The Great American Physician Survey

Who is the modern American physician?

It’s a question that pop culture has done a lousy job answering over the years. Remember when Americans imagined the family physician as Marcus Welby, MD, the avuncular doctor who always had plenty of time for all his patients?

That was nice. But it was never really true, and for decades that image has been fading. Today, the public view of American doctors is probably closer to Gregory House: super smart and committed to quality care, but overstressed, grumpy, and unhappy.

But this image, too, is a distortion. Despite seemingly insurmountable frustrations, you’re not an unhappy bunch. As a group you’re pretty content with your lives and you like being physicians.

Here at Physicians Practice, we’ve been growing tired of half-baked caricatures of physicians; we knew that the real, modern American physician community is more complex and diverse, more like the rest of the American public than an upper crust elite standing apart, and we wanted to better understand you - and maybe help you better understand each other. We asked nearly 1,600 physicians about their outlook on work, life, politics, and family as part of our first-ever Great American Physician Survey.

What emerges from our data is a varied landscape of individuals, but also a group that is, for the most part, content.

(*Interested in looking at survey data broken out by gender, age, and region? Here are the stats you’ll need.)

You’d like more time with your family. You wish we had a better healthcare system. But most of you feel more rewarded by your work than burned out on it, and you strive with some success to find time for yourself and your family.

A few daily hassles

Pediatric surgeon Chris Anderson, who logs more than 100 hours a week and volunteers his surgery skills on his “off” weekends, is in the minority. His marathon work weeks aren’t that common among physicians we surveyed. It turns out only 3.7 percent of you clock more than 80 hours a week, and the most common work week spanned 41 to 50 hours.

But Anderson doesn’t mind the long hours. “I wouldn’t volunteer those extra weekends if I didn’t really like it,” he says, adding that you can’t go wrong in a profession where you help children. Considering the hours, says Anderson, who works at Advanced Pediatric Surgical Specialists in Orlando, Fla., “You better like it, or you’d be miserable.”

And it appears as though you do like it. Contrary to some surveys suggesting that business and management issues are killing physicians’ job satisfaction, more than half of respondents strongly agree with the statement, “I like being a physician,” with another 30 percent agreeing. (Only 2 percent strongly disagreed with that sentiment.)

That compares favorably to other Americans. Some 60 percent of U.S. workers in general are reportedly “very happy” in their jobs, according to a 2007 survey.

The likes of Miami gastroenterologist Miguel Rodriguez, 50, who yearns to be a marine biologist, are also a decided minority. Though he says he does like medicine, he adds: “All this hassle with medicine - if I could secure my life in [financial] terms, I would with no hesitation drop out of medicine.”

But most physicians would not. In fact, most physicians we surveyed said they’d change little if anything about their careers: Pluralities or majorities were happy with their specialty choices and employment situations. Pediatrician John Clapper couldn’t really imagine leaving his current employer, Pediatrics Northwest in Tacoma, Wash. “It’s an amazing group,” he says. “Every time we hire someone, we unanimously agree and hire people we are really going to trust taking care of our patients. We all just trust each other.” Indeed, a plurality (37 percent) would encourage a son or daughter to consider medicine.

Yet you are open-minded about sensible change now. For example, many say you’re open to emerging practice models, like cash-only or retainer-based practices, if it made economic sense.

Yet fewer than one in four said they’d be willing or able to trade a percentage of income for a commensurate amount of additional personal time.

Psychiatrist Lesley Schroeder of Sacramento, Calif., is part of that minority. She works part time in a private practice where she doesn’t take insurance, and instead accepts fees for consultations. That choice may have cost her income but earned her peace of mind, and she’s glad she made it. “I found a niche and a balance,” she says. “I purposely chose early on not to … work like a nut.”

Home for dinner … sometimes

Ah, that elusive work-life balance: such a challenge for all Americans to achieve, and perhaps more so for physicians. A solid 66 percent of you tell us you don’t have as much time for your personal life as you think you should. Surprised? Neither were we.

Only 44 percent said they spend more than 10 waking hours with family and loved ones during the work week, and a surprising 23 percent see them for fewer than six hours during the work week. Total. Enter the mountains of paperwork and constant call.

Still, nearly three out of four physicians are getting home for dinner at least a few nights a week - about a third just about every night. Only 10 percent “hardly ever” do.

Sudja Purohit, an internist in Rochester, Mich., chose her specialty knowing she wouldn’t have to be on call 24-7 and potentially miss spending time with her two children. In fact, she managed to still be a hands on mom to her son and daughter, who are now grown. Every day, she packed their lunch bags, and she made sure to attend every music recital and sports event, she says. “If you want to do something, you can always find time,” she says, adding that she even cooked dinners - from scratch! - a couple times a week.

For many, nabbing that family time is a matter of juggling hours a bit. Montgomery, who is based in Orangeburg, S.C., may work 60 hours a week, but he’s awake early to cook breakfast for his 4-year-old daughter each morning before heading to the office, and does his best to be home before she’s in bed. Some nights, he goes back to the office after tucking his two small children in bed. “I do family time when they are awake, and then go back and do paperwork and dictation,” he says.

What about the ever-elusive “me time” say, for exercise? Physicians overwhelmingly say they know they should “maintain an appearance of physical health” as a professional responsibility, yet many struggle to squeeze in the time to work out. A third of you said you don’t get much physical activity at all, and another 30 percent exercise three days a week, about the minimum required for health maintenance, according to most experts. Many physicians say they squeeze in the physical exercise when they can - often in the wee hours. Obstetrician Julie Snow in Evanston, Ill., is an Iron Man triathlete - oh, and also a mother to two small children - so she’s up “really early in the morning” to train. Rodriquez is also out of the house most days by 5:30 a.m. for a gym session.

In other ways, you seem to be doing a pretty good job taking care of yourselves, given your reputation for neglecting your own bodies. Most respondents (64 percent) have a regular primary-care physician and get regular checkups. And most of you report feeling pretty good, if not a bit stressed and tired. All of this isn’t to say the picture is all “Leave It to Beaver.” In fact, there were quite a few less-enthused answers in our survey. Here’s one example of a response to a question about what you’d like to say to the general public about the life and work of a modern physician: “We work hard all the time. We’re under a great deal of stress, emotionally, physically, financially. We don’t make money the way you perceive. All of our work gets discounted and physicians are often the last to get paid by their patients after the cable bill. There is a general lack of respect for our knowledge, for the time we put into our education. Things need to change.”

Those frustrations were shared among many respondents.

One doc boiled it down to this: “No job satisfaction, constant aggravation, all the responsibility but no authority.” Another weighed in with this: “We generally love our work but do not love the conditions under which we practice.”

Despite those professional woes and the at-times scant hours with family, almost half of respondents report being “happier and better adjusted than most people.” Another 29 percent count themselves as emotionally average. When asked to rate their happiness on a scale of 1 to 10, 78 percent ranked themselves at seven or above.

So it doesn’t seem as though physicians are any grouchier than other Americans. Gallup’s annual personal satisfaction poll reported late last year that about 80 percent of Americans say they are satisfied with the way things are going in their personal lives. That’s a dip from previous years, but not too shabby considering the general state of affairs.

In the voting booth

From Anderson’s marathon weeks to Purohit’s homemade meals, the physicians we surveyed proved to be a diverse group of individuals, each with different ways of taking on some of the common ills of the profession. And although you might all struggle with pay, long hours, and day-to-day stress, when you enter the polling booth, it’s hard to pin you down as a group.

While 34 percent of those surveyed are registered Democrats, 30 percent are registered Republicans, and a surprising 10.8 percent aren’t registered at all. About half voted for President Obama, and when it came to selecting your congressional representatives, respondents were split; 39 percent voting mainly Democratic and 33 percent mainly Republican. These numbers shake out similarly among age groups as well, though the left-leaners tended to be younger. Just over half of you consider yourselves “moderately involved” in politics, paying attention and voting, but leaving the dirty work to others. “I just watch CNN and follow things in the newspaper,” says Anderson.

Most of those surveyed (56.6 percent) see America’s healthcare system as needing fundamental reform, and another 24 percent consider the system in trouble, but say it could be fixed without a major overhaul. Only 12 respondents (0.9 percent) contend the system is just fine the way it is.

But what should healthcare reform look like? On this subject physicians are as discordant as the rest of the country.

We offered several possible reform models and asked respondents to pick one. The most popular idea was to require all uninsured citizens to get private insurance, with government subsidies to help pay the bills, while allowing everyone else to keep what they have. Next was a proposal to eliminate employer-sponsored coverage, replacing it with a system of government-subsidized individual insurance on the private market. In truth, though, none of our ideas garnered support from even three physicians out of 10. (Our survey was conducted before the current debate about a “public option” to compete with private insurers for non-Medicare beneficiaries, so that wasn’t among the choices.)

Besides a major overhaul to the system, many respondents have other changes in mind. Topping that list is tort reform to reduce malpractice lawsuits, which 87 percent agreed needs a fix. In Miami, Rodriguez expressed particular concern about frivolous lawsuits, saying his city is known for being sympathetic to malpractice suits. “People are there to see how they can kind of hit the lotto of malpractice,” he says. This also makes it hard, he says, as the managing partner of the group, to recruit new physicians.

Also high on the list of reforms, each with about 58 percent, were quality of care initiatives aimed at reducing medical errors and financial incentives to encourage people to go to medical school. Others called for the government to get out of healthcare entirely, while another asked to “bring the humanity back.”

But even in the face of the complicated and at times frustrating healthcare landscape, most of you are happy with the path you’ve chosen. You responded to a calling that you found intellectually stimulating and that provided an opportunity to help people. “Every patient is a learning experience,” says Purohit. “I enjoy what I do. The busier I am, the better I perform.”

(*Editor’s note: If you are looking for raw survey data, here are survey results broken out by question, response, and percent.)

Sara Michael is an associate editor at Physicians Practice. She can be reached at sara.michael@cmpmedica.com.

This article originally appeared in the October 2009 issue of Physicians Practice.