Doctors trust their employers less, ABIM Foundation says

The COVID-19 pandemic has impacted nearly every part of healthcare, including how much doctors trust their own employers and the medical system overall.

Almost one-third of doctors say their trust in their organization leadership and health system overall decreased during the pandemic. That's according to new survey data of 600 physicians from the American Board of Internal Medicine Foundation conducted by NORC at the University of Chicago.

ABIM is also launching a new campaign called "Building Trust" aimed at increasing trust among clinicians, patients and other healthcare stakeholders.

"Our goal is to make trust an essential, important aspect of healthcare that people intentionally focus on," said Daniel Wolfson, executive vice president and chief operating officer at ABIM. "Whether or not doctors receive received protective equipment, how organizations communicated with their employees about guidelines and operations largely determined whether their physicians thought they could trust [their administration leadership]."

The campaign will mirror ABIM's now almost decade-old "Choosing Wisely" campaign, which aimed at reducing low-value tests and procedures. Researchers found little evidence that the effort moved the needle significantly.

The Building Trust project already has about 50 healthcare organizations, including Scripps Health, Novant Health, Humana, Walmart and the Camden Coalition of Healthcare Providers, submitting practices that they think build trust.

Campaign partner UnityPoint Health, an integrated health system in Iowa and Wisconsin, created exam room table tents indicating a room had been cleaned and an infographic for staff on how to safely greet patients to create small intentional gestures to build trust of patients.

The campaign will include conversations with thought leaders and research into how organizations can drive trust through communication, competence and compassion.

"We've seen that in organizations like Virginia Mason (Franciscan Health), which has a contract between the physicians and administration to align their interests," Wolfson said. "Alignment of values is always important and when the administration and physicians are not aligned on what they think are their values—and financial considerations have to be put into play—there are concerns. I think the antidote to that are real conversations between administration and physicians."

Among other findings in the survey, physicians mostly either hold the same level or have increased levels of trust in their fellow physicians (94% trust doctors within their own practice, and 84% trust doctors outside of their practice) and nurses (89%) the most out of other stakeholders. Meanwhile, levels of trust decreased toward government agencies like the Centers for Disease Control and Prevention and health insurance companies.

Physicians say their trust is increased when health employers treat them with respect, are ethical and have policies that put patients first. Physicians said showing empathy, listening, answering questions and the length of time with patients were most important for building trusting relationships with patients. Wolfson tied the trust issue to reported metric outcomes.

"Quality improvement goes at the speed of trust: if there's not lots of trusting relationships within the healthcare system, quality improvement will lack because of the foundation of trust is not there," Wolfson said. "I think you're going to see a lot of that in the future organizations doing their own challenge of asking, 'What are the things that we do that build trust in the organization?' "

Among other findings, over half of physicians said their healthcare employer ensured a safe workplace during the pandemic, communicated effectively about COVID-19, reduced the spread inside facilities and integrated telehealth as an alternative to in-person appointments.

On the patient side, of about 2,000 people 78% said they trust their primary-care doctor, with older adults, white people and higher-income patients reporting the highest levels of trust in doctors. Among people who reported lower trust in their doctors, 25% said their doctor spends too little time with them and 14% said their doctor does not know them or listen to them.