She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable for all of her primary care needs. Since she had not received a mammogram that year, or received a diabetes screening, he incurred an end-of-the-year penalty for failing to meet these quality standards.
Is it any wonder that many providers — primary care physicians, physician assistants, and even many beleaguered specialists — are increasingly dissatisfied with their jobs? What is happening to medical practice and what can we do to bring the joy back to being a health care provider?
am early into a one-year quest to connect with leading thinkers from inside and outside medical care, so I can better understand why many clinicians are miserable in their careers, and much more importantly, what can be done to help them thrive at work even though an increasing number of outside parties are looking over their shoulder, assessing the quality of the care they provide.
These increasingly burdensome rules and regulations are making it hard to enjoy medical practice these days. Several decades ago, physicians largely practiced as autonomous professionals, governed by standards developed by their professional peers. Physicians underwent intense and prolonged training to develop the knowledge and skills to know how best to help patients with their problems. And the world generally stood back and accepted, on faith, that most physicians would provide excellent care to most of their patients.