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Survey Finds Pediatricians Experiencing Heavy Burden and Stress

by Iyue Sung, PhD, Director of athenaResearch

In numerous conversations with our pediatrician clients over the last year, individual clinicians report increased complexity in their practices and, in many cases, decreased fulfillment in their work. To get a closer read on the “State of Pediatrics,” Epocrates and athenaResearch recently surveyed more than 700 pediatricians on the Epocrates network. Here are a few of the more prominent findings:

Declining Morale
The survey results paint a troubling picture of declining job satisfaction. Only 15% of pediatricians say they are happier than they were five years ago; 47% are less satisfied over that period of time.



Not surprisingly, these overall figures obscure a fair degree of nuance and variation in how pediatricians feel about their work. We certainly found many pediatricians that were deeply fulfilled in their practice, but also encountered a distressing number who were burned out and disillusioned.

Most common were those pediatricians trying to balance the immense meaning and satisfaction they derive from caring for children with the drudgery of the administrative and business aspects of their practices. As one respondent remarked, “The acuity of my practice and the increased requirements for documentation and Meaningful Use greatly add to my frustration. I still love what I do. But some days I wonder if it is worth it.”

Stress from Growing Complexity
As shown in Figure 2 below, a substantial majority of pediatricians report that administrative and clinical complexity have increased their workload while reimbursement has stagnated, adding economic stress to the mix.


Interestingly, these trends are generally similar for both academic and community practitioners. While a somewhat larger proportion of academic-based providers report a greater case mix complexity, percentages for increased workload and insufficient reimbursement were nearly identical for both groups.

Seeing More Patients with Chronic Disease
Even before taking administrative hassles into account, pediatricians report that the very nature of their practice is shifting. Academic and community practitioners alike are seeing more patients with asthma, depression, diabetes, and hypertension. And roughly 80% report seeing more cases of obesity.


As we reported in a previous post, mental health diagnoses are particularly challenging in pediatrics, having increased steadily for the five years we at athenaResearch have been tracking this trend. One pediatrician reported, “I feel like a primary mental health provider without adequate training.”

Even for those physicians feeling comfortable with the growing behavioral health needs, there is a widespread sense that reimbursement levels have not kept pace with the increased complexity of these patients’ needs, as well as the growing demands from parents.

Particular Dissatisfaction with Administrative and Documentation Complexity
Problematic reimbursement combined with growing complexity would be challenging enough; but the incremental pressures of administrative and documentation requirements are proving to be particularly stressful for pediatricians. They complain about the growing burden of complying with Meaningful Use, more demanding pre-authorization requirements, and other administrative hassles. Among these issues, struggles with electronic health records (EHRs) stand out as being particularly frustrating for pediatricians. The following response from a community pediatrician is representative of multiple comments we received about EHRs:


"The requirements of EHRs and all the stipulations… has to be recorded each time even if not pertinent to the visit that day… more work vs. doing paper… I spend twice as long clicking and documenting the information on the computer than I would paper. This leads to either patients waiting longer to be seen so I can document or leaving the documentation till after clinic hours to give patients the time they deserve.


It has also changed the focus from personal to tech… I am not a fan. It is taking away one of the best and most important part of the world of pediatrics—the doctor-patient-parent relationship. It is a tragedy."

As technologists who provide EHR services to thousands of pediatricians, we appreciate the complexity and understand providers’ frustration. But we firmly believe that when good technology is designed with the users in mind (in this case, of course, caregivers), a simple, purposeful user experience can help manage this complexity.

Dr. Stephen Bien, an independent physician in Maine, recently wrote about a similar topic in his blog post, “How the Small Independent Provider’s Role Has Come Full Circle.” In the article, Dr. Bien discusses the role technology plays in helping him tackle the challenges of working as an independent doctor in the 21st century, keeping his focus on the main reason he got into practicing medicine—patient care.

Regardless of where pediatricians practice, their preferred health care software, or their perception of health care reform, change is on the horizon (and in many instances, already here). Understanding and coping with these changes will come not only from technology, but also from reporting on changes experienced in the delivery system. Over 2014, we will monitor trends related to pediatric practices, based on real-time data available from our cloud-based platform. We hope to discover and share meaningful insight, and we look forward to robust conversations.

Follow @IyueSung on Twitter.

1. Response to statement “To what extent would you agree with the following statements about your practice today compared to 5 years ago: My job satisfaction is higher”.
- Better: corresponds to response “Strongly Agree“ or “Agree“
- Neutral: corresponds to response “Neutral”
- Worse: corresponds to response “Disagree” or “Strongly Disagree”

2. Respondents answers “Strongly Agree” or “Agree” to the following questions: “To what extent would you agree with the following statements about your practice today compared to 5 years ago?”
- Economic realities have increased the intensity of my workload
- My caseload has increased in complexity
- Reimbursement from commercial payers have not kept pace with the increased complexity of my caseload
- My job satisfaction is higher

As a statistician, Iyue is responsible for methodology, analytic infrastructure, and extracting data-driven insights from the athenahealth patient database. 

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