Domains, Themes, and Representative Quotes
| Themes | Representative Quotes |
|---|---|
| BUSINESS OF MEDICINE, NATIONAL TRENDS IN HEALTHCARE DELIVERY | |
| Compensation model | “I’m not really influenced by money much. I feel like what I have is enough. You could throw another $100,000 at me, and I wouldn’t go back to the job. |
| “There’s always gonna be that balance between running a financially stable organization where you can have growth and you can afford to pay the staff, the overhead costs, etc., and also not cause burnout in your physicians and expecting for them to see too many patients.” | |
| Emphasis on metrics | “The parts of compensation that are tied to, ‘If you click this many boxes for mammograms, we'll give you another $2000. If you do this, then we'll give you that,’ and, ‘No, if you think I'm doing a good job, and I have exceptional patient loyalty, then pay me better. Don't try to jump me through three hoops.’” |
| Corporatization of medicine | “After 26 years of education and 25 years of experience—how do I end up a follower of administration people?” |
| “[The word provider] is offensive. It's an insurance term that was brought forth to equalize us and keep us down. God forbid somebody should call you “doctor.”” | |
| “It’s spending so much time on prior authorizations and fighting for the things that people need. I never ordered anything that wasn’t needed. When most of the day becomes fighting or doing free labor, I find that it becomes a bit taxing and overwhelming.” | |
| EHR | “[The EHR] was very easy to learn, and it made a lot of other things super easy like keeping track of health maintenance, for instance. It was wonderful for that, for being able to graph all of your lab results, being able to access things so quickly, and it was just a great system.” |
| Inbox burden | “I'd end up spending half to two-thirds of my day off just going through results because by 7:00 pm at night, you wanna have a little bit of time off. I'd triage through them and say, “Okay, this can wait 'til tomorrow.” Patients, especially, don't realize that it takes time to go through results, at least for me.” |
| “I got to a point where [my time] was maybe 40% patient-facing care and 60% in-basket management.” | |
| COVID-19, Patient expectations | “The patient demands have gone up. At the very beginning, with the COVID pandemic, we would be thanked for what we were doing. They would express thanks. They would not put extraordinary demands on us and, as time went on, and everybody got stressed with COVID, it spilled over to how everybody was treating us. You’ve seen all the pictures of the unruly passengers online on the planes.” |
| LOCAL PRACTICE CULTURE, LEADERSHIP | |
| Leadership visibility and support | “They didn't check in with us at all. At all. Like “How’s it going?” even just once a week. If they did come by, it would be like, I'm in the middle of patient care. I don't have time to talk to you.” |
| Value alignment with leadership | “[They are] the bosses, and they have their own agenda and their own things that they wanna achieve.” |
| Teamwork/coverage | “All of my partners, every single one of them, was kind and compassionate, and somebody that you want to work with.” |
| “There was no effort to, say, maybe have one of the PAs look at my paperwork because there was all this like, “Well, that's not my patient” attitude, too, in the background.” | |
| “It was really hard to find anybody just to cover me for a weekend.” | |
| Staffing | “Now you have eight physicians in one office. I don’t know that the ratio’s backed up. You have eight physicians and only three people up front. I can imagine that can get quite tight. That causes a lot of stress and strain on the staff.” “We had less staff to be able to do more work.” |
| Professional development, teaching, and advancement/promotion opportunities | “There were some things that I was promised at the beginning of my position that never came to fruition such as teaching medical students.” |
| “I was offered a position to move up and be a residency director. That position may not have been as attractive if the current situation… wasn't as difficult as it was.” | |
| PERSONAL CONSIDERATIONS | |
| Family support/happiness | “You make decisions as a married couple. She didn’t have a path forward there.” |
| Work-life integration | “When you go home and you know that you have another note to write, it’s like an alarm that keeps going off in your head.” |
| “I would say that I had a better work-life balance when I didn’t have Epic on my phone. That was a big change because, when I left work, I could leave work, and it was my choice if I wanted to open up my laptop or not. But then when there’s Epic on your phone, you’re constantly getting the ping notifications.” | |
| Feeling isolated/stressed, burnout | “I had noticed I was dreading going to work. [I had] never had a panic attack in my life and started having them at age 40.” “Part of it is that I have become mentally exhausted, and my motivation went in my boots, and I just didn't care.” |
Abbreviation: EHR, electronic health record.