Intent to leave
What medicine’s new misery metric means for doctors and hospitals
This month JAMA published a cross-sectional study of academic physicians and their intent to leave medicine. Bottom line: about one-third of survey respondents reported moderate or greater intent to leave medicine. The paper is free and you can see how your favorite specialty measures up.
More than who’s most dissatisfied is the diffuse penetration of this sentiment that’s most remarkable. The fact that there’s even a measurable number of physicians looking to bolt means more than the relative risk by specialty.
And what caught my eye wasn’t the data as much as the terminology. Specifically, the idea of ITL, intent to leave. Apparently, we now have an epidemiological term with its own acronym to quantify the number of physicians pissed off enough to fold. And it’s dropped in the paper almost casually, like some kind of public health curiosity.
The study offers more validation of what physicians have long been feeling. And for many, their only power has been their capacity to complain. But problems of healthcare shouldn’t be our burden. We should have bigger things to worry about than spending the morning chasing prior authorizations.
As the sustainability of independent practice becomes more difficult, the ranks of physician employees will grow. And while some suggest that this is part of the problem, it also creates the environment and opportunity for a solution.
I’ll reshare the Physician Suprefecta, my recipe for the mitigation of physician flight risk.
Mission - Prioritize professional purpose based on values and professional identity. Young doctors more than ever need to be inspired by and drawn to a sense of purpose. As part of this we need to rethink physician work — What does it look like? What should it look like?
Agency - We need to build in the capacity for medical professionals to have some control over decisions and day-to-day work.
Community - Health professionals need community — local colleagues they can lean on. This means professional organization — not in the labor sense but in the idea of professional unity and pride.
Safety - Safety is a powerful need as professional sovereignty has eroded over the past generation. Docs need to believe that someone is advocating for them and their ability to do meaningful work.
And so the responsibility will fall on organizations and health systems to revitalize and sustain these elements. Operationalizing these needs calls for strong physician leadership which has been absent in medicine.
I can’t underscore the responsibility of individual physicians to advocate themselves. From seeking out healthy workspaces to taking responsibility for prioritizing their needs and well-being. Of course, this isn’t enough. But we have to begin to see ourselves as part of the solution.
The smartest organizations will prioritize the Suprafecta to retain their physicians and keep them doing their best work. The short-termism of the recent past will morph into the bigger priority of what a healthcare ecosystem needs to create the experiences that keep them competitive.
I suspect that over time hospitals and health systems will have no choice.
Dear Bryan,
Thank you for this post and for staying with this topic. I agree with you 100%. I see very little enthusiasm among those I work with daily. In fact, Enthusiasm is on my to-do list for 2024. Both personal and professional. I have no idea what that will look like yet, but it’s a place to start.
I have managed to stay in the game by reducing work hours to 28 hours a week.
I can’t tell you how many physicians in and around my generation (50-60 yo) have left or seriously cut back on their work hours. Unbelievable amounts of experience and knowledge are now permanently lost to the system.
Even with that, I struggle to keep up with my non-face-to-face work. So do ALL of my colleagues. Leadership signals we are the “problem,” and the proposed solution is “Just Do It.” It’s not working. It’s a slow, passive-aggressive stalemate for everyone.
I feel hesitant about unions, but those seem to be taking hold, and I do see that as a positive sign that there is energy and appetite for change.
One fundamental problem is that payments are unfairly low and unequal.
It drives a bunch of what providers and patients suffer from. The answer has been volume, but that has long maxed out. Quality has been the new buzzword, but that’s not easy to measure or control, and providers are ultimately not recognized or paid for those efforts. It has transformed into an administrative and soul-killing exercise.
I wish I could say something positive. However, I do believe we are approaching a tipping point and the speed of that is increasing as it’s inversely proportional to falling satisfaction and ITL.
I’m not a physician, but an elder patient with a few doctors helping best as they can. When I visit them, I often feel somewhat bad for them. Considering, all “the hard work, commitment, cost and time to be who they are and responsibility, liability etc. And, then to be ultimately directed by lawyers, insurance industry protocols, management types etc, and professional health alliance driven by politicians & bureaucrats, I’m also “concerned and ask the question, “am I receiving from my doctor his best advice”? I want to ask questions, “have I used up my allotted time”….am I too challenging…….is there, in all of the above, an unstated directive that limits, by cost involved and my age, the treatment I am receiving etc? “And” then there is the “system”……….. I never know what the true cost is, I never know what I am really paying, I never know “who is billing me” etc and I never know what I am paying for. And, and……………the nickel & dime stuff………..and the hours on the phone waiting for someone to talk to after pressing buttons and……….then wondering if you will still be alive by the time you receive a treatment or test or what ever.
Greed is the root cause, not by the medically trained pros, but by every other entity connected and leaching off those who have paid the price of hard work and commitment and of the AKA the customer/patient………..date of birth. Thank you Hillary, Obama, Joe etc