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.

12 replies »

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  2. 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 for. We just passed the most sweeping healthcare legislation in the history of the US and yet it completely ignored tort reform – one of the most pressing, expensive, and broken aspects of US healthcare.

    We need to work for a system that encourages patient-provider relationships and places responsibility for outcomes on patients as well as providers. If providers are dissatisfied with their jobs, drowning in regulation and always afraid of litigation, we will continue to have a system with high costs, poor patient outcomes, and provider shortages.

  3. 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 they are not comfortable with is having to use a bureaucrats way of thinking that has been incorporated into the EMR’s. EMR’s should be left to develop organically. The biggest obstacle to the development of integrated EMR’s so happens to be government policy. One small example would be the Stark laws. The other would be as Legacyflyer says the imposition of government software that helps government, but not the patient or doctor.

  4. 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 hate bad software.

  5. 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 prescriptions through the mail which I then send on to my mail order pharmacy. Since he and all but one of the other docs in his group practice were at least 62 by 2014, he/they do not have to adopt electronic records.

    My new local PCP who I’ve been seeing for over a year now is part of a group practice that uses electronic records and the practice is also part of an ACO. One of his assistants enters some of the data into the computer such as vital signs and my initial drug history. He enters additional data based on what he finds after examining me though he, like most docs, complains about the electronic system. He says it wouldn’t be so bad if someone else could do most or all of the data entry. Prescriptions for acute drugs are sent electronically to my local pharmacy and maintenance renewals are sent electronically to my mail order pharmacy. When I come for a follow-up visit, he can easily see what was done recently and what drugs I’m taking.

    The fact that he has to spend some time entering information into the computer rather than looking at me doesn’t bother me in the slightest. 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. There may be lots of information available to him electronically to help determine a diagnosis that didn’t exist in such accessible form in the old days. My bottom line is that electronic records are a good thing though I understand that there is an annoying learning curve during the transition from paper records. I didn’t like having to learn how to use a computer in my field either but, after a short time, I wondered how I ever functioned without it.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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 some of it back to society via the Democratic party. We have already seen such donations by hospitals, pharmaceutical companies and the AMA if not with money, then with support of the ACA.

  11. “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.
    – According to some “experts”, nurses can do just as good a job as docs. So why did I bust my hump in Med School and Residency?

    As for me, I just need to hang on for a couple more years before I can retire. As they say in Old Mexico City – AMF! Adios My Friend – or something like that.