Professional satisfaction for docs tied to better care, RAND study shows

Physicians' perception of their ability to provide high-quality care most strongly determines their level of professional satisfaction, according to a newly released RAND Corp. study.

The American Medical Association sponsored the study as a way to better understand—and hopefully address—the issue of declining physician morale. Researchers conducted hundreds of face-to-face interviews and surveys of physicians and other health professionals in 30 practices across six states.

“What we found was interesting because most prior studies had said that satisfaction can lead to better care because physicians are happy with their jobs,” said Dr. Mark Friedberg, a natural scientist at RAND and the study's lead author, in an interview. “What we found is actually the reverse—physicians see barriers to providing quality care as a persistent source of stress, even when they're satisfied in other areas.”

Physicians also reported mixed feelings about electronic health records. While the vast majority said they preferred EHRs to paper records, they said the technology brought with it vexing problems such as less face-to-face time with patients, inadequate health information exchange and interfaces that aren't congruent with the realities of patient care.

“There was also a real concern about the degradation of documentation because of template-based notes in the EHR,” Friedberg said.

The report comes after a yearlong effort by the AMA to beef up its knowledge of the factors that affect professional satisfaction and to design solutions, said Dr. Jay Crosson, the AMA's vice president of professional satisfaction. He said many of the determinants of physician satisfaction mentioned in the report—autonomy, work pace and payment—were not at all surprising.

What was unexpected, he said, was the degree to which quality affected how physicians feel about their jobs.

“The core dissatisfier was whether physicians went home at night thinking they delivered good care or whether they were blocked from doing so because of time pressures, EHR problems or simply being overwhelmed with administrative work,” Crosson said.

The next step for the AMA will be to use the study's findings to craft easy-to-implement techniques to improve practice efficiency and free up as much of physicians' time as possible, he added.

Those nuts-and-bolts changes in practice will be small and manageable, like boosting the level of the data-gathering done by medical assistants in preparation for the doctor-patient interaction. But the hope is their effect will be significant.

The AMA also plans to work with vendors to address EHR usability issues, Crosson said.

“Over the next six to 12 months, we'll be codifying as many of those improvements as we can in detail and making them available to as many practices as we can, irrespective of size,” said Crosson, who said he hoped the changes in practice would be available by mid-2014. “Our goal is to make uptake as practical as possible.”

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