 80 to 90 hours per week had the same impairments as someone who has knocked back a few beers. Not so many as to be legally drunk, but a little tipsy nonetheless.
Such impairments from being overworked put patients at risk, as well as the health and safety of the residents themselves, the study said. The study didn't say how residents would spend their extra time if they cut back their hours to 60 per week. Hopefully, they would spend it studying and resting, not dealing with their stress at the local bar and grill.
If physicians survive their residencies and actually make it into practice, it seems that everyone wants to tell them how to care for patients, according to this issue's feature story by reporter Michael Romano (p. 10). Derided by physicians as another form of "cookbook medicine," the pay-for-performance craze is threatening to suck the subjectivity out of practicing medicine by linking physicians' clinical performance to reimbursement. A number of physician professional associations tried to wish the movement away by simply ignoring it. But, as Romano points out, the movement sped out of the gate and is only accelerating. That's forced a number of associations to switch to damage-control mode, attempting to steer the movement in physicians' favor and away from payers. But it may be too little, too late.
And what's the reward waiting for physicians who survive their residencies and somehow make it through 20 to 30 years of everyone from hospital administrators to insurance executives telling them how to practice medicine? As Modern Physician contributor Elizabeth Gardner reports in this issue's cover story, they can become chief medical officers and start telling everyone else how to practice medicine and how to manage patient-care operations. As Gardner points out, the role of the CMO in a hospital or hospital system is evolving well beyond serving as a buffer between the medical staff and administration or even overseeing quality-improvement activities.
More and more, CMOs are getting involved in operations -- everything from finance to staffing. New-style CMOs are also getting paid more handsomely than their predecessors. According to exclusive data from Sullivan, Cotter and Associates, the median total cash compensation for CMOs working at individual hospitals rose 6.2% this year to $283,800. For CMOs of systems, median total cash compensation jumped 7.7% to $400,500 this year.
The stories in this issue tell an overarching story of a physician's life, from overworked and exhausted resident to practicing physician harassed by payers and administrators to powerful executive dictating how hospitals and hospital systems deliver cost-effective, high-quality care. Anecdotally, we hear about physicians' disillusionment with medicine and how most of them wouldn't recommend the profession to their children. But I don't buy it. It's a tough gig, perhaps one of the toughest. But that's exactly what makes it a great profession and one that will remain attractive now and in the future.