Survey Results: Doctors Say Morale Is Hurting
Jan.–Feb. 2007
Doctors are exhausted. They’re burned out. The stress of their work is causing marital and family discord. And nearly 60 percent of physicians who participated in a recent survey have considered leaving the practice of medicine behind.
Those are just a few of the findings of the first American College of Physician Executives Physician Morale Survey. Some of the physicians in the survey are resigned to the idea that low morale is here to stay.
“I think it is safe to say that no physician is optimistic about the future of medicine at this point,” one participant wrote. Others seemed downright hopeless.
“One thing that rarely gets mentioned is that unlike other industries that are cyclical, the practice of medicine continually gets worse and worse, more intolerable, more onerous, with absolutely no hope or reason for any optimism either in the near or remote future.”
There was little good news.
When asked to rate their own morale on a scale of 1 to 10 — with 1 as very low morale and 10 as very high — a majority of 54 percent of the doctors rated their own morale as 6 or higher, while 46 percent were 5 or lower.
But when asked to rate the morale of the physicians they work with, the numbers took a dive, with 59 percent rating morale at 5 or less, and just 40 percent rating it 6 or higher.
The survey was conducted July 15 through August 1, 2006, and drew responses from 1,205 physicians across the U.S. (A total of 7,000 surveys were mailed, with a response rate of 17 percent.) Judging from more than 330 comments written by those who participated, morale is very shaky.
No Exact Cause
The turbulent medical malpractice climate was actually one of the lowest ranked reasons for doctor discouragement. The number one reason was low reimbursement rates from insurers and government health care plans.
After low reimbursement, the other causes of diminishing morale included loss of autonomy, bureaucratic red tape, patient overload, loss of respect, and the medical malpractice environment.
Although it may seem like a drastic measure to combat the morale problems, the idea of getting out of medicine all together is an option many have considered. Almost 60 percent said they’d thought about it, and nearly 70 percent said they knew of at least one doctor who stopped practicing medicine due to low morale.
“Physicians age 45 and over have gone through a very demoralizing career,” one physician wrote. “My peak earning capacity occurred in my eighth year of my 23-year career so far. We have physicians around age 60 who are having to leave practice to find some outside source of income because their overhead is so high in comparison to their ability to generate an adequate income practicing medicine.”
Morale Maladies
Low morale manifests itself in various ways in different people. The doctors in the survey listed fatigue as the number one problem, coming in at 77 percent. Emotional burnout, 66 percent, was a close second.
Marital and family discord and depression were experienced by about 32 percent of the respondents, and 4 percent have had suicidal thoughts.
To combat the low morale, physicians in the survey:
- Talked to fellow physicians about the morale problems (53 percent)
- Searched for a job outside of health care (35 percent)
- Lobbied local, state, or federal - government for health care changes (27 percent)
- Sought personal counseling (26 percent)
- Sought substance abuse treatment (1 percent)
An analysis of the survey results compared to demographic information collected in the survey also found that doctors fewer than 50 years of age have slightly lower morale than those over 50. The younger set also suffers higher rates of marital discord and emotional burnout. And they are more likely than older doctors to consider leaving the practice of medicine. That probably comes as a surprise to some who think older doctors are likely to be the most dissatisfied. Females also were found to have slightly lower morale than males and were more likely to walk away from medicine.
A few other demographic highlights:
- Doctors working in academic medicine experienced the highest rates of fatigue.
- Physicians employed by insurance companies reported the lowest rates of fatigue.
- Doctors in group practices, hospitals, and academic medicine had slightly lower morale than those working in government, insurance, or industry.
Are Doctors Partly to Blame?
Some survey respondents said it’s not the health care system that’s dragging doctors down. Physicians themselves are to blame.
Gregg Broffman, M.D., medical director at Lifetime Health Medical Group in Buffalo, New York, and president/CEO of TransitionConcepts, Ltd — a partnership of health care professionals dedicated to facilitating change and transition management — said physicians need to face reality.
“It is long past time for physicians to look in the mirror and have a real heart-to-heart conversation with ourselves. Clinging to the notion of autonomy, ship captains, power, authority, etc. is a losing strategy. As German philosopher Friedrich Nietzsche once said, ‘Many are stubborn in pursuit of the path they have chosen, few in pursuit of the goal.’”
“If we accept the notion that the vast majority of us chose medicine for altruistic reasons, to help people, then we must realize that to do that in today’s world, the path to that goal must be different than we expected it to be, and that in all likelihood the path will change continuously for the rest of our professional lives.”
“Once we embrace new ways, we can potentially regain our right to lead the change. Once we embrace the grieving process, understand it, and work our way through it, we will see a dramatic improvement in health care and our morale.”
Doctors’ Advice
Despite the doom and gloom that many survey respondents expressed, some of the physicians were quick to diagnose the problems and offer some remedies.
“When I feel beaten, stressed, or burnt out, I remind myself that this is still the career of choice for me,” one doctor wrote. “I love the practice of medicine, and my patients, and the challenges. But I truly appreciate my family (husband and son, as well as siblings) and friends, and time away from the office… I am slowly allowing myself to spend more time at leisure…and scheduling time off.”
Another said setting limits is important.
“One of the major sources of stress seems to be more the pace and the amount of work and balancing that with our life outside of work. With technology available today, you can essentially have the ability to always be connected to your work responsibilities. I know of more physicians now finishing their documentation and checking their e-mails at home after they have completed a long day of seeing patients. We need to make a conscious effort to “end the day” at some point and put as much effort into our personal lives and time.”
Source: Edited and reprinted with permission from the American College of Physician Executives (ACPE). “Physician Morale Study,” 2006, Bill Steiger. For the full article and more study highlights, visit www.acpe.org/morale.
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