Maintaining positive relationships with employed and independent physicians continues to be easier said than done for hospitals and health systems.
Physicians in every market size had similar issues, criticisms and concerns this year, most building on the complaints they had in 2012. Last year's issues are still troubling physicians, according to Rochell Pierce, vice president of physician relationship management with Aegis Health Group, but this year other challenges overshadowed the complaints of 2012.
While some issues from 2012 do not appear here, "it doesn't mean what was a problem last year has been solved," she says.
The following 10 complaints are what Aegis' physician relationship specialists have been hearing from physicians about the most all year.
1. Uncertainty about the future. Now that the Patient Protection and Affordable Care Act implementation is definite, physicians are left wondering how it will directly impact their practice. "There's still a great deal of uncertainty of how this will impact them and their futures," Ms. Pierce says.
This uncertainty has led to many physicians considering retirement. "We're hearing from older physicians that if they can retire, they are retiring. They're done," she says.
2. Financial concerns. Closely tied with general uncertainty of what the future holds are financial concerns. "Physicians feel they are working harder now to make what they were making 10 years ago," Ms. Pierce says. Congress continues to threaten to cut Medicare reimbursements, and physicians who want to remain independent are having a tougher time doing so, leading to unhappiness.
3. Medical group or employment onboarding. As hospitals also adjust to the new healthcare landscape, they are employing physicians or creating medical groups and recruiting physicians to join. As Ms. Pierce puts it, hospitals are "picking teams" and many physicians choose to join.
After the groups are created and the physicians leave private practice, though, hospitals are falling flat. Many hospitals haven't articulated an onboarding strategy for after physicians join. "Physicians join the groups and look at the hospital and say, 'You've got me, now what?'" says Ms. Pierce. "Physicians are getting a little frustrated with the lack of communication they're receiving from the administration and the institution."
4. Communication with independent physicians. Physicians that choose to remain independent are feeling undervalued and left out of hospitals' newly expanded network of employed physicians, according to Ms. Pierce. These independent physicians are then likely to take their referrals to other hospitals in the area. "They feel like they are now competing with the hospital," she says. Hospitals used to only have a few specialists employed, but now have a cadre of physicians of all specialties to include primary care, so physicians "see themselves as a direct competitor with the hospital."
To rebuild relationships with independent physicians, hospitals need to show the physicians they are still valued and they can rely on the hospital to provide not only excellent patient care and support whenever possible.
5. OR efficiency. Surgeons want to grow and become more productive, and they are looking to hospitals for help with increased efficiency in operating room turnover. "Physicians are telling us they need dedicated teams to do that," Ms. Pierce says. But that takes resources and time on the part of the hospital.
To meet this need, Aegis has created a surgical score card for different service lines, that a high-level team — think COOs, CMOs and OR directors — can use as the basis for discussions with surgeons about how the organization is performing related to efficiency, quality and other key indicators and what the hospital is doing to continue to improve.
6. Regulatory requirements. New regulatory requirement tasks take physicians away from what they want to be doing: caring for patients. "Physicians are spending more and more time doing things that aren't related to patient care," Ms. Pierce says. "It's a cause of frustration and concern for them."
7. EMR and HIEs. Tied to the last point, requirements around sharing information, electronic medical records and health information exchanges have physicians concerned about the use of their time and the cost to stay in compliance, according to Ms. Pierce.
8. Leadership requirements. New care delivery models, like patient-centered medical homes and team-based care, require physicians to take on more of a leadership role than they have in the past — and many are not trained or prepared to take on those tasks. "They're being pulled into committees and care teams, but they're ill equipped to be successful in that setting," says Ms. Pierce.
Hospitals can help in this area by setting up physician leadership academies. Hospitals can provide mentoring, education and workshops or bring in outside consultants to help develop physician leaders, which will ultimately lead to the success of the new delivery models.
9. General access to the hospital or system. Large health systems can be unwieldy, and communication, access and navigating the systems have been problematic for physicians this year. It is not easy for physicians, independent or affiliated, to get information on a patient or make a referral. "Hospitals have not done what is needed in regards to streamlining the communication process," she says.
10. Work-life balance. "This is always an issue," Ms. Pierce says. Indeed, it appeared on 2012's list of physician complaints. Physicians have new responsibilities beyond direct patient care — but many only want to work eight hours a day. "Those just don't match up," she says. "It will be a constant struggle for physicians to maintain work-life balance."
It is important for hospital and health system leaders to address these 10 complaints and continue to work closely with both employed and independent physicians to maintain a solid patient base and move confidently forward with changes under healthcare reform.