Your peers on morale, money, and meddling
In what had already been a turbulent year in healthcare, on the brink of a roiling national Presidential election that might decide the future of the Affordable Care Act, we asked you, our readers, to weigh in for the 4th year on what lights your eyes—or your fuses—about your pediatric lives and lifestyles. And you didn’t hold back. The nearly 1000 responses seem to self-sort into 3 main “pain points,” but, as has been the case in previous surveys, it was the write-in comments that were the most attention grabbing. It’s clear that the road to pediatric nirvana is potholed with resentment over bureaucracies both private and public.
The trend lines here based on past survey years are cautionary.
Over 68% of respondents say their stress level at work increased in 2016, compared with 4 years ago when 34% stated that their stress level had either remained the same or decreased. Nearly 15% who answered said they are considering leaving private practice to become an employee of a hospital or other organization in 2017, compared with only 11% just 2 years ago.
Whereas competition from Minute Clinics and urgent cares has been cited in the past as a practice threat, the morale hangover now seems to also extend to advancements with which readers do everything from disagree to outright reject, such as telemedicine. Many question its clinical validity absent an actual physical exam. Others believe that although it was initially well intentioned to reach the underserved in remote communities, its genesis still bore a whiff of the stench of cost-cutting and “imposed efficiencies”— regardless of whether it yielded better patient outcomes.
Only 8.5% of survey respondents’ practices presently incorporate telemedicine, and over 65% state they won’t be introducing it next year, adding to their clinical disaffections with it a lack of financial incentives and prohibitive capital investment to launch it.
Compared with our first survey in 2013, in which “Not having enough time with patients” ranked next to last as chief challenges to their effective practice as pediatricians, this year it surged to number 2, cited by over 36% of respondents, outpaced only by “Dealing with insurance companies” at nearly 44%.
It’s clear from past surveys that pediatricians hold no financial illusions about their status on the lower income tier versus their physician peers. That said, some of the actions from insurance companies and states’ Medicaid programs have hit hard—even striking some pediatricians as punitive.
The fiscal pinch manifests itself in many instances in longer hours, more on-call duties, and, in some cases, a second job.
And while this year “Financial compensation” ranked only 4th on a 5-point scale (“Not important” to “Extremely important”) on “How important are the following factors to having a good lifestyle as a pediatrician?,” the sense from the accompanying comments is that the present reimbursement situation is neither tenable nor sustainable.
Of those who stated that they were “less optimistic about their ability to adequately care for patients in 2017 than in 2016,” “Inadequate reimbursement” was 1 of the 2 chief reasons cited, edging out “Healthcare reform” by less than a full percentage point.
Interestingly—and perhaps a commentary on how pressing other concerns are—as much as the reimbursement pinch is being felt, “Financial compensation” still ranked at the bottom when asked to name the “Top 2 challenges in 2016 to your effective practice as a pediatrician.” This matches its ranking 3 years ago.
Meanwhile, the jury is out whether the new Administration will offer relief, reward, or even more uncertainty for both payments and reform—and likely for patients’ access to care under public programs.
An overarching vibe in both the survey data and accompanying comments is that pediatricians are simply tired of being micromanaged. Regardless of the source of the interference, it is keenly felt and resented.
Whether it’s their clinical judgments being called into question by faceless insurance administrators, burdensome paperwork, or requirements for Maintenance of Certification (which many see as little more than expensive busywork), the recurring theme is that these activities take away from precious time with patients. To add to their irritation, many commenters believe these larded-up administrative burdens add little to the actual quality of care and outcomes.
Perhaps most troubling is respondents believe 2017 will bring more of the same. Of those who stated that their stress level had increased within the past year, 62% identified the key culprit in their stress was “Increased administrative work,” followed closely by “Ineffective or burdensome technology.”
Over 27% are considering a job change in the next 12 months, and almost 13% went from working full time to fewer than 40 hours a week. Still another 16% are considering such a switch in 2017.
Despite it all, however, responses to our annual end-of-survey inquiry—knowing what you know, “Would you still go into pediatrics?”—is positively character revealing. Remarkably, the response has consistently ticked within a percentage point or 2 each year of the survey, and this year is no different. Although many state they wouldn’t have chosen a medical career at all in retrospect, and dermatology came in in its perennial second place, it seems most pediatricians intend to continue to love their work and patients—soldiering on even in the face of an adverse practice environment they often feel is beyond their ability to impact.