The ACP Advocate Blog
by Bob Doherty
Monday, September 14, 2009
Internists and the pursuit of happiness
Internal medicine physicians, it is often suggested, are a pretty unhappy bunch. They are overworked and underpaid. They spend too much time on paperwork and too little time on patient care. Older internists, who remember the good old days, are less happy than younger ones. Rising costs and low fees have caused most to close their practices to new Medicare patients. General internists are more dissatisfied than subspecialists.
Most of these assumptions are based on anecdotal information, but what do we really know about how internists view their careers and their profession? A new survey of over 4,500 physicians, conducted by the well-respected Center for Studying Health System Change (CSHSC), suggests that the state of internal medicine is more nuanced than the popular portrait of disgruntled practitioners looking for an exit sign. (See Wall Street Journal writer, Jacob Goldstein's, take on the new survey.)
The CSHSC found that more than three out of four internists (76.4%) are "very or somewhat satisfied" with their careers; 5.4% are neither satisfied nor dissatisfied, 14.1% are "somewhat dissatisfied"and 4.1% are "very dissatisfied". Still, a smaller proportion of internists reported that they are more satisfied than any of the other surveyed specialties. 80.3 percent of family physicians, 83.4% of medical specialists, 80.5% of psychiatrists, 81.5% of surgical specialists, 80.5% of ob/gyn physicians, and a whopping 88% of pediatricians said that they were very or somewhat satisfied. Surgical specialists reported the highest proportion (4.7%) of physicians who said they were very dissatisfied.
The survey also shows that money doesn't necessarily buy you love (of career). Among all physicians, physicians who make more than $250,000 annually reported higher levels of satisfaction (86.7%) than those who make between $150,000 and $250,000 (81.8%) and those who earn less than $150,000 (76.8% very or somewhat satisfied). Yet money isn't everything, given that more than three quarters of the lowest earners expressed satisfaction with their careers. More pediatricians say they like their careers than any other physician specialty, even though the Medical Group Management Association reports that pediatricians are second from the bottom in annual physician income. And 11% of the highest earners expressed career dissatisfaction in the CSHSC survey.
Size matters, but also not as much as you might think. More than 82% of physicians in groups of three or more are satisfied with their careers compared to 77% in solo or two physician practices. (There wasn't much difference in satisfaction based on practice size beyond three physicians.) The length of time in practice also is not a clear indicator of satisfaction: "physicians in practice for more than 20 years provided more extreme responses: they were more likely to be either very satisfied or very dissatisfied relative to newer doctors."
What about the idea that most internists have closed their doors to new Medicare patients? 54.7% of internists said they accept all, another 18.6% said they accept most, and 17.2% said they accept some new Medicare patients. Only 9.5% of internists reported that they will not see any new Medicare patients.
The CSHSC survey provides important baseline data for policymakers and the profession on what can be done to make internal medicine a more attractive career path. A glass-half-filled person would say that the good news is that most internists are satisfied, while a glass-half-empty person would point out that internists are less happy than other doctors. The nuanced responses to the survey suggest that getting to the bottom of internists' varying degrees of career (dis)satisfaction is going to more complicated than, say, just increasing pay or getting them to go into larger groups. Money and size matters, but not as much as one might have expected.
Today's questions: How would you interpret the CSHSC data and how it might inform policy decisions on making internal medicine more attractive? How does it square with your own experiences?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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