Is the American dream dead? Many Americans believe so. According to a New York Times poll, only 64 percent of respondents said they still believed in the American dream, the lowest rate in nearly two decades.
Pessimism is widespread and is even more potent now than it was during the depths of the financial crisis — in 2009, 72 percent of Americans still believed hard work would lead to big payoffs, according to the NYT.
The timing of the poll's results is interesting because economists say the economy is at its highest point since the recession. Furthermore, the nation added 321,000 jobs last month and average hourly earnings have increased much more than expected. That, combined with lower oil prices, puts more money in the wallets of average Americans, according to the NYT.
So, why the sad face? Is the Gatsbian notion of the American dream — the promise that through hard work, anyone can transcend the boundaries of inequality and get rich — merely a romantic vestige of the past, a fallacy? Is the American dream hopeless? Is the green light simply out of reach?
Perhaps. Or, maybe Americans have shifted their idea of who's to blame for their inability to attain the dream. According to the NYT's poll, the majority of respondents, 54 percent, said they were more concerned that over-regulation in Washington would limit economic growth than they were about inequality.
Sounds familiar. One of the biggest complaints in healthcare is the burdensome, often excessive regulatory demands of the Patient Protection and Affordable Care Act, including the regulations of meaningful use and the two-midnight rule, as well as preparing for the implementation of ICD-10, among others.
The law is further exacerbated by Congress' inability to cooperate across the partisan divide, most recently demonstrated by the lawsuit House Republicans, led by House Speaker John Boehner (R-Ohio), filed against the Obama administration over unilateral actions he took on the healthcare law regarding the employer mandate and subsidy payments to insurance companies.
The belief that politics and regulations play too heavy a hand in healthcare — and more importantly, the seeming inability to effectively adhere to the many demands of these regulations — has led to increased frustration across the industry. According to the biennial "Survey of American Physicians" by Physicians Foundation and Merritt Hawkins, 46 percent of physicians would give the PPACA a failing grade, while only 25 percent would give it an A or a B. One half of respondents believe implementing ICD-10 will cause "severe administrative problems" in their practices, and three-fourths believe it will "unnecessarily complicate coding."
Industry-wide dissatisfaction is endemic. Nearly a quarter of physicians (23 percent) said they would not choose to become a physician again if they could turn back time in a survey by The Medicus Firm, and 21 percent of respondents said they would not choose a career in healthcare at all.
Also, 61 percent of physicians who experienced a pay cut last year would not encourage a young person to pursue a career in the medical field, according to a survey by Jackson Healthcare. Notably, only 35 percent of physicians whose income increased in the past year reported they would be very likely to recommend such a career path.
Such negative outlooks are troubling, to say the least, and cast doubt on the industry's ability to achieve its goals of providing high-quality healthcare services at low costs to as many people as possible with this level of demoralization.
But it's not all bad, Old Sport!
Yes, the stakes of a dissatisfied, disengaged workforce in healthcare are higher than some other fields because essentially everyone depends on medical professionals for care. But keep in mind, dissatisfaction occurs in all industries. And, more importantly, it is not irreversible.
Surveys such as the ones cited above shed light on the degree of dissatisfaction experienced by the healthcare workforce and help healthcare leaders understand what factors they should aim to remedy. There are ways to combat dissatisfaction and turn it around. It may not be fast or easy, but it's possible.
While changing the way politics and regulations challenge the everyday operations of the healthcare workforce may be an unrealistic undertaking, there are other ways to combat discontent.
A prime example is the recognition that certain foundational principles in healthcare are in a need of a makeover. Healthcare's triple aim — enhancing patient experience, improving population health and reducing costs — is the commonly accepted set of top priorities in healthcare systems across the nation. Although they're all important goals, the triple aim fails to address a critical component of the healthcare model: the providers. By including a "fourth leg" to the triple aim, one focused on improving the work life of healthcare workers, overall system performance will improve and rates of satisfaction will rise.
Addressing the day-to-day concerns and setbacks contributing to burnout is a solid first step. Most physicians cited the amount of time spent performing "secretarial" or administrative tasks encroaching on time with patients, the lack of autonomy over their schedules, isolation and unrealistic timeframes for implementing change as the major factors contributing to dissatisfaction. Implementing strategies to help alleviate these everyday concerns can go a long way.
Sometimes, in the face of seemingly unsurpassable challenges and discontent, pessimism is easier than change, but it's a choice. The road to achieving the goals of the U.S. healthcare system may seem riddled with hurdles, but it's not impassable.
Here is what some CEOs had to say about their outlooks on the future of healthcare at Becker's Hospital Review's CEO Roundtable this past November.
Julie Manas. President and CEO of Sacred Heart Hospital (Eau Claire, Wis.).
I am optimistic because I see all of you here willing to learn and share best practices. If I’m not optimistic as a leader, I can’t expect those taking care of patients will be optimistic. We have to mold ourselves to the changing environment rather than being rigid.
Ora Pescovitz, MD. Former CEO of University of Michigan Health System (Ann Arbor).
I’m extremely optimistic, too. Darwin said those that best manage change survive. There are dramatic changes, new discoveries and advancements all across the industry. I think the future is very bright.
Jim Rohan. Vice President and Managing Director of SullivanCotter and Associates (Chicago).
This is a great opportunity to reinvent yourself. You’re not the first CEO to go through this stuff. There are a lot of lessons to be learned from auto, banking and other industries.
Alan Channing. Former CEO of Sinai Health System (Chicago).
I’m bullish on healthcare reform and bullish on today’s environment. This is a tremendously exciting time, and I think each of us has said we’re excited because we’re leaders.
Chuck Lauer. Former Publisher of Modern Healthcare (Chicago).
I’ve been in healthcare for about 50 years. Look at the quality of the people on this panel. They’re all adapting to change. This is a great industry and will continue to be, and the quality of people in this industry is better than any other industry. I think the future of healthcare is great, and this is an exciting time to be here, and I applaud the professionals in this industry.