9 Top Challenges Facing Physicians
Feeling stressed? Overburdened by administrative requirements? Worn out by COVID-19? Or simply wishing you had more time to spend with your patients? You’re not alone.
Today’s physicians are juggling several obstacles and challenges, despite their devotion to the practice of medicine and the health of their patients. Plus, COVID-19 has upended the entire healthcare community, starting in early 2020. You may be grappling with a whole host of pandemic-related issues on top of the “ordinary challenges” of your chosen career.
Here’s an overview of some top challenges facing physicians in today’s healthcare climate.
9 Common Physician Challenges
1. Less Time with Patients
Are there any physicians who are truly satisfied with the amount of time they must spend with all their patients? Electronic documentation and other administrative burdens continue to cut in on the time physicians actually spend with patients.
According to a 2016 study in the Annals of Internal Medicine, physicians spent just 27 percent of an average day or shift with patients, while nearly 50 percent of their day was spent on electronic health records and other “desk work.” This imbalance can wear on physicians who desire to spend more time in direct patient care.
Creative solutions may involve streamlining work processes, sharing some responsibilities with advanced practice providers and other staff, changing your work environment, or finding ways to make every minute with patients count.
2. Regulatory Requirements
Physicians have to deal with a mountain of administrative burdens and paperwork on a regular basis. They have to report a steady stream of data and information to the Centers for Medicare and Medicaid Services (CMS) for reimbursement. The data reporting duties required by Medicare Access and CHIP Reauthorization Act, or MACRA, may never be very far from their minds.
Even with recent efforts by CMS to streamline the reporting process, “it’s a headache and will only be more so over time,” said Fred Bentley, managing director for the Center for Healthcare Transformation with the healthcare consulting firm Avalere Health.
3. Funding Challenges
Many smaller and independent practices may be worried about funding issues. “A big challenge is depending almost entirely on a third party for reimbursement,” said Alejandro Badia, MD, who co-founded the orthopedic care clinic OrthoNOW in Florida and serves as a chief medical officer. “The irony is that the onus of the increasing expenses is completely on the physician with those third parties, or the government not helping fund that.”
For example, physician practices are required to use certain kinds of technology, such as the electronic health record, but they have to come up with the money to fund it, said Badia. These types of challenges are driving more physicians to consider employment options vs. running their own practice.
4. Medical Staffing
A growing number of independent practices have been swallowed up by hospitals and healthcare systems in recent years, with the trend accelerating even faster among rural hospitals than urban hospitals, according to a 2016 report from Avalere and the Physicians Advocacy Institute (PAI). And a 2020 benchmark survey from the American Medical Association reported that only about 49 percent of physicians were working in physician-owned practices in 2020, down from 54 percent in 2018.
That can present staffing challenges to the practices that remain independent.
“Getting highly qualified nurses and administrative staff and keeping them is that much more challenging,” said Bentley. “It’s really tough. The smaller your practice, the harder your ability to remain competitive with salaries.” And while staffing is an ongoing challenge, the nurse staffing crunch has accelerated in recent months during the pandemic.
When physician shortages are the problem, both small practices and large health systems often turn to locum tenens physicians to alleviate temporary vacancies.
5. Ethical Dilemmas
Physicians also must confront a number of ethical challenges on the job, as they deal with life-and-death situations amid priorities that can pull them in different directions.
For instance, how do you balance patient needs with their ability to pay, or make decisions about expensive end-of-life care that only delays the inevitable? The pandemic created new ethical dilemmas that put stress on physicians, as some working in areas overwhelmed with COVID patients found themselves having to confront the possibility of rationing care.
The American Medical Association Code of Medical Ethics provides guidelines and building blocks for ethical practice, but each physician is responsible for doing their best within the circumstances. It can make for some very tough decisions on a daily basis.
6. Physician Burnout
Job burnout continues to be one of the biggest challenges facing doctors today. It’s not a new problem, as more than half of the physicians in a 2018 Medscape survey exhibited some signs of burnout. And a NEJM Catalyst survey on physician burnout and resilience found that 83 percent of clinicians and healthcare leaders believe physician burnout is a “serious” or “moderate” problem in their organizations.
“By and large, physicians are satisfied with the work they do, but they’re highly stressed, and stress is a predictor for or an antecedent to burnout,” said Elizabeth Goelz, MD, associate director, Institute for Professional Work-life; chief wellness officer for the medical staff, Hennepin Healthcare in Minneapolis.
The multiple challenges they face can all contribute to an increased risk for physician burnout. “All those pressures come together,” Goelz said.
And the repercussions can be dire—from doctors leaving the profession to entering a downward spiral in their physical and mental health.
The problem has also worsened since the pandemic began. A survey released in August 2021 from the Physicians Foundation found that 61 percent of physicians reported feeling burned out often. And 57 percent reported feeling “inappropriate feelings of anger, fearfulness or anxiety because of COVID-19.”
7. Financial Fallout from the Pandemic
The Medical Group Management Association (MGMA) reported in April 2020 that almost all physician practices took a significant hit in terms of decreased patient volumes and decreased revenues as a result of the pandemic. In fact, at that time, 97 percent of practices reported experiencing some type of negative impact from the pandemic. Many practices are still recovering from that financial hit or struggling to get back on track.
8. Ongoing Supply Chain Issues
Last year, personal protective equipment (PPE) was in short supply. And some items, such as nitrile gloves and sterilization wrap may still prove more challenging to source at times. Although the overall situation has improved, some rural communities may still run into occasional problems sourcing all the equipment that they need, as the American Hospital Association noted earlier this year. Reuters also recently reported that healthcare organizations are experiencing delays in sourcing items such as exam tables, defibrillators, and IV poles.
9. A Growing Telemedicine Emphasis
More opportunities for telemedicine mean more opportunities for physicians to see patients. That’s not the challenging part. Emergency measures were enacted during the pandemic to temporarily open the opportunity for physicians to provide care to patients via telehealth—the keyword being “temporary.”
Without permanent extensions, physicians would be unable to get reimbursement for providing care via telehealth, if they were even allowed to offer it. That might present a dilemma to some practices. However, many telehealth advocates are asking the Centers for Medicare & Medicaid Services to amend the proposed 2022 Physician Fee Schedule to permanently extend coverage for telehealth.
Increased Opportunities and Solutions
The ongoing shortage of physicians is predicted to stretch into the future, providing job security and expansive opportunities for those in the field.
“There is strong demand for your services, and it’s only going to get stronger,” said Bentley.
Plus, there is a much greater awareness of the prevalence of physician burnout and its serious repercussions, and a growing body of research focused on measuring and addressing it, noted Goelz. Individuals and organizations are aware of the problem, and its costs, which is progress.
"There's certainly more work to be done," she continued. "But it's moving in the right direction."
Physicians are also becoming better self-advocates for their own health and well-being and less accepting of the status quo. Whether asking for assistance, opting for a change in schedule, or changing jobs entirely, they know that ultimately, they have the power to make positive changes.
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