Primary care physicians being stressed to the max

Commentary. By Amy J. Rosenthal, MD, AMNews contributor. July 7, 2003.

We physicians can be adept at griping and grumbling about our working conditions. To a world that sees us as wealthy and privileged, our complaints can be baffling. We aren't always able to make it clear to outsiders what the reasons for our angst might be.

Some have recognized low morale in primary care physicians, but not enough has been written from our perspective about what is causing the problem. Often, low morale is attributed simply to "loss of autonomy," but I believe the reasons are more complex. To advocate for ourselves, we need to better state the cause of our grievances and make them clear to outsiders.

To clarify the reasons for frustration among primary care physicians, I have created the following list. It's the reality we live with but it reads like a how-to manual for anyone interested in maximizing stress in the work environment.

• Establish rules for physician reimbursement that are impossible to follow, even for experts. Assume that when physicians make "errors" in following the rules, they are fraudulent and greedy. Prosecute accordingly. (Doctors pay either way -- if they "undercode," they lose money; if they "overcode," they are presumed to be committing fraud.)
• Create a system that rewards people with ridiculous amounts of money to find fault with their physician, whether fault exists or not. This will place doctors under a constant threat of being sued, regardless of how hard they try to do the right thing for their patients. Remember Psychology 101? The above roulette game, which clinicians are forced to play, can lead to "learned helplessness" and various defensive behaviors.