‘State Of The Union’ For America’s Physicians

The results of the biennial 2018 Survey of America’s Physicians, intended to “take the pulse” of doctors in the U.S., were recently released and tallied from responses of 8,774 physicians (along with 2,472 written comments). And the findings leave much to be desired. In yet another investigation into the plight of medical practice today, the trends discovered echo what we already know: the system is broken. If those on the front lines continue to be left out of the healthcare discussion, then the 46% of doctors who plan to change career paths will only be surpassed in the next survey.

Here are some of their findings (see complete work here)

  • 80% of physicians are working at full capacity or are overextended

  • 62% are pessimistic about the future of medicine

  • 55% describe their morale as somewhat/very negative, while 78% report sometimes/often or always experiencing burnout

  • 23% of their time is spent on non-clinical paperwork (meaning unrelated to patient care)

  • 49% would not recommend medicine as a career to their children

Of no surprise

“Physicians indicate patient relationships are their greatest resource of professional satisfaction, while electronic health records (EHR) are their greatest source of professional dissatisfaction.”

Loss of clinical autonomy, diminished time with patients, burdensome regulatory requirements and the EHR unfavorable design and lack of interoperability all contribute to dissatisfaction. With independent practitioners on the continued decline, now at 31%, due to rising overhead costs, the hefty price of EHR implementation, and volume-driven reduced reimbursements among other things, it is also not a shock 46% of physicians characterize their relationships with hospitals as somewhat or mostly negative. The environment has favored hospitals employing more doctors to the point it is becoming more and more difficult to remain independent.

Nearly 58% of doctors do not agree that hospital employment of physicians is a positive trend. This is likely due to the perverse incentives hospitals create that tether reimbursement to considerations that do not improve, but rather more often harm the highest quality of medical care. So-called “value-based” payments are anything but. The survey even found many hospital-employed physicians agreeing with this assessment.

Basically, their analysis concludes, there is a major misalignment between what drives physicians into the field in the first place, caring for patients, and what third party stakeholders outside of the doctor-patient relationship compel them to do (e.g. tedious data entry unrelated to clinical status, inefficiency and impersonal nature of EHR, government regulations). To understand the detrimental impact of EHRs and how they were thrust upon practitioners without their input or patient consent, review here. To appreciate the downward trend in physician morale from, in part, increasing clerical burdens, see here.


2018 Survey of America’s Physicians - Practice Patterns & Perspectives: An Examination of the Professional Morale, Practice Patterns, Career Plans, and Perspectives of Today’s Physicians, Aggregated by Age, Gender, Primary Care/Specialists and Practice Owners/Employees. Survey conducted on behalf of The Physicians Foundation by Merritt Hawkins. Completed September, 2018. See in full here.

**Please be sure to read the report's highlighted commentary submitted by physicians to appreciate the extent of the issues addressed only on a cursory level in this article.