In recent years, healthcare has learned a harsh truth: it will be just as affected by customer-satisfaction as any other industry. Health systems have responded by sprinting toward what seems to be a conversion from hospital to hospitality. Some are investing enormous amounts of money into providing luxurious accommodations with plenty of amenities, seemingly prioritizing customer service over any other aspect of operation. Whether or not it is true, hospitals are under the impression that patients want to encounter a friendly staff during their stay. What does this mean for physicians? It's time to smile like "it's a beautiful day in the neighborhood" and it can't be done with a monumental sleep debt.
Lately, a new trend among some large corporations is an effort to treat their employees very well. This year, General Electric began to offer unlimited time off to nearly half of its workforce. This sort of concept is old news to the startup scene and last year even Virgin made headlines by offering an unrestricted vacation policy to a small group of its employees. Why? Companies are starting to believe that trusting their employees in this way will lead to more success.
In healthcare, a focus on physician work-life balance is long overdue. Regardless of the applaudable work-ethic of the older generations of doctors, who essentially lived at hospitals, the current state of physician morale is unsustainable. When 46% of physicians overtly identify as feeling burnout in 2015, from 40% in 2013, there is undoubtedly something seriously wrong with the industry.
Back in 2011, Dr. Karen Sibert, an anesthesiologist, wrote an eye-catching opinion piece in the New York Times, detailing the substantial sacrifice required to be a physician. As a mother of four, she practiced medicine full-time, losing out on many hours of family time in the name of better patient care. She speaks at length about the societal investment in training physicians who are taking on a lifestyle, not a typical 40-hour per week job. She concludes that medicine shouldn't be a part-time interest, but rather a life's work.
The reality, however, is that for one reason or another, physicians are changing. As Eve Glicksman puts it in her AAMC article, today's young doctors "want it all." The average hourly workload of 51 hours per week for practicing physicians has decreased 10% since 2003, an 80-hour weekly limit was put into place for resident physicians, and more doctors are choosing to work part-time. In the end, they want better lives outside of their careers. Of course, there is a downside a better work-life balance for physicians. Less hours for doctors means more transfers of care between providers, thus more chances for communication errors. Patients will experience less continuity with an individual provider and instead see groups of providers, which is already becoming common today. Finally, pay for doctors may continue to decrease, but as some have pointed out, new generations of physicians are willing to sacrifice pay for better hours and lifestyle.
Yet, regardless of what physicians choose to do about work-life balance, a change may be implemented with or without their approval. Over the last decade or so, the government initiated an emphasis on patient satisfaction with its release of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, in which patients are asked about their experience while being hospitalized. Evaluated aspects of care include communication with nurses and doctors, cleanliness, noise levels, discharge instructions, pain management, and whether or not patients would recommend the hospital to others.
Unfortunately, the immediate reaction of health systems was to game the scores by largely improving their customer service. At some hospitals, all patients will now enjoy a private room, flat-screen TVs, and room service. Lobbies can be seen featuring stone fireplaces and waterfalls. One can only imagine what the VIP rooms look like. As usual, however, the quick fix won't be enough. Research is showing that the most impactful aspect of a patient's experience is actually the interaction with the nursing staff. Specifically, the better the work environment for nurses, like manageable patient-nursing ratios and excellent physician-nurse collaboration, the higher the patient satisfaction scores. It makes perfect sense, as nurses spend more time with patients than any other member of the care team.
Therefore, hospitals are finding that to keep patients happy, they must keep their nurses happy. Knowing that nurses would rather interact with a collaborative, relatable, and probably well-rested doctor instead of an out-of-touch, sleep-deprived jerk, health systems are put in a tough position. For better or worse, the crowd is speaking and it prefers approachable physicians. Considering that physicians are becoming employed at an increasing rate, these rapidly growing health systems are now becoming largely responsible for the happiness of physicians. They will bear the burden of those alarming physician job dissatisfaction numbers and as patient experience scores and social media become even more impactful, the deteriorated morale of burnout physicians will continue to damage the brand. Sadly, this in particular is what it may take to finally fuel a massive transformation of the lifestyles of future doctors.