Complaining Physicians: What's the Story?

Complaining Physician: Letter from Students

Why Does It Seem That Primary Care Physicians Have More Complaints?

Students usually see the primary care doctors in their natural settings. They see the full picture, often involving the lifestyle and family of the physician, especially in a rural setting. They spend a whole day with the physician rather than a few minutes, as with many medical school attendings. All doctors complain, but spending a whole day with a physician can be revealing as to how much they complain.

Do Older Physicians Complain More (Older, not just primary care)?

Yes, studies of physicians reveal that 1 out of 10 younger doctors (less than 35 yrs) are dissatisfied, as compared to 1 out of 4 older physicians (Journal of Family Medicine article, see link below)

Complaints By Type of Physician

General Internal Medicine         20.6 % dissatisfied

Specialists                                18.0 % dissatisfied

Family physicians                      17.3 % dissatisfied

General pediatricians                 12.6% dissatisfied

Dissatisfaction in family physicians and general practitioners was related to physicians who strongly disagreed with the statement "I have the freedom to make clinical decisions that meet my patient's needs."

Those FP or GP docs who were more dissatisfied were older, tended to own their own practices (vs shared ownership or being employed), or made less than $100,000. Also those who served as gatekeepers for more than 30 % or less than 10% of their patients were not as satisfied.

"The strongest factors associated with dissatisfaction, however, were not personal or practice characteristics but the perceptions of family physicians about their ability to take good care of their patients."  1. The freedom to make decisions, 2. communication with specialists, 3. enough time with patients, 4. the ability to provide high quality patient care, 5. the freedom to make clinical decisions without financial conflicts of interest, 6. the ability to maintain continuing relationships with their patients.

1996 and 1997 data reveals the following

Dissatisfied physicians accept less Medicare and Medicaid patients

DeVoe et all  Does Career Dissatisfaction Affect the Ability of Family Physicians to Deliver High-Quality Patient Care?  Journal of Family Practice March 2002  Vol 51 no 3 p223-228

From email info

We have also had to point out to students on family practice rotations that all doctors are whining and complaining right now, not just their family practice preceptors. They just happen to spend more time with our rural preceptors when compared with their other rotations in the M-3 and M-4 years.

It is guilt by greater association.

We obviously do not want to minimize contact with these fine examples, but we do need to inform students about these issues. One of the difficult things to assess is the impact of the preceptor vs that of the preceptorship. Mercer studies have noted that the preceptor has more impact than the preceptorship. Our students have consistently rated the rural family practice preceptorship as the best in the M-4 year (in the past) and then in the M-3 year more recently. We would love to claim credit, but know that the relationship between student and preceptor is a major part.

Robert C. Bowman, M.D,8/2001

Make sure that students and residents understand these concepts and appreciate the gift of more complete contact!  

Osler and Rural Practice