He cited the mismatch between the corporate mentality of these organizations, particularly those increasingly owned by private equity groups, and the mentality of people who go into medicine. When the profit motive rules and physicians are judged by and paid based on the volume of patients seen in a day, physicians lose a sense of the autonomy and agency that led them into medicine. “What is being extracted is the ‘art of medicine,’” said Dr. Backous. “When you lose that, you lose those intangible relationship qualities among all healthcare workers.”
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January 2025He cited the “social trust” that physicians build with their patients and the deep satisfaction that trust carries for both physician and patient. He suggested that when that bond is loosened by the demands of volume-based care versus relationship building between physician and patient, the incentive to work harder is also loosened.
Currently, in private practice with ENT & Allergy Associates, PS, as well as a partner in Proliance Surgeons, a multispecialty group of 35 practices in Seattle, of which he sits on the governing board, Dr. Backous noted that he doesn’t think that monetary incentives are the only or even main incentive to getting physicians and other healthcare workers to engage more. He cited the exodus of workers from large technology companies, such as Google, as belying the notion that high wages encourage engagement.
He returned to the sense of autonomy workers need to feel a part of a team, or village, as he called the team approach to caring for patients. Such autonomy leads people to feel they are making an impact, and that, in turn, leads to better worker engagement. Essential to this feeling is that each person understands and is recognized for their distinct role and responsibility on the team. “As lines get blurred between, for example, responsibilities of physicians versus physician assistants versus nurses, the pathways to creating impact of each of their roles gets reduced, and people then become less engaged,” he said.
Twist on Autonomy—Post-COVID-19 Remote Work?
Ironically, an increase in autonomy may also be at work in creating quiet quitting in some margin of the healthcare workforce—employees who were relegated to remote work during the COVID-19 pandemic and now are resistant to returning to on-site work.
Although some workers may claim that working remotely offers more autonomy and improves work-life balance and, thus, work satisfaction, such autonomy may be viewed as disturbing the cultural ethos of strong teamwork and collaboration needed in the healthcare industry.
Eben Rosenthal, MD, chair of the department of otolaryngology–head and neck surgery at Vanderbilt University Medical School in Nashville, cited the insistence of staff to continue working remotely from home as having a negative impact on the “esprit de corps” among staff and faculty that is essential to maintaining a good culture, one that ultimately benefits patients.
“I feel it is hard to maintain a good culture in an environment where people are working from home and not interacting on a daily basis,” he said, citing the potential conflicts people have when working at home, such as juggling looking after children in the home