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How to Help Primary Care Physicians Craft Sustainable Careers

(Excerpted & lightly edited from Harvard Business Review article by Timothy Hoff, 9/19/2022)

Physician burnout, particularly in primary care, receives much attention these days. However, burnout among primary care physicians (PCPs) is a symptom of a bigger issue: the need for healthcare organizations to help them build sustainable careers.

The US primary care system is undergoing major change. Companies like Apple and Amazon continue their slow-but-steady march into the primary care space. Big hospital systems use primary care services as loss leaders for higher-cost specialty care. And primary care physicians continue to disappear from the landscape.

The stage is set for a wholesale transformation of primary care—and perhaps after that all of healthcare—into something less physician-centric and more transactional and technological.

How will PCPs survive and thrive in such a reality? How can they balance some loss of traditional professional identity with new identities that help them navigate uncertain and fluid work situations? What will end up as their “typical” career trajectories in this new world? How can the industry make sure they remain engaged in their work?

Trend Has Been Growing

I have interviewed hundreds of primary care physicians (PCPs) in my research over the years. Many of them have seen this day coming for a while for these reasons.

There has been a steady erosion of primary care physician work, making the everyday job of a PCP more routine and less autonomous. This is especially true when the physician is a salaried employee rather than a practice owner, with more doctors than ever now working for someone else. For example:

• There has been a continuing decrease in medical students picking primary care as their career specialty.
• The healthcare industry has devalued PCPs as clinicians, turning them into paper pushers and goodwill ambassadors for larger corporate healthcare brands.
• Their workloads continue to increase, impacting their ability to forge trusting relationships with their patients.

This perfect storm of circumstances has left too many primary care physicians worn down and dissatisfied.

Many PCPs with whom I have spoken over the past decade have told me about a general malaise they feel. For them, it starts and ends with what they perceive as a general degradation of their status as professionals and experts. No one seems to be paying attention to them.

Everyone thinks they are invincible in their capacity for working long hours and putting up with poor job conditions. They lament that their employers see them only as high-cost cogs in the production process and want them to move their patients through the daily treadmill as efficiently as possible. They feel less empowered to control their fates.

Dealing with this malaise starts with sustainable career building, and a big component of that is effective career crafting. Neither of these things has been talked about much with doctors. But they are at the root of cultivating a stronger and more resilient PCP workforce. Here are four ways healthcare employers can facilitate the PCP career-crafting endeavor:

1. Hire PCPs for fit.

Physicians are rarely treated as individual talent by their employers. The “MD” or “DO” initials create a widespread perception that they all think the same way, but they don’t. Employers should take that into account in hiring.

• First, healthcare employers should implement hiring assessments to identify what prospective job applicants prioritize in their jobs and careers. They should not simply throw a net out into the waters and hire any PCP that gets caught in it.

• Second, they might approach PCP recruitment the way top tech firms like Google do when recruiting talent: by striving to fit the applicants to the type of jobs and work (and workplaces) in which they will engage.

  For instance, some PCPs may want to do more telemedicine than in-person care; others the opposite. Some may want to share their job with another PCP. Some may like routine work that is interesting, while others may wish for more complex work that carries a higher stress workload.

  Fitting the PCP to the job and work that suits them helps these doctors craft careers that they feel in control of, keeps them invigorated, and leaves them feeling better about their employer.

• Third, let the physician assume significant control over the job-fit process. In this way, healthcare employers could learn from the concept of locum tenens, in which physicians work on contract for different employers, and are driven by individual preferences for different job rewards and job structures.

  The general principle inherent in locum tenens recruitment—the employer is highly specific about what the job entails and offers and then lets physician applicants seek out the fit according to their personal wants and needs—can be applied to all types of PCP jobs.

2. Emphasize work-life balance in every PCP job and workplace.

Primary care physicians, particularly younger ones, want work-life balance. Healthcare employers can make that happen in several ways:

• Rid the PCP job of excessive administrative demands.
  Whatever can be done to save the PCP time and aggravation should be promoted. Ways to do this include hiring scribes that reduce PCP documentation time and reducing the number of quality metrics that physicians need to report on for each patient. The overabundance of quality reporting disrupts PCP workdays and often serves to placate the documentation requirements of the health insurer rather than add value to the patient visit.
• Set strict weekly work-hour limits.
  Doing direct patient care for eight hours a day is difficult enough. But PCP workdays often contain too many administrative tasks, as noted, and just one or two unpredictable patient visits can produce additional hours of work that bleed into the early morning or late evening. Healthcare employers should treat PCPs in the same way airlines treat their pilots. After a set number of work hours each week, they must stop working completely for a period of time.
• Use electronic health record systems to foster cross-team communication and collaboration.
  EHR systems that streamline documentation tasks and facilitate real-time communication among the members of a primary care team are imperative: It allows care work to be transferred more quickly across the team and practice, easing the PCP’s workload when needed.
• Tie a portion of pay to non-clinical accomplishments.
  For example, an employer might base some portion of PCP raises and promotions on factors that include how PCPs contribute to advancing community or public health in their spare time. This conveys that the employer cares about the PCP’s interests in fulfilling all elements of his or her generalist doctor role.

3. Promote professional development.

Many PCPs don’t want to see patients full-time in a clinical setting forever. This is a natural inclination given how hard the job of direct patient care is day in and day out. Healthcare employers should assume this inclination exists for all PCPs and act accordingly in the way they facilitate career development for this group.

Assume many PCPs are interested in learning skills related to what may start as side hustles but blossom into more over time. These include engaging in public and community health activities; doing nonprofit work; learning niche areas of primary care such as hospital medicine, geriatric care, and emergency medicine; becoming medical educators; and getting involved in health policy and advocacy.

Then provide time off and financial support for them to pursue formal training in these areas and create opportunities in their existing jobs to gain real-world experience doing them. Create attractive job titles which embody these opportunities that go beyond the generic title of “primary care physician.” If you’re a big health system, encourage PCPs to seek out and apply for these jobs in your own backyard.

4. Let PCP teams craft their members’ jobs.

There has been a growing recognition that taking a team approach to primary care—where multiple PCPs work together collaboratively—not only can improve the quality of care but also can foster an esprit de corps among PCPs that bonds them closer together.

Let the PCPs on a team figure out how best to share their workload, plan their work schedules, figure out what they each are good at and want to do clinically, and support each other. Incentivize the PCP team to figure out the best way to deliver care to their patient panels while giving team members the ability to create personally rewarding experiences for themselves. Make the clinical team even stronger by letting it self-manage more.

Burnout is a symptom of the larger malaise afflicting primary care physicians today. Address the malaise by enabling PCPs to build sustainable careers and the burnout problem will shrink. Happier PCPs will emerge—physicians who will be more likely to lead and be led.

There are certain emerging realities about how the US primary care system soon will look that must be accepted by primary care physicians. The bigger questions now for primary care doctors who plan to work in that system are (1) How will they adapt to these realities? and (2) What will their employers do to make that adaptation successful?