What’s the Source of Provider Discontent?

In the comments of my post, “Do Doctors Care About the Triple Aim?”, Dr. Randall Oates, Founder of SOAPware offers his perspective on the provider discontent we see growing:

What you say is true and largely explains the growing discontent of physicians. Multiple surveys reveal that at least 40% of physicians are not just unhappy, but manifest symptoms of burn-out. Most of them have become complicit with systems where everyone is more focused on how to get paid more. The few healthcare delivery systems achieving on the Triple Aim and who have better physician satisfaction have almost all been blessed with physician leaders who step up to the challenge of collaboratively creating the necessary cultures focused on delivering value to patients. Value = Quality/Cost. This focus is necessary in order to produce not only the highest satisfaction but the greater financial rewards going forward. Again, doctors not operating at the top of their license and who have become distracted data drones are complicit with an increasingly corrupt system. The vast majority of physicians view that being able to be part of a quality process is more satisfying than the income received. So, those that are the happiest, and thriving the most are ones who are on a pleasing path to the Triple Aim.

Sadly, the trends of the government-medical-industrial complex are increasingly filled with the hubris that value can be forced from the top-down via controlling algorithms into which patients and their doctors become data points to be plugged in and controlled.

The degree of success we will see with any true healthcare reform will be the degree to which patients become more engaged and accountable. Those will need relationships with physicians deserving of their trust within healthcare delivery systems focused more on the value equation. Success simply has to come from the bottom-up, so this will force many true physicians to have to leave the more toxic delivery systems in some locales. They will be forced to either move or more directly interact with patients minus the misguided, controlling interference in their communities.

Dr. Oates is highlighting the comment I made in the post. Not all incentives are financial and we need to find a way for healthcare to more than just a financial reward.

As most of you know I do a fair amount of work with tech companies in my home town of Las Vegas. The most famous Las Vegas tech company (casinos aside) is Zappos. If you haven’t heard, Zappos has created a unique culture. Next time you’re in Las Vegas, let me know and we can go on a tour of Zappos together and you’ll see what I mean. Everything from allowing people in their office to decorate their desk (and they are unique I tell you) to the competitions and events they run. Their blog subhead says it all, “Experience fun with a Little Weirdness.”

Why do I bring this up? It turns out that beyond Zappos tech component, the majority of Zappos employees are call center employees. I heard one person describe Zappos as a big customer service call center. That’s not far off. If you’ve never worked in a call center before, it’s not what most would consider a “fun” job. However, the Zappos culture has created a place where people love working for a company that is paying them a low wage to answer the phone. Let me assure you that their employees are fiercely loyal.

I’m not suggesting that healthcare should adapt the model of fun and a little weirdness. What I am saying is that Zappos created a workplace where the job was about much more than just your paycheck. Healthcare needs to embrace a similar notion where doctors enjoy their job for much more than just the paycheck.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • If your last sentence didn’t turn off every MD reading this, I’d be surprised. To imply that docs went into medicine soley based on $$ is [fill in the blank].

    Stick those happy people on call multiple days a week and see how happy they are. Continually increase how much work they need to accomplish to make the same wage and see how happy they are. Make it more and more difficult to do quality work and see how happy they are.

    Yes, Zappos does a great job in keeping people motivated and happy (as does Southwest), but decorated desks and positive affirmations eventually wear off.

    Also, you can’t clump hospitalists in with private practice docs. This is a big biz vs. small biz comparison, which is…apples and carrots.

    The bigger issue is this: docs, in general (and I’m speaking from the private practice side) thought they had a great partner in the Gov. They stuck out their hand and where able to have a nice life. Then costs got out of control and the squeeze came along. Docs had a few choices which boiled down to: make less or work more. Either way, a bad attitude was building. I’ll bet you the happiest docs out there are those who don’t deal with the Gov or insurance.

  • John Brewer,
    I don’t think that’s a fair characterization of the last line. I wouldn’t imply that docs went into medicine solely based on money. In fact, I know very few people who would endure med school when money is their motivation.

    What the last line does imply is that we’re losing that extra incentive that goes beyond money. Many of them entered the workforce with the ideal of helping patients, but then they run into the things you mention.

    Long story short, we need to simplify things so that doctors can be paid a decent wage, but that they also enjoy the other intangible benefits of the job as well. For example, I don’t know any doctor who enjoys churning through patients to keep their revenue up. I imagine job satisfaction for doctors would go up dramatically if they could spend 30 minutes per patient instead of 15 like they do now. Many can’t do that now because they need to keep the revenue up.

  • Must of had a glitch, my last response didn’t appear, I think I said…:

    I’m a cynic by nature, so that’s how I read that line. I’ve been wrong before, just ask my kids.

    Unwinding most areas of medicine from the G will be painful, but is needed.

    Simplifying running your own practice is a necessity or all we’ll see is hospital owned practices which…I won’t open that can of worms.

  • “Success simply has to come from the bottom-up…”

    Brewer: “…happiest docs out there are those who don’t deal with the Gov or insurance”

    ==> Health Savings Accounts (bottom-up)
    ==> Discounts for cash payment (no ins overhead)

  • I work
    good —

    but not all three at the same time.

    Triple aim

    Fast/quick fix = Improve patient satisfaction and quality of care
    Good = Improve the health of the community/population
    Cheap = Reduce the cost of healthcare

    The holy grail…


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