The latest Gallup poll on employee engagement shows that almost 20% of employees are actively disengaged and only a third are on board. Gallup defines engagement as being involved in, enthusiastic about and committed to your work and workplace. Millennials are particularly worrisome.
With more doctors becoming employees of hospital systems, physician engagement is becoming an issue, and it concerns lots of people in the C-suite.
Many current trainees see medicine more as a job than a calling.
A NEJM article notes that corporatized medicine seems ripe for this critique. Joel Katz, who recently stepped down as the internal medicine residency program director of Brigham and Women’s Hospital after 22 years, notes that historically the missions of trainees and hospitals were better aligned. Hospitals were invested in residents’ education, and there was a shared commitment to serve vulnerable people. Today, Katz notes, most hospital boards, and leaders — even at so-called not-for-profit hospitals — increasingly prioritize financial success. Some hospitals view trainees more as an “inexpensive labor force with a short memory” than as doctors vested with medicine’s future. As educational missions are increasingly subordinated to corporate priorities (such as early discharges and billing documentation), sacrifice becomes far less appealing.
While these numbers may or may not be reflective of physician engagement attitudes, there are reasons why they might apply:
1. Doctors feel dissed.
2. Somebody moved the cheese and doctors are having a tough time adapting to all the change.
3. They are getting a mixed message. They are told how important it is to improve the patient’s experience when all they see is emphasis and measuring how much money they generate for their employees.
4. They resent highly paid hospital executives who have never treated a patient in their lives.
5. Administrivia and burdensome IT and compliance regulations are burning them out and distracting them from taking care of patients.
6. They are experiencing a deterioration of the doctor-patient relationship
7. They see more non-clinical career options and Plan B.
8. They are burdened with anxiety producing educational loan obligations
9. They no longer believe in the mission of their employers
10. They don’t trust their bosses
11. They feel like cogs in a capitalist machine
12. They feel abused and neglected
13. The opportunity costs of being a doctor are rapidly rising
14. Financial fear makes cowards of us all so they resent having to wear the golden handcuffs
15. They have a different generational persona
The triple aim of healthcare includes improving outcomes (quality and experience), reducing per capita costs, and improving population health. Some have proposed a fourth aim, bringing joy back into the practice of medicine.
But here is the RUB: resentful, unhappy, burned out.
Physician disengagement threatens to further erode quality and significantly impact patients. It’s a disease that needs immediate treatment or it will metastasize.
