OP-ED

Tending to the Health Care Workers of America

flying cadeuciiGiven the attention now paid to implementing national health reform, the bulk of which is now upon us as 7 million new individuals now have health insurance, one important issue remains largely ignored by policy makers and industry leaders–health care workers are very unhappy.

A 2012 national survey of 24,000 physicians across all specialties found that if given the choice, just over half of these doctors — only 54 percent — would choose medicine as a career again.  Fifty-nine percent of physicians in a 2013 survey could not recommend their profession to a younger person, and forty-two percent were dissatisfied in their jobs.  Forty percent of physicians in another 2013 national survey self-identified as burned out.

Nursing has gained the moniker of one of the least happy jobs in America, with nurses traditionally experiencing high rates of job dissatisfaction, burnout, and turnover.  Some of the reason for this malaise among our highest status health professionals has to do with the stressful, uncertain nature of health care work.

But it also is an outcome of the everyday worlds in which all health care workers now find themselves:  a world drenched in paperwork, packed patient schedules, and decreased control.  In short, the new world of health reform.

We are in the midst of a technological and business revolution in health care delivery. We are also on expanding patient demand in ways not seen in generations.  But we are not meeting the needs of health care workers, who are expected to produce at a higher level than ever before.


Health reform’s simultaneous push to expand access and reduce costs is imposing greater rationality on the system through a combination of innovation and administrative control. Production is being sped up dramatically to push more transactions through the system and meet the growing demand.  At the same time, doctors and nurses are doing more with less.

So many resources are now devoted to things like work redesign and electronic medical records that we are forgetting what is needed most—people on the front lines of patient care who can do their jobs in ways that are competent, caring, and self-fulfilling.  Lest we forget, health care is a service industry.

Perhaps the scientific revolution occurring in health care today will pass by health care workers, leaving them captive to a new delivery system that places too much faith in everything else but them. For example, as we embrace electronic medical records, we ignore the pleas of physicians who keep telling us they want to look their patients in the eye more and talk with them during a visit, not click on a keyboard.

Failing to understand the perspective of health care workers would be a tragedy. It will likely make growing health workforce shortages worse and leave untouched significant problems like burnout that negatively affect quality of care.

In the worst case, it would exacerbate them, while signaling that human capital is not the central figure in this nation’s health care transformation, but rather a system input to be strategically deployed in making other inputs like health information technology work.

Greater attention must be paid now to improving the everyday circumstances of health care workers through careful consideration of their diverse needs—better pay, less intrusive technology, safer work environments, job design and work schedules that reward rather than demoralize, richer career opportunities, and greater voice in deciding how to best deliver the health care product.

In addition, we should remember that most people pursue a job or career in health care because the thought of helping others appeals to them, and health care organizations should fulfill rather than take advantage of these intrinsic motivations.  This will pay dividends for important goals like improving quality, since a stable, supported health workforce has been shown to deliver a better health care product.

I would place a high-performing health care worker who listens to and cares about me at the top my health care wish list for the new system into which I am being thrust. So too I think would everyone else. But those types of workers don’t grow on trees.  They need to be cultivated and maintained.  And if the system destroys the passion that many of these individuals have for their work and careers, then we are in trouble.

For while we may end up finding ways to provide more services to more patients, it’s a good bet that many of those services will leave us dissatisfied, feeling like widgets within an impersonal health care production machine that values transactions over relationships.

Timothy Hoff, Ph.D. is Associate Professor of Management, Healthcare Systems, and Health Policy at Northeastern University, D’Amore-McKim School of Business and School of Public Policy and Urban Affairs, and author of the book, Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century.

Livongo’s Post Ad Banner 728*90

12
Leave a Reply

11 Comment threads
1 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
9 Comment authors
gucci store onlinejimmy choo pumpsJonLegacyflyerBarry Carol Recent comment authors
newest oldest most voted
gucci store online
Guest

thank you for share!

jimmy choo pumps
Guest

This bag is coated in supple yet classic black suede plus exotic elaphe snake, And trimmed with suede. This black suede handbag with flame detail in red elaphe snakeskin is greatest day bag with a rebellious edge and ultra luxe finish. The double handles with gold tone clasps harmoniously matched with seen the bag. The whole design gives you a very gorgeous looking bag that can be very hard to resist. think the hefty price, 2250.00, Every detail is the reasons that women will cry over to get a piece.

Jon
Guest
Jon

Sadly, I have to admit that I feel the same as many of the healthcare workers polled. Had I known 10 years ago what I know about healthcare now, I likely would have chosen another profession. I understand that healthcare costs are out of control, but the “do more with less” mentality charging ahead on the backs of clinicians isn’t the solution. Healthcare providers, from nurses to physicians, are under enormous pressure to be perfect or drown in lawsuits trying; all for a paycheck that hardly makes up for the 6-8 years of college they have attended and paid heavily… Read more »

allan
Guest
allan

Barry C.”What I’m most interested in and concerned about is his ability to diagnose my problem or complaint and recommend an appropriate treatment or provide a specialist referral if needed.” Then you are most interested in seeing to it that the physician chooses the best methodology for him rather than the elitists who have never practiced private medical care without their own caravans of people following behind to do the scut work. Just in case you don’t realize it physicians use the highest tech around and are comfortable with change. Physicians are surrounded with computers and used to them. What… Read more »

Legacyflyer
Guest
Legacyflyer

Barry, I think you are confusing using a computer with using a poorly designed, proprietary electronic medical records. They are not the same thing. To understand the difference, you need only to go back to the post about the Residents at Oregon who created their own electronic database of patient records (of course it was not HIPAA compliant) rather than having to use the University’s horrible, proprietary EMR. They were clearly not against computers, just bad software! I have been using a computer since the early ’90’s, was a leader in my groups adoption of PACS and Teleradiology. I still… Read more »

Barry Carol
Guest
Barry Carol

I’ve experienced both sides of this issue from a patient’s perspective. My New York City based cardiologist / PCP is brilliant, I think, and has taken good care of me during the 15 years I’ve been his patient. Over that time, I’ve built up two large folders of paper files containing test results, office notes, surgery reports, etc. Sometimes, as he flips through them, he can’t find what he’s looking for. When I need a prescription, he either writes it out if I’m in his office or, if I need annual renewals for my maintenance drugs, he sends me paper… Read more »

Nhan H Nguyen
Guest
Nhan H Nguyen

While I applaud your idealism, the reality of the current healthcare landscape is an entirely contracting system – do more with less. While access, innovation, technology intervention, new knowledge, and other advances in medial delivery have improved patient opportunities, these and other factors add demand to the system. Supply in human capital and resources most importantly are limited and in short supply. This ultimately results in an unbalanced equation and places stress on healthcare workers. Without resources to boost medical education (and therefore positions), we are left with the “do more with less” scenario.

Elliot Barry
Guest

Your Blog is really informative. i am agree wit you that health reform’s simultaneous push to expand access and reduce costs is imposing greater rationality on the system through a combination of innovation and administrative control. So many resources are now devoted to things like work redesign and electronic medical records that we are forgetting what is needed most—people on the front lines of patient care who can do their jobs in ways that are competent, caring, and self-fulfilling.

Perry
Guest
Perry

Unfortunately, we dinosaurs that believe in face to face interaction with the patient are going to be eliminated with this new Medical Industrial Complex . I agree Allan, I think what is wanted is Medibots who will crank out treatments strictly according to guidelines and proficiency in documenting gobbledy-goop on EHR.
I have low hopes for this new system, I can quit working in it, but unfortunately may have to be a patient someday.

allan
Guest
allan

If what you say is true in your editorial the ACA couldn’t have come at a better time. With such a demoralized physician population we need a new breed of physicians trained in moving paper in triplicate and setting their eyes on a computer screen instead of the patient. The businessmen can come in and run the show. Out with the old doc and in with the new MBA entrepreneurs. For instance the new ACO entrepreneur can figure out all the ways of saving money by denying care and subsequently gaining such amazing profits that in gratefulness he can give… Read more »

Legacy Flyer
Guest
Legacy Flyer

“Greater attention must now be paid to improving the everyday circumstances of health care workers …” It will never happen. Everything that has been happening has gone in the other direction. – Malpractice is just as bad with no help in sight. Certainly not from the Democrats/Trial Lawyers. – EHR have made physicians less efficient, while providing patients no benefits. – Meaningful use has been a pain. – ICD-10 coding will be another big pain. I heard an expert estimate that many docs will need a 3 month line of credit because of the cash flow problems it will create.… Read more »

allan
Guest
allan

Legacy Flyer, if you have enough time and strength left don’t quit, go private. It doesn’t work for everyone, but it has worked for a lot of people. There are always those that need treatment and aren’t getting it timely enough. Things will get worse in the ACA world and more people will learn to pay for private care which costs a lot less than government care.