Given 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.