'Feeling like a cog in a factory': 8 leaders on what frustrates physicians

The sources of physicians' frustration the last few years have been numerous, from administrative burdens to strained relationships with patients to dwindling autonomy. 

Researchers recently found 43 percent of physicians said they would not choose to become a physician again. Of physicians, 62.8 percent manifested at least one trait of burnout in 2021, compared to 38.2 percent in 2020.

Leaders are honing in on the greatest issues with regard to physician burnout and dissatisfaction. Here are the top issues facing physicians, according to eight leaders.

Note: Responses have been lightly edited for clarity and length.

Thomas Corkery, DO. Chief Medical Officer at Canonsburg (Pa.) Hospital/Allegheny Health Network: The administrative burden of practicing medicine has gotten larger between electronic health records and the kind of authorizations. There's more need to get preauthorization for simple testing — preventive testing, diagnostic testing, echocardiograms, even bone densities, CT and MRIs. They require you to jump through a lot of hoops, and I think that beats physicians down.

Michael Ivy, MD. Deputy Chief Medical Officer at Yale New Haven (Conn.) Health: Nobody becomes a physician because they hope to feel like a cog in a factory. However, between meeting the demands of payers for referrals, denials of payment and increased documentation requirements in order to assure proper reimbursement and risk adjustment, as well as an increasing number of production metrics, it can be difficult not to feel like a cog.

On top of that, the default solution of many health systems for regulatory or medico-legal concerns is requiring clinicians to document more, even if the benefit is small. We blame the EMR for the increased time spent documenting, but much of that burden is not the fault of the EMR.

Another key issue is that the work physicians perform can be isolating. Physicians only come into the hospital if they need to be there, which means less social interaction with colleagues. The physicians who work solely in the hospital are very busy without much time for connecting with colleagues. Similarly, practicing in an office can be lonely. It is a smaller pool of people and everyone's schedule is packed. 

Eric Katz, MD. Chief Medical Officer at Banner Estrella Medical Center (Phoenix): It seems like people are no longer willing to trust anyone who is not in their immediate circle. As a result, patients trust their care team less, physicians trust their employers less and the close relationships between co-workers become threatened. It makes for an uncomfortable experience. Add to that the normal frustrations of increasing regulations, EHR systems that are not intuitive and we will have a challenging practice.

Oliver Mayorga, MD. Chief Medical Officer at the Lawrence + Memorial and The Westerly Hospital (New London, Conn.): Non-patient-facing work probably tops the list of issues. The increase in administrative and computer tasks can take away from the meaning and joy that physicians get from direct patient care. Additionally, the burdens and barriers of insurance authorizations can also detract from what many physicians expected from medicine. Lastly, at least in Connecticut and Rhode Island, the challenging malpractice environment continues to give doctors in these states some pause when considering whether to remain in medicine.

Ryan O'Connell, MD. Regional Director of Quality at Hartford Healthcare Fairfield (Conn.) Region: Physicians may be reluctant to publicly share this because of the optics of "blaming" patients, but many physicians, especially in primary care, are feeling much more strain because patients have more direct access to them, around the clock. In the height of the pandemic, patients were strongly encouraged to sign up for patient portals, which facilitate a kind of "email" with their physicians. At the same time, federal guidelines have pushed most health systems to provide immediate access to notes and test results — often patients see results before their physicians do, and this invariably leads to questions.

Although this is clearly positive for patients, the result is that physicians get many more questions in their "in basket" which they feel they must address, often on nights and weekends. Just this morning, I learned of a well-regarded local primary care physician who left primary care for an urgent care setting because he was overwhelmed by in-basket messages.

Karan Singh, MD. Chief Medical Officer at San Gorgonio Memorial Hospital (Banning, Calif.): I think what's going on has puzzled a lot of us physicians and physician leaders. There's definitely a generational change that's occurring with some physicians that are reaching retirement. They have been used to a different style of practicing medicine. They valued autonomy, independence from larger corporate structures. And we see the new generation coming in with different priorities: priding themselves on being profession driven and valuing being home more. 

The pandemic also heightened frustration and burnout, but not so much because of critical care or sick patients — that's what we live and breathe and what we went to school for — but I think it's the extra things that came with that. A lot of physicians like to be autonomous and the things that were rolled out during the pandemic did not allow us to practice that. There's still that frustration of being told what to do that hasn't settled well. A lot of physicians retired early so they would not have to deal with this.

And I think a lot of patients are frustrated with the system in general, and physicians feel the brunt of it.

Nancy Sudak, MD. Chief Well-being Officer and Director of Integrative Health at Essentia Health (Duluth, Minn.): Physician burnout and moral injury escalated during the pandemic and are currently compounded by the financial crisis health care systems are experiencing across the US. The primary drivers of burnout are:

  • Higher acuity and complexity of patient conditions.
  • Inadequate time to attend to complex patients' needs, let alone establish strong relationships.
  • Lack of control over workload.
  • Time pressure for documentation.
  • Chaotic work environments.
  • Burden of messages from patients who expect swift responses.
  • Failed recruitment for partners.
  • Inadequate staffing.
  • Sentiment that health care systems do not value physicians' time that is not generating income.
  • Feeling unappreciated.
  • Values misalignment between healthcare leadership and clinicians.
  • In some cases, mistreatment by patients and their families.

Donald Yealy, MD. Chief Medical Officer and Senior Vice President of Health Services Division at UPMC (Pittsburgh): While compensation, nonclinical clerical work and the electronic medical record are common sources of physician ire, I see a more pervasive and insidious set of concerns. The pace of change in everything about care expected of physicians serving patients has increased dramatically in the past few years; that, coupled with a sense of less gratitude and more hostility, serve to create a sense of "Why am I doing this? This isn't what I thought I'd be doing X years ago when I started." Change has always been needed in medicine, but the pace and the breadth today are dizzying, even for those freshly entering practice.

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