Being able to provide high-quality health care is a primary driver of job satisfaction among physicians, and obstacles to doing so — such as electronic health records — are a source of stress for doctors, according to a new RAND Corp. study.

Researchers say that physicians reported being more satisfied when their practice gave them more autonomy in structuring clinical activities and more control over the pace and content of patient care. Doctors in physician-owned practices or partnerships were more likely to be satisfied than those owned by hospitals or corporations.

The study did not identify recent health reforms as having major effects on physician satisfaction. It was clear, however, that a common response to reform was for physician practices to seek economic security by growing in size or affiliating with hospitals or larger delivery systems.

Other findings include:

• Excessive productivity quotas and limits on time spent with each patient were major sources of physician dissatisfaction. The cumulative pressures associated with workload were described as a "treadmill" and as being "relentless," especially among primary care physicians.

• Physicians described the cumulative regulatory burden as being overwhelming and draining time and resources away from patient care.

• Perceptions of collegiality, fairness and respect were key factors in physician satisfaction. Frequent meetings with other doctors and other health professionals fostered greater collegiality and satisfaction.

While physicians note some advantages of the EHR, they complain that the systems are cumbersome and contribute to their dissatisfaction, according to the study. They expressed concern that the EHR interferes with face-to-face discussions with patients, requires too much clerical work and degrades the accuracy of medical records by encouraging template-generated notes.

Doctors also worry that the technology has been more costly than expected and different types of EHRs can't exchange data, preventing the transmission of patient medical information when it is needed.

Medical practices reported experimenting with ways to reduce physician frustration. Some hire staff to perform many of the tasks involved in using the systems, helping doctors focus their interactions with EHRs on activities truly requiring a physician's training.

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