Becker’s connected with 20 physician leaders to gauge their thoughts on how physician quality of life has changed in the last five years, and most seemed to be in agreement — quality of life is largely on the decline.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Do you personally think physician quality of life has improved or worsened over the last 5 years? Why?
Doug Blaty, DO. Spine Surgeon at Inland Northwest Spine (Coeur d’Alene, Idaho): There are, for the most part, two main answers to that question. Of the physicians who have accepted and embraced the ever-worsening reimbursement cuts, overhead cost increases, and more complex administrative work to take care of patients, some are finding an appropriate work-life balance and focusing financial success on other avenues of revenue rather than active income through medicine.
For myself, I am exactly 5 years into practice, and I have been fortunate enough to enjoy my work situation, location of work and type of medicine I practice, and thus do not dwell over the aspects of medicine outside of direct patient care. However, for many of my colleagues who would otherwise be able to focus on their patients and truly apply their passion to this amazing industry of patient care, many have not found this career path to be as rewarding as they had hoped, both financially and with personal satisfaction. The amount of effort and time involved in non-direct patient care to treat a patient over the last 5 years has grown exponentially, and this has led to an overall decline in quality of life for many doctors I know. Many physicians, as polls are showing, will not encourage their children to go into medicine. And this causes me fear, because who will take care of my generation when I’m retired, and what type of person will be sitting in front of me when I’m asking the doctor questions?
Russell Bodner, MD. Orthopedic Surgeon at Northwestern Medicine (Chicago): Worsening conditions, reimbursements down, insurance interference and denials up, administrative burdens up, autonomy down, employed positions up (as it’s nearly impossible to sustain a private practice), and rates of burnout and suicide up.
Brian Curtin, MD. Surgeon at OrthoCarolina Hip and Knee Center (Charlotte, N.C.): I believe the quality of life for most physicians has worsened over the last 5 years. COVID stretched the medical field thin and added a whole new level of stress. Reimbursement rates continue to fall, increasing the pressure to see more patients and do more surgeries to maintain previous income levels. The electronic medical record continues to add time to your day with bureaucratic requirements that have little to do with actually treating patients. The patient-physician relationship continues to evolve as well, with different expectations and demands that continue to pressure the practice of medicine.
Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: I think the quality of life has improved, but not in a desirable or sustainable way. Many physicians have become more attuned to their well-being versus killing themselves at work. This slight quality of life improvement is a result of two important factors. One, physician reimbursement has gone down, so many folks have realized there is very little motivation to staying at work all hours and being on call constantly, and two, the interference in the joy of practice by the administrator class. As any graph will tell you, the number of physicians has stayed stagnant while the numbers of middle management and administrators have gone up by a legion. Physicians have realized that rather than sacrifice their collective sanity and family, they will concentrate on being happier, despite the obvious downward pressure to work harder for less and provide value to the shareholders and insurers, rather than the patients. It is a sad and perverse state of affairs where things got better, but for the wrong reasons. Certainly, eventually this will invert and there will simply be a dangerous shortage of physicians who actually care.
Samer Hasan, MD, PhD. Department Chair of Orthopedic Surgery at the Jewish Hospital (Cincinnati): Overall, I think it has worsened over the past 5 years. CMS and private payer reimbursements have been in a race to the bottom and are not sustainable in the long run. We are badgered with claim denials and peer reviews. It has gotten to the point that I sometimes question how we are viewed as physicians and surgeons — it’s as if no one believes us when we recommend a diagnostic test or indicate a patient for surgery. Although our professional societies try to advocate on our behalf, collectively, we are not doing enough to fight back. Thankfully, we still do make a difference in our patients’ lives, and that remains the most rewarding aspect of our profession.
Brandon Hirsch, MD. Spine Surgeon at DISC Surgery Center at Newport Beach (Calif.): It is difficult to generalize across the board as to whether physician quality of life has improved or worsened in the last 5 years. Many factors affect physician quality of life related to each physician’s work environment, practice type, specialty, market, and professional priorities. Overall, I do not know many physicians who would say it has become easier to do their job over the last 5 years. Those physicians who have experienced improvements in quality of life in the last 5 years have almost universally done so by pursuing nonclinical work, reducing the amount of clinical work they perform, or retiring altogether.
Remarkably, in the 5 years following a once-in-a-century global pandemic, there has been no substantial discussion in Washington regarding our broken healthcare system. Physicians continue to be taken advantage of by larger entities (hospitals, insurers) as they have much greater budgets for lobbying our legislators. Unfortunately, without meaningful campaign finance reform and/or term limits in Congress, this will likely go on indefinitely. This is certainly detrimental to physicians’ quality of life. More importantly, it negatively impacts patients’ quality of life as many struggle to navigate and access healthcare in the richest nation in the world.
As difficult as the last 5 years have been for physicians, I do believe some bright spots are emerging that will improve the outlook over the next 5 to 10 years. Word has gotten out about the manipulation of medical loss ratios, the corporate practice of medicine and inappropriate denials of care, and regulators are beginning to take notice. Patients are beginning to understand how little they receive for their ever-increasing premiums and deductibles as insurance companies continue to shift more cost to their “beneficiaries.” As a result, patients are increasingly seeking care outside of the commercial insurance ecosystem. As more practices adapt to meet the growing demand for direct care, I envision a trend away from the use of health “insurance” for routine, elective care. Many physicians in primary care and some surgical specialties are already making this transition. In doing so, they are introducing price transparency and competition into the market, which will only stand to benefit the patient and, in turn, their physician.
Thomas Loftus, MD. Founder and Neurosurgeon at Austin (Texas) Neurosurgical Institute: I feel the quality of life overall has continued to worsen. The additional burdens of weekly peer-to-peer to obtain authorizations for obviously necessary surgeries chips away at time dedicated to actual patient care. Continually, increasing regulatory requirements create unnecessary strife and additional time commitments also pulling us away from patient care. The continually decreasing reimbursement throughout our careers creates a perversely lower reward for our increasing experience level. These factors alone, combined with a multitude of other unpleasant changes in healthcare delivery, continue to erode happiness and fulfillment in practicing medicine and, unfortunately, can have significant rollover effects into work-life balance and relationships.
Peter Passias, MD. Orthopedic Spine Surgeon at NYU Langone Health (New York City): The overall health, happiness and quality of life have increasingly experienced a vicissitude of tremendous proportion in the last several years, as evidenced by numerous recent surveys and independent assessments. There are underlying themes contributing to this situation. Financial trends, healthcare consolidation, loss of autonomy, role convergence, and even title modifications have combined with the increased pressure for expansions of volume and administrative burden to result in this trend. Fortunately, many leaders and medical societies have recognized this issue and have fought to bring it to the forefront.
Deepak Reddy, MD. Spine Surgeon at South Bend (La.) Orthopedics: Unfortunately, I think quality of life has continued to decline over the past 5 years. Paramount to that decline is the continued trend of decreasing physician reimbursement year by year. Continued cuts to the physician fee schedule are simply unsustainable. As reimbursement declines and inflation climbs, the physician post-tax dollar continues to wither over time. Surgeons are working longer hours, doing more cases than before and getting paid less year over year, leading to unhappiness and burnout. Secondarily, continued challenges with prior authorizations, peer-to-peer discussions and denials of payment by the insurance companies are a progressive frustration for surgeons. Millions of dollars in wasted time are lost due to the insurance companies attempting to ‘save money’ by rationing care via arduous, illogical criteria for necessary complex spine surgery that’s failed conservative care. Lastly, the rise in physician extenders, whilst helpful at times, can be challenging for providers in private practice. Increasingly, calls from the ED or referrals made to clinics are incompletely worked up prior to consulting or referring for spine surgery. We find ourselves often on call, feeling like “WebMD” for the extenders, providing basic guidance that seasoned ER docs or primary care MDs wouldn’t require. Despite the apparent despair of the five-year trends, most of us (including myself) love what we get to do for a living and are sustained by our patients’ happiness along with the lives we are privileged enough to improve.
Charles Sansur, MD. Spine Surgeon at University of Maryland Medical Center (Baltimore): Worsened. Increased demands on the physician workforce, with higher expectations for quality of care, with decreased reimbursement.
Lali Sekhon, MD. Neuro and Spine Surgeon at Reno (Nev.) Orthopedic Center: Physician quality of life has definitely worsened over the last 5 years. There are 2 groups. Those who are employed and have lost their voice, and those in private practice who are drowning in increased expenses and reduced reimbursement. That latter will affect employed physicians when they renew their contracts. A combination of rising practice costs, reduced reimbursement, loss of autonomy, more work being required to maintain status quo and a general dissatisfaction with the American HealthCare Machine (prior authorizations anyone) have not put physicians in a good place. I’ve been a physician for 35 years and take my hat off to the next generation of physicians who are being groomed as shift-working data collectors with no voice and having every facet of patient care having external controls. One day, we may not see the best and brightest as doctors.
Jeremy Steinberger, MD. Director, Minimally Invasive Spine Surgery, Department of Neurosurgery, Mount Sinai Health System; Assistant Professor, Neurosurgery and Orthopedics, Icahn School of Medicine, Mount Sinai (New York City): I think physician quality of life has unfortunately been on the decline over the past few years. Burnout is on the rise due to insurance companies obstructing care at every turn – ordering appropriate imaging is met with denials for MRI and CT, surgery recommended with textbook surgical indications for suffering patients who have failed months of conservative management is procrastinated and obstructed – this is the most challenging aspect of the job for me.
Kevin Stone, MD. Orthopedic Surgeon at the Stone Clinic (San Francisco): My quality of life has improved as I have gotten older, hopefully wiser, and have a more nuanced approach to what we do for patients. Since we are a cash practice, the nightmare of insurance authorization is significantly lessened. The fantastic opportunity to care for patients and simultaneously advance science through our public non-profit research foundation www.stonerearch.org makes each day better than the last as we keep improving our techniques supported by scientific research.
Robert Swift, DO. Orthopedic Surgeon at American Spine and Orthopedics (Bonita Springs, Fla.): I believe it has gotten worse. With insurance reimbursements declining and the cost of everything increasing, there is more financial pressure in running a practice. It becomes harder to improve your work-life balance when the costs of providing care cost more than the reimbursement. We have been cut 12% and inflation has gone up 30%. There is no cost for inflation adjustment in my fees.
Zeeshan Tayeb, MD. Owner and Medical Director of Pain Specialists of Cincinnati: Finding a work/life balance is challenging. I don’t think there has been any improvement to a physician’s quality of life. With the high demand on physicians to provide care to more patients, due to the closure of multiple pain centers over the past decade, including the past 5 years, it has put a strain on physicians. Since the pandemic, limited access and increased costs of supplies, along with demands for higher labor from staff, the struggle of being a private practice is more and more challenging. All of these factors impact the quality of life a physician has. It is important to take time to take care of yourself. Whether it is finding peace in family, faith or other activities such as travel or family time, allotting time for yourself is key to succeeding in this highly demanding field of work.
Mark Testaiuti, MD. Spinal Neurosurgeon, Partner and Vice President at Coastal Spine (Mount Laurel, N.J.): I believe the main reason there is less rewarding work life balance for physicians in the last five years, if not longer, is primarily because of the insidious loss of practice autonomy and time management as hospitals and insurance companies dictate more and more of how and what we do with patient care.
A healthy work-life balance was more easily achievable for most of us up until 10 or 15 years ago and has only become more difficult in the last five years, depending on the specialty and the geographic practice location. The ever-increasing overreach of managed care and insurance companies now dictates the way hospitals and doctors practice medicine and not always for the betterment of patient care. Although the pursuit of best practice guidelines, quality metrics, etc., generally makes us all better, we have unintentionally been made to feel like a commodity or a cog fitting into a larger and more important financial equation for hospitals and insurance companies.
The personalized approach to medicine that was a large part of how we achieved self satisfaction, happiness and self worth no longer seems to matter as much as the number of patients processed or the bottom line. This then results in a frustrating struggle to maintain the autonomy we thought we would have as doctors. In response, it then affects our self-esteem and relevance, causing strains in our interpersonal relationships and minimizing happiness.
Not to mention the struggle to care for patients in the office has turned into a daily or weekly battle of appealing denials and struggling for approvals from insurance companies. Mainly interested in cost savings, they deny coverage by claiming what we asked for is experimental or not medically justified when we know it indeed is.
Nikhil Verma, MD. Professor and Director, Division of Sports Medicine and Director, Sports Medicine Fellowship at Rush University Medical Center Midwest Orthopaedics at Rush (Chicago): I am sad to say that I think physician satisfaction has continued to decline over time. Some specialties are more affected than others. The volume of non direct patient care work continues to increase, specifically EMR based functions. Compensation continues to decrease despite being in one of the most inflationary periods of our time. This translates into a bigger demand on physicians to see more patients in less time to achieve financial sustainability. Only 24 hours in the day, so something has to give.
Katherine Wagner, MD. Neurosurgeon at Ventura (Calif.) Neurosurgery: This is a great question. Unfortunately, I think the average doctor’s quality of life has worsened recently. Our patients are increasingly frustrated with the healthcare system and understandably upset about fees, prescription and imaging costs/co-pays, and wait times. They unleash some of that frustration on us and our staff members, and sometimes they use after-hours MyChart messages and other electronic forums for this. Even worse, some patients turn to Google and Yelp to leave us bad reviews. Some of my older colleagues are glad they retired before this started. Dealing with payers has been increasingly difficult. Medicare reimbursement cuts are making it harder for private practice physicians to keep the lights on and keep seeing Medicare patients. Our compensation has trended downwards, while demands on our time continually increase. Some of my colleagues have also been subjected to interpersonal violence. Recent attacks on physicians and nurses show how vulnerable we are at work. Polls also show that patients and their families are increasingly losing their confidence in doctors, and this chips away at the doctor-patient relationship even more. All of these things grate on physicians and stay in the back of our minds, and I think these concerns take a toll on our quality of life. These are hard issues to solve, and some of these problems are getting worse, not better.
Nolan Wessell, MD. Assistant Professor and Co-Director for Orthopedic Well-being in the Division of Spine Surgery at the University of Colorado School of Medicine (Aurora): I think the data on physician wellness is quite clear: burnout and dissatisfaction with the current healthcare climate are at all-time highs. Nearly 60% of orthopedic surgeons will contend with burnout or depression at some point in their career, and 10-12% will develop a substance abuse disorder. Sadly, 1 in 6 physicians admit to having contemplated suicide at some point. We have a true crisis on our hands, and the root of the problem is multifactorial. Declining reimbursements, the dissolution of private practices, degradation of physician autonomy, increasing demand for non-patient care tasks, battling insurance companies and provider shortages are just a handful of the easily identifiable problems we face.
Recognizing the problem is the easy part; finding meaningful solutions is the hard part. For starters, I think healthcare leaders need to look outside healthcare at industries where a true investment in employee wellness has created improvements in job satisfaction, employee retention and even productivity. Too much emphasis has been placed on profitability that we forget that healthcare is about person-to-person relationships. Health systems and practices that shift focus away from profits and back to quality and value are likely to see improved happiness among their workforce. Happy employees often equate to productive employees, something healthcare administrators should readily support.
At the governmental level, we need to ensure that investments are being made in the right areas. Witnessing the continued decline of physician reimbursement over the past 30 years with a subsequent shift in funding to hospitals and large health systems makes providers feel devalued despite the years of education, training and dedication to the health of our patients. I encourage all healthcare providers to join their local, state and regional societies and do their part to advocate for ourselves and our patients. It’s going to take a true grassroots shift to regain control over how healthcare is delivered in this country. Putting patients and providers above profits is a good place to start.
Richard Wohns, MD. Founder and Medical Director of NeoSpine (Puyallup, Wash.): The quality of life for physicians and their patients has worsened over the past 5 years due to the epidemic of insurance denials for medically necessary care.
