Dr. Nancy Gagliano, Chief Medical Officer at Culbert Healthcare Solutions.
In an era of increasing physician burnout, it is critical to understand core motivators that affect physician satisfaction., We all have intrinsic and extrinsic motivators that contribute to job satisfaction. Intrinsic motivators for physicians are the “Why I went to medical school,” while extrinsic motivators include factors such as autonomy, resources, leadership, community, and appreciation. While many may think a “full waiting room” is a sufficient motivator for physicians, understanding what truly motivates physicians is essential to developing a road map to improve their satisfaction.
A typical physician finds satisfaction in providing high quality care, learning and discovery, delivering excellence and “making a difference.” While all healthcare organizations value these core elements and often include these in mission statements, it is likely their regular communication to physicians is focused on EHR deployment, MACRA, Pay for Performance, productivity and other such initiatives. Organizations should step back and commit to a balance of communications highlighting business imperatives while consistently embracing and recognizing its core mission.
In addition, business units should consider these attributes when working with physicians. For example, the revenue cycle team may view the EHR documentation as a tool to support compliant coding and charge capture and thus communicate deficiencies to physicians. It is important to recognize that physicians see the value of the EHR to share clinical information to enhance patient care, while all other components are viewed as a burden. Therefore, business units should remember to highlight what is valuable to the physician and the importance of accurate and timely billing for their patients.
External motivators are those that the organization can impact directly. These factors include: Autonomy, Resources, Community, Leadership, and Appreciation.
Autonomy falls into three areas: environmental, financial, and clinical.
Environmental: We have come a long way from the autonomous, independent physician running their own practice, determining how hard they want to work, where they work, and who works in their practice. Today, many physicians work in practices managed by administrators and arrive for their assigned session hoping that the same medical assistant is there to support them. While standardization is essential for efficiency, no longer are diplomas or family pictures hanging in exam rooms.
Financial: Although physicians can impact their earning potential through specialty selection and productivity negotiations, many physicians are now salaried with only minimal ability to control their earnings.
Clinical: With quality program reports, guideline protocols and prior authorizations, we are telling physicians that the quality of care they provide without these programs, is inadequate. Given that a typical physician spends a decade on education and training, it is easy to understand that physicians feel insulted by these programs. While research-based guidelines and standardization are foundational to quality and reducing cost, they are often not well received by physicians. It is critical to understand and reinforce the importance of clinical autonomy for physicians when designing quality programs and highlight how standardization can be used to support physician excellence.
Unfortunately, as the complexity of healthcare has increased and revenue has fallen, the tasks falling onto the physician shoulders have increased, and a core contributor to burnout is insufficient resources. The EHR has increased the time physicians spend doing tasks previously done by others. There are numerous opportunities for organizations to reduce the administrative burden and increase productivity. These include EHR optimization projects, workflow analysis and process improvement, staffing right-sizing, and deploying virtual scribes. While seemingly costly, these efforts cost far less than the expense incurred with physician turnover.
Gone are the days of the physician cafeteria to break from the demands of clinical work and share challenging patient cases. Physicians now go room to room seeing patients, while performing the litany of administrative tasks during “lunch” and after hours. Today’s physicians are increasingly isolated. Organizations should actively look for ways to support the physician community, reduce isolation and provide outlets to share the emotional burden of patient care responsibility.
Physicians, like all employees thrive under effective leadership. Unfortunately, as physicians are inherently very individualistic, it can be challenging to find physicians who are strong, effective leaders of their peers. It is important to select leaders who have solid leadership qualities in addition to academic or other credentials. In addition, it is wise to invest in leadership development programs as well as coaching and mentoring.
Last, but certainly not least, physicians need to be appreciated and valued, just like everyone else. A culture of stoicism may lead organizations to think appreciation and recognition are not necessary for physicians. While balloons or “physician appreciation days” may not be appropriate for physicians, there are many other ways to demonstrate appreciation for the integrity, commitment and caring provided by physicians in a way that aligns with the integrity of their role.
Implementing organization change in an era of physician burnout may be daunting. There are tactics that organizations can take to improve physician satisfaction. Therefore, understanding what makes physicians “tick” can help leaders design an approach to reduce burnout and implement important change. Organizations are encouraged to develop and implement a plan which reduces administrative burdens, as well as, supports other motivators such as community, leadership, appreciation and autonomy.
 Shanafelt, T, Noseworthy, J. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proc XXX 2016 : 1-18
 Kao, A Driven Care: Aligning External Motivators with Intrinsic Motivation. Commentary: Health Services Research DOI 10:1111/1475-6773.12422