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    88th annual Physician Report: Ambivalence wreaking havoc in primary care

    Like many physicians, Ann Brotzman, DO, thinks of medicine not just as a job, but a calling. Nevertheless, when her 20-year-old son announced recently that he wanted to become a doctor, her reflexive response was: “Why”?

     

    Further reading: 88th annual Physician Report results

     

    An internist in a two-physician practice in Nazareth, Pennsylvania, Brotzman felt surprise at hearing her own reaction to her son’s plans. “I felt bad as soon as I said it,” she recalls. “But it’s the way I feel right now.”

    Brotzman has plenty of company, according to the 88th annual Medical Economics Physician Report. When asked whether they would recommend that their child or a friend’s child pursue a medical career, 36% of primary care providers (internists, primary care/general practitioners and pediatricians) said they would not, 25% said they weren’t sure and only 39% said they would. 

    Similarly, when asked if they would pursue the same career again, half of primary care respondents said they would, while half said they would choose a different specialty or another career entirely.

    The findings of the latest Physician Report reflect the sense of ambivalence among many primary care physicians regarding their chosen profession. It is an ambivalence born in large part from frustration with the mountains of paperwork and seemingly endless government mandates and reporting requirements that eat up ever-larger chunks of their time.  

    Add to these the ongoing financial pressures resulting from stagnant reimbursements, rising overhead costs and time spent on uncompensated tasks, and the result is high levels of stress and emotional exhaustion—symptoms that psychiatrist Vania Manipod, DO, frequently sees among her physician patients in her Ventura, California, practice. 

    “Typically they’ll say they’re struggling with keeping up with work, or they can’t balance home life with work life the way they’d like,” she says. “But it’s also a feeling that they have no sense of control over their practice and their ability to do what brought them into this career, and that’s being able to focus on their relationships with patients.”

    The growing emphasis on teamwork in healthcare delivery gives physicians the opportunity to delegate some tasks, but that’s often easier said than done, notes Russell Libby, MD, a board member of The Physicians Foundation, an advocacy and educational organization for doctors, and a practicing physician himself. 

    “Many doctors find it incredibly difficult to hand off responsibilities that they felt were originally theirs. They feel if they don’t have total control it won’t be done properly,” he says. “So we see some docs saying they spend up to 40% of their day on non-patient-related chores, and that’s probably greater in primary care because of the trend toward value-based and patient-centered practice models.”

     

    Hot topic: Black female physicians face challenges just doing their jobs

     

    But even with the frustrations and relentless time demands facing today’s primary care doctors, many still find ways to maintain their enthusiasm for practicing medicine while balancing their personal and professional lives. Here are a few of their stories from respondents to this year’s survey. 


    Ann Brotzman, DO
    Nazareth, Pennsylvania

    Type/size of practice: Internist in two-physician, hospital-owned family medicine practice
    Years in practice: 21 Number of patients seen in a typical day: 22-26
    Hours in typical work week: 50-57

    Biggest source(s) of stress: “There’s this expectation from patients that everything has to be done now. Results come in constantly. Patients constantly call, they want answers right away. I’m sitting in front of my computer now [during a Friday afternoon off], as a matter of fact, and my husband [also a physician] is next to me with his computer on. It just never stops.

    “You have a task list, and if you don’t look at it for a day it could get up to like 60 or 100 very easily. And it’s stupid stuff—you have to check off whether they saw the podiatrist—or it could be a critical lab value. You wonder, ‘Jeez, am I missing a protime that’s through the roof, or a pneumonia?’ So that adds a level of stress. 

    “I go in an hour early in the morning, just to get prepped, and that’s fine. But now there’s no lunch hour. If you get done by 12:15 you’re shoving food in and you’re typing away while you’re doing it. There’s barely time for a bathroom break. 

    “I believe there’s been kind of a cheapening of medicine and we [physicians] aren’t as valued as we used to be. We’ve been put on an equal level with pharmacists and nurses. What your chiropractor tells you, what your pharmacist tells you, what I tell you, it all has the same level of importance.”

    Next: "The absolute number one bane of my existence"

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    • [email protected]
      Nice comments and I probably agree with most. Perhaps you should have also interviewed a private solo DPC physician. You might have found a doc who actually enjoys practicing and is mostly removed from many of the distractions/intrusions mentioned by the docs in the article.

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