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Physician Retention: SatisfactionPart 3 in a Series

Katz, Barbara

doi: 10.1097/01.EEM.0000313920.01362.86
Career Source

Ms. Katz is the president of the Katz Company, an emergency medicine consulting firm dedicated to providing expert physician recruitment services and training emergency medicine residents in effective job searching.



I asked a wide range of emergency physicians what job satisfaction means to them. More than 98 percent of the answers included the same three words: people, respect, and trust.

Nearly every respondent said the most important factor in achieving job satisfaction is the people with whom they work, or as Thomas Falvo, DO, emergency medicine residency faculty at York Hospital in Pennsylvania, said recently, “It only takes one bad apple to upset the balance of an entire group. Hire in desperation; regret it forever.”

The next two most important factors for job satisfaction were mutual respect and trust from medical staff colleagues and hospital administration. But when I asked how many were experiencing job satisfaction at this time, less than 40 percent said they were, and under 60 percent said they had never experienced job satisfaction at any time in their careers.

One physician who is experiencing job satisfaction, Tony Guarracino, DO, the director of the emergency department at Carlisle (PA) Regional Medical Center, put it this way: “I am respected and valued by my employer, staff, and patients. Respect of an employer equates to reasonable salary and work environment with my employer's actions demonstrating my importance to them. My job satisfaction comes from congeniality and respect among the ED docs, respect within the medical staff, respect from administration. Call me Aretha Franklin: R-E-S-P-E-C-T!”

What makes most physicians smile on a day-to-day basis? When the ED team works together like a well-oiled machine and when patients and their families acknowledge their efforts with simple thanks. What makes physicians feel depressed and stressed out? Many mentioned a lack of time to spend with patients and no time to decompress between patients due to overwhelming volume and not enough coverage. Abusive patients were another issue as was the increase of nonemergent patients in the ED “who are often very whiny and demanding,” as one doc described them.

Another response I found interesting was from one physician who said negativity among the team took the life and fun out of an already challenging environment. Here's another of my favorite comments: “The onslaught of patients, volume, and nonstop ambulance traffic. It's akin to trying to bail out a ship taking on water with a teacup!” Other stress factors included long, complicated, and uncompensated IT/charting responsibilities at the end of a shift; lack of cooperation from nursing, other medical departments and administration; and, of course, inadequate compensation for the work being done.

My survey on EP job satisfaction certainly proved one thing: emergency physicians have a lot to complain about and few avenues for venting. Veteran emergency physician Harry Kintzi, MD, of Lancaster, PA, tried to put some of this into perspective. “Physician maturity and experience significantly [affect] job satisfaction. I have seen younger/starting physicians with an enthusiastic ‘I can handle anything, no problem’ attitude change as volume increases, night shifts take their toll, and small hassles become large ones. After a while, hassle factors cause physicians to try to correct the hassles or look elsewhere for a job.”

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EP Burnout

Early emergency physician burnout isn't new, but the percentage of EPs in danger of succumbing to it appears to be growing. Dr. Guarracino said overwork, lack of job satisfaction, and immaturity contribute to it. Another physician said burnout also stems from “high liability mixed with constant worry about patient perceptions mixed with increased volumes and ok-at-best compensation.”

“When lives are on the line,” he said, “worrying about crafting your sentences just right or checking every box so we might get some payment for our service is beyond irritating.”

One physician made this interesting observation: “Ironically, because emergency medicine has supposedly become so much better, emergency physicians now enjoy the worst lifestyle of any specialty. The funny part is, 30 years ago, when I started, it was considered the best lifestyle!”

This physician went on to say that “an important aspect of provider satisfaction is the workload and its impact. There can be real conflicts of interest between the leadership of a group and the providers. The number of shifts required to make a decent living can [affect] families and lead to real problems.”

A significant number of emergency physicians said declining quality of life was a serious factor in their lack of job satisfaction. They reported that longer, more difficult shifts were taking a toll on their ability to recover and enjoy quality time with their families. I asked if fee-for-service compensation models contributed to this factor by creating dangerous competition between emergency physicians working on the same team. Responders primarily said that was not the case. “Competition is not necessarily a bad thing,” one physician said, “as long as the EPs recognize that there is plenty of work to go around. I've also seen EPs with the reputation of being slow improve their numbers when the difference is seen in their personal bottom line.”

Another physician pointed out, however, that “any competitive model that keeps the doctor literally running to keep up his paycheck leads to burnout.” One response seemed to put the majority's thoughts into a nutshell: “Fee-for-service on top of a baseline salary lets an EP determine just how hard he really wants to work. If the physician chooses to make as much as possible, this can be more stressful. But at some point, money just doesn't really matter as much as a balanced life does.”

When it comes to competing for fee-for-service/RVU compensation, Dr. Kintzi had this advice: “Change competition from ‘among yourselves’ to ‘between you and the better you.’”

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Finding Satisfaction

I asked the emergency physicians in my survey what new practice trends and innovations should be implemented in the ED. Many asked to have doctors or PAs in triage. In fact, more than 75 percent of the answers referred to improvements in triage. Dr. Guarracino reported that his group hired a patient concierge to greet people as they enter the ED and to help them while they wait. Other physicians agreed that improving patient care delivery is directly linked to improving physician job satisfaction.

I also asked emergency physicians if they would be willing to give up a portion of their income for a guaranteed increase in job satisfaction, and if so, what percentage they would be willing to lose. Responses were split. At least half said they would be willing to give up as much as 10 percent of their income for a guaranteed reduction of stress and increase in quality of life. Others were less willing to lose a portion of what they considered to be substandard income in the first place. Once again, Dr. Guarracino made an interesting point: “It shouldn't cost me money to get job satisfaction. A savvy employer should do everything possible to retain physicians. Retaining good physicians is cheaper than recruiting new ones.”

Emergency physicians are seeking job satisfaction, but the majority isn't finding it. While employers must keep up on the new operational and compensation trends and best practice models, they can't forget that physicians are people, too. Employers must choose their teams carefully and actively engage in keeping them fulfilled by providing the tools and systems that make them capable of doing their best work. If money is an issue, employers might consider creative fund raising. Get the community involved. Happy physicians equal happy patients.

© 2008 Lippincott Williams & Wilkins, Inc.