How to Help Primary Care Physicians Craft Sustainable Careers

Physician burnout, especially in primary care, has received a lot of attention these days. However, burnout among general practitioners (PCPs) is a symptom of a larger problem: the need for healthcare organizations to help them build sustainable careers. This can create healthier, happier physicians who feel empowered to make better career choices, while bringing more of them into work environments that support their personal values, likes, and needs.

Healthcare organizations have an important role to play, and yet few have taken on this role. It includes aligning PCPs with the jobs and work settings they desire; give them a fair chance for work-life balance; take their professional and professional development seriously; and give them the freedom to collaborate with other colleagues in the clinical team.

The US primary care system is undergoing a major transformation. Companies like Apple and Amazon continue their slow but steady march into the essentials space; large hospital systems use primary care services as a loss-maker for more expensive specialty care; and GPs continue to disappear from the landscape. The stage is set for a comprehensive transformation of primary care – and perhaps all healthcare thereafter – into something that is 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 their traditional professional identity with new identities that help them navigate uncertain and fluid work situations? How will their “typical” career paths end in this new world? How can industry ensure they remain committed to their work?

I have interviewed hundreds of general practitioners (PCPs) in my research over the years. Many of you have seen this day coming for a while for these reasons.

• There has been a steady erosion of GP work, making a GP’s day-to-day work more routine and less autonomous. This is especially true when the doctor is an employee and not a practice owner, since more doctors than ever are working for someone else.
• There has been a steady decline in medical students choosing primary care as their professional specialty.
• The healthcare industry has devalued GPs as clinicians, turning them into paper pushers and goodwill ambassadors for larger corporate healthcare brands.
• Her workload continues to increase, affecting her ability to build trusting relationships with her patients.

This perfect storm of circumstances has left too many GPs exhausted and unsatisfied.

Many GPs I’ve spoken to over the past decade have told me about a general malaise they’re feeling. For them, it begins and ends with what they perceive to be a general deterioration in their status as professionals and experts. Nobody seems to notice her. Everyone thinks they are invincible in their ability to work long hours and accept poor working conditions. They complain that their employers only see them as expensive 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 destiny.

Dealing with this malaise starts with sustained career development, and a big component of that is effective career crafting. None of these things have been discussed much with doctors. But they are the root for developing a stronger and more resilient PCP workforce. Here are four ways healthcare employers can facilitate PCP career development efforts:

1. Set PCPs to be fit.

Doctors are rarely treated like this individual talent from their employers. The MD or DO initials create a widespread perception that they all think alike, but they don’t. Employers should take this into account when hiring.

First, healthcare employers should conduct hiring assessments to determine which potential applicants are prioritizing their jobs and careers. You shouldn’t just throw a net in the water and hire any PCP that gets caught in it.

Second, they could approach PCP recruitment the way top tech companies like Google approach talent recruitment: by making an effort to match applicants to the types of jobs and work (and workplaces) they will be participating in. For example, some GPs may want to do more telemedicine than in-person care. others the opposite. Some may wish to share their job with another PCP. Some like interesting, routine work, while others want more complex work that involves more stress. Matching the PCP to the job and work that suits them helps these doctors create careers they control, keeps them empowered, and makes them feel better about their employer.

Third, let the doctor take ultimate control of the job-fit process. In this way, healthcare employers could learn from the concept Locum tenens, in which physicians work on a contract basis for different employers and are driven by individual preferences for different wages and work structures. The general principle inherent in surrogate recruitment—the employer being very specific about what the position entails and offering, and then letting applicants search for physicians based on 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.

GPs, especially younger ones, want a work-life balance. Healthcare employers can achieve this in a number of ways:

Free the PCP job from excessive administrative requirements.

Whatever can be done to save the PCP time and hassle should be encouraged. Ways to do this include hiring clerks, who reduce the time it takes to document PCP, and reducing the number of quality metrics physicians are required to report on for each patient. The overabundance of quality reports disrupts PCP’s day-to-day work and often serves to appease the health insurance company’s documentation obligations rather than to enhance patient visits.

Set strict weekly work time limits.

Providing direct patient care eight hours a day is difficult enough. However, as mentioned, PCP workdays often include too many administrative tasks, and just one or two unpredictable patient visits can result in extra hours of work lasting into the early morning or late evening. Healthcare employers should treat PCPs the same way airlines treat their pilots. After a set number of working hours per week, they must stop work completely for a specified period of time.

Use electronic health record systems to encourage cross-team communication and collaboration.

EHR systems, which streamline documentation tasks and facilitate real-time communication between members of a primary care team, are essential: They allow nursing work to be more quickly delegated to the entire team and practice, reducing the workload of the GP when needed.

Tie part of payment to non-clinical services.

For example, an employer might base a portion of PCP increases and promotions on factors that include how PCPs contribute to community or public health benefits in their free time. This conveys that the employer cares about the general practitioner’s interests in fulfilling all elements of his role as general practitioner.

3. Promotion of professional development.

Many GPs don’t want to see patients in a full-time clinical setting forever. This is a natural tendency given how hard the work of direct patient care is day in and day out. Healthcare employers should understand that this propensity exists for all GPs and act accordingly by facilitating career development for this group.

Suppose many PCPs are interested in learning skills related to things that start out as side hustles but evolve into more over time. These include involvement in public and community health activities; do community service; learning of niche areas of primary care such as hospital medicine, elderly care and emergency medicine; become medical instructors; and to engage in health policy and advocacy.

Then provide them time off and financial support to pursue formal training in those areas and create opportunities in their existing jobs to gain hands-on experience. Create attractive job titles that embody these opportunities that go beyond the generic title of family doctor. If you are a large healthcare system, encourage PCPs to seek and apply for these jobs in your own backyard.

4. Let PCP teams design their members’ jobs.

There is increasing recognition that a team approach in primary care – where multiple GPs work together – can not only improve the quality of care but also promote it spirit of the corps between PCPs, which it welds more closely together. Let GPs on a team figure out how best to share their workload, plan their work schedules, figure out what they’re good at and what they want to do clinically, and support each other. Incentive the PCP team to find the best way to care for their patient groups, while empowering team members to create personally rewarding experiences for themselves. Make the clinical team even stronger by giving them more autonomy.

Burnout is a symptom of the greater malaise affecting GPs today. Manage the malaise by enabling PCPs to build sustainable careers and the burnout problem will shrink. Happier PCPs will emerge – those who are more likely to lead and be led.

There are certain emerging realities about what the US primary care system will soon look like that family physicians need to accept. Now the bigger questions for GPs who want to work in this system are how they will adjust to these realities and what their employers will do to make that adjustment successful.