You’d be forgiven if, on March 30, you didn’t set aside time to celebrate Doctors’ Day. Admittedly, it’s not the most important holiday on the national calendar. On my end, I heard from a few friends and colleagues, and we all expressed our appreciation for the well wishes and cards.
And then we discussed what it’s really like to practice medicine these days.
Which leads me to posit that it’s time to focus less on “days” and more on showing consistent appreciation for the work of healthcare workers—skilled professionals who work in the service of others.
I’m not alone. Several people told me that while they appreciate trinkets bearing corporate logos, greeting cards and even gift cards, they simultaneously feel like the existence of these “days” offers organizations absolution for their working conditions.
Physicians in particular seemed to express this sentiment. Perhaps that’s not surprising. The notion of physician burnout has been well-discussed. Different reasons for it have been proposed, but I stick to the idea that the main cause is invisibility—which is to say, in an industry increasingly dominated by large, vertically integrated companies, doctors feel small and powerless. This idea is backed up by some interesting data: nearly 75% of physicians are employed by a hospital, health system or corporate entity. At the same time, research that finds that burnout rates are lower among physicians who own their own practices.
No wonder, then, that cheery Doctors’ Day notes ring hollow in the context of broader professional devaluation.
But it doesn’t have to be this way. Here are five steps that the hospitals, health systems and other entities that employ physicians and other healthcare professionals can revalue their work and give it the prominent place of honor it deserves.
1) Welcome and invite clinical perspectives into organizational decision-making. People who work in healthcare systems know that too often, they are run by career administrators without medical degrees. In and of itself, that’s not a bad thing. I’ve worked with and been mentored by several talented administrative executives without clinical training who were expert at putting patient care at the forefront of their organizations’ priorities. On the other hand, a well-known study shows that “Hospitals in physician-led hospital systems had higher quality ratings across all specialties.” Too many health systems treat clinical leaders as employees to be managed instead of bold thinkers who bring expertise to the table. Involving them in top-level decision making would go a long way to showing them that they’re not merely cogs in an impersonal system.
2) Compensate physicians fairly against market wages for their roles and levels of expertise. Let’s be honest: physicians aren’t starving. And yet, that doesn’t mean they’re always fairly compensated for their work, especially when one takes into account their training and expertise.
It might surprise people to know that 38% of physicians say they’re unsatisfied with their pay and 52% say physician pay itself is not fair or equitable.
Why do doctors feel undervalued? They say they’re not compensated for the time they spend with patients—particularly those whose conditions they manage outside of office visits. They also note that peers in other industries without the same levels of education, training and seniority often make more than they do. Also, they point out that physician pay usually fails to keep pace with the rate of inflation. To be clear: there is no healthcare without physicians, and that’s as true for a primary care doctor in a large health system as it is for a superstar surgeon with a half dozen fellowships under her belt. Both should be rewarded for their value—and a simple way to do that is to pay them what they’re worth.
3. Cease labor arbitrage practices in which physicians are replaced by less expensive, less skilled professionals. If you’ve booked an appointment with your physician lately, you may have been surprised to find that you were evaluated and treated by someone else. In the face of rising wages, labor shortages and increased demand—particularly on the heels of the pandemic, when many people forwent treatment—many healthcare companies have taken to supplanting physicians with other, lower-paid clinicians. Sometimes this makes sense. Much work done today by RN’s for example, would have been done by physicians 25 years ago, and we’ve seen no negative effect on patient health.
However, healthcare is defined as much by complexity as anything else, a fact many systems ignore when they place patient care under the purview of individuals with different levels of professional training, and without clearly defined parameters delineating where and how patients are best served—other than cost, of course. In these cases, patient care suffers, physicians are demeaned and their worth is devalued. Ensuring that complex cases are treated by highly trained people prepared to address complexity—which is to say, physicians—is one way to restore dignity to the profession and improve outcomes.
4. Recognize and acknowledge the moral tensions healthcare professionals live with every day.
Is end of life care appropriate for the patient?
Should an expensive treatment be tried when less expensive options have been exhausted?
Should I perform a diagnostic treatment on an elderly patient?
How do I tell my patient’s family that the diagnosis is terminal?
These questions represent a small fraction of the difficult choices healthcare professionals face every day. And yet, especially inside large health systems, it’s assumed that a series of protocols is sufficient to navigate these thorny issues. I’m not calling for health systems to make decisions for health professionals; but I am calling for them to acknowledge the moral and ethical complexity inherent in the practice of healthcare, and to honor the people whose job it is to make difficult decisions by acknowledging repeatedly both the difficulty of making those decisions and the sheer bravery it takes to confront them.
5. Ensure that all healthcare workers have access to excellent healthcare benefits. Many companies struggle to determine how much of the cost of healthcare their employees should bear. Healthcare companies shouldn’t be among them. Pricing your own employees out of your life-saving product makes little moral sense. It also doesn’t make economic sense, since healthy workers are more productive and therefore more likely to produce better outcomes.
Additionally, making their core products affordable to the people they employ is an obvious way for employers to demonstrate their appreciation for their work. To burden them with high costs is as misguided as it is insulting.
The “Days” Ahead
I’m not a curmudgeon. I like celebrating colleagues and being celebrated by them. And I’ll admit that special “days” have a place in the fabric of appreciation for clinicians of all kinds. Nevertheless, I can’t tell you how many people quietly complain that “days” often feel like from a cynical deflection from some of the bigger issues plaguing the health professions.
It’s those issues we should fix before we run out to buy greeting cards.