If you listen to social media and the popular press, it seems that no one in healthcare is happy.  Articles abound describing nursing shortages, provider burnout, and low job satisfaction.  Team morale is a hot topic at every high-level meeting in the urgent care where I work.  And we’re not the only ones.  I frequently receive emails from groups like the American Medical Association (AMA) or AAPA requesting that I fill out surveys on the subject.  It seems like everyone is searching for ways to keep medical professionals happy in their jobs.  For me, this is more than a theoretical exercise.  As part of my urgent care managerial role, I was specifically assigned to investigate the subject and offer recommendations on improving provider satisfaction. 

Why Does it Matter? 

Employers have a vested interest in provider satisfaction because turnover is expensive.  And let’s face it, without providers, there is no business.  It matters to me as a medical professional because I don’t want to dread going to my job every day.  I want to be a part of the pushback against burnout and dissatisfaction.  It seems that sometime after COVID, everyone had a period of self-reflection caused by burnout.  I certainly got my first taste of it through the pandemic.  Whether it was the ever-changing government regulations, the constant updates in hospital policies, being an essential worker in a world gone remote, or the sheer volume of patients we faced – burnout hit us all. 

What did I do with these feelings?  I worked through it, leaned on my coworkers, did my best, and made it through.  I knew I wasn’t alone.   It was obvious that I was surrounded by other medical professionals, feeling the same thing.  In the past two years, the question has arisen: can medical professionals find satisfaction in healthcare today, or have we passed the point of no return? 

Current Healthcare Professionals 

The spectrum of provider archetypes is broad.  On one end are seasoned providers, the OG workers, characterized by their steadfast routines, dedicated work ethic, and reluctance to seek change.  In the middle, some providers are self-motivated, work hard, and pursue excellence for themselves.  Although they may desire recognition for their efforts, they typically refrain from constant complaints, striving to establish their reputation.  On the opposite end of the spectrum, a newer generation of providers can exhibit something akin to entitlement, seeking financial rewards without proportional effort and behavior.  They want to collect an ever-increasing paycheck without working harder.  While these examples are extreme, they illustrate the diversity in attitudes toward work that healthcare professionals now have.   

Approaching provider satisfaction within this framework is challenging, as each category of providers will be motivated differently, have different expectations from their job, and have a different perspective on what will satisfy them.  I find myself between the first two types- a blend of OG with strong advocacy for professional development, but I am bold in exploring new opportunities.  Satisfying the first two groups appears less challenging, given their intrinsic motivation (which we will dive into later).  While I have less than a year of management experience, I have already worked with providers from various points on this spectrum.  The shift in the characteristics of healthcare professionals is most apparent when comparing new providers to those who have been in healthcare for over 15 years.  

Current State of Provider Satisfaction 

While it’s tempting to attribute the shift in dynamics in healthcare to the challenges posed by a global pandemic, the story extends further back.  Studies about provider satisfaction have been around since APPs began establishing a foothold 20 years ago.  Typically, 50-60% of APPs have high levels of professional fulfillment, but most have low levels of satisfaction.  Satisfaction is positively correlated with career advancement and pay opportunities while negatively correlated with workload (3).  Specifically, the Journal of the American Academy of Physician Assistants and APPA have researched physician assistant job satisfaction and mental health over the last few years.  One study showed that most PAs (53%) had high levels of professional fulfillment, but 30.2% reported interpersonal disengagement, 45.9% reported work exhaustion, and 34.3% reported overall burnout (1). 

Common Factors Influencing Provider Satisfaction

So, what does all this mean?  What influences provider satisfaction?  Can management interventions truly make a difference, or is dissatisfaction an inevitable outcome of the evolving healthcare landscape?  Does anything we do matter, or is satisfaction purely intrinsic?  Overall, I believe the factors influencing satisfaction are both intrinsic and extrinsic.  It is important to differentiate between the two because the solution to dissatisfaction differs depending on the source of the provider’s motivation.  Let’s discuss the factors and actions that providers and their managers can use to navigate satisfaction improvement in healthcare. 

Intrinsic Factors

Workload 

Provider workload is a hot topic of conversation when discussing satisfaction.  The healthcare workload undeniably surged during the COVID-19 pandemic and seemingly hasn’t returned to pre-pandemic levels.  However, increasing workloads have been a reality for years.  The cause is multifactorial and beyond the scope of this article, but can be grouped into four main categories. 

  1. Increased corporate ownership of hospitals and medical practices. 
  1. Decreased reimbursement from private insurance and government programs. 
  1. Shifting consumer demands for “retail” medicine.     
  1. Increased charting requirements.   

    

Regardless of specialty, healthcare providers are expected to see more patients and document more extensively than ever before.  How you perceive and manage this increased demand has become an intrinsic aspect of satisfaction.  Some providers find motivation in seeing more patients as it gives them a sense of purpose, contributing to efficient team performance and timely patient care.  I like to say, “It’s fun to feel like a badass.”  On the flip side, there are those with a negative intrinsic perspective on workload, driven more by concerns like not wanting to see more patients than the person they are working next to or questioning the necessity of patient visits in the first place.  These providers keep score and aim to do minimal work to maximize their “dollar per effort.” 

A few things that can improve the outlook toward a provider’s workload are a positive work-life balance, granting more autonomy, and having supportive leadership that understands the workload struggles.  In my experience at a previous ER, I appreciated the management’s role.  The physician-owners of the group actively worked clinical shifts, most pulling full-time hours.  Even the big boss took night shifts.  This fostered an environment of teamwork, with a shared goal of providing prompt care to all patients.  Complaining about the workload isn’t well received when your bosses face the same challenges. 

Autonomy 

Autonomy is a recurring theme in our conversations with providers in the Urgent Care business.  We expect providers to practice independently and make sound medical decisions without direct, daily supervision from a physician.  However, professional autonomy does not only apply to medical decision-making.  Some of our experienced providers recently asked for more autonomy in directing patient flow.  Ultimately, I think the intrinsic factor is the desire for empowerment, not to be micromanaged but instead to make decisions for the clinic and your patients.  From a management perspective, the key is to leverage this insight and continually empower our providers through education, instilling confidence in their ability to seek more autonomy.  Establishing protocols that support autonomous decision-making is crucial.  With such autonomy can come abuse of power, but the hope is the empowerment they feel instills a sense of responsibility that mitigates this temptation.    

Patient Relationships 

Relationships play a dual role in shaping our job satisfaction, with positive and negative impacts.  Positively, the ability to make a meaningful difference in some patients’ health outcomes is fulfilling.  There must be some level of compassion if you are in this field, and if we feed into those positive interactions, this can increase our satisfaction.  However, the reality is that not every patient interaction is sunshine and rainbows.  Unfortunately, some patients just flat-out suck.  While I consciously try to be a responsible prescriber and educator, the constant uphill battle, fighting against every patient’s desire and request, can take its toll.   

     In recent years, I’ve learned to choose my battles wisely, a principle I now emphasize when teaching new providers.  You will burn yourself out fighting the good fight with every patient.  If their request won’t harm them, sometimes preserving your energy is better than winning.  You won’t change the world by refusing antibiotics to a few patients.  I recently had to counsel a provider who was constantly getting into high-intensity patient conversations, always trying to win her point.  I explained that it was her approach and tone that was causing patients to react this way.  While some patients will inevitably be difficult, I’ve personally faced intense confrontations only twice in my career; both centered around pain medications.  The goal is simple: everyone does not have to love you, but you don’t want people storming out of the clinic/ hospital every time you work.   

Extrinsic Factors

Compensation 

Financial compensation is the first thing people think about when it comes to increasing satisfaction.  Money fixes all problems, right?  I’ve been there, too – seeking a raise from a position where I felt I was excelling, wanting an external acknowledgment of my efforts.  While the raise eventually materialized for me and the entire team, I’ve recently found myself questioning this mindset.  The idea that a raise alone significantly boosts job satisfaction has started to lose its weight for me.  Don’t get me wrong; competitive compensation is essential, and high-performing employees deserve pay increases annually.  However, I’ve come to believe that the correlation between a pay raise and increased job satisfaction is not a direct one.  Pay increases become less of a driving force if you feel appreciated and have intrinsic motivation. 

As management, we should focus on genuinely recognizing and appreciating our employees for what they do.  I like the idea of compensating with extra education opportunities to further their skills or providing long-term retention bonuses.  Some books frown upon any external rewards for performance, but I don’t entirely agree with that.  However, I don’t think raising a disgruntled employee’s wage is the answer to raising satisfaction.  There won’t ever be enough money to incentivize employees to work harder if they don’t have the intrinsic desire.  

Mixed 

Recognition/Appreciation 

If you have ever been to couples therapy, one of the first things they talk about is Love Languages.  Words of affirmation are relatively low on my list, but for some, outward expression of appreciation and recognition is their “love language.”  In the context of employee motivation, substitute love language for “primary motivator.”  This is somewhat unnatural for me as a leader, as I don’t crave extensive external validation.  I know I am awesome and intrinsically valuable (and humble, too). 

Yet, I recognize that some employees need external validation.  It is imperative to fulfill this need for them as a manager.  I believe that many high-level teams fall short in this area.  While seemingly straightforward, acknowledging appreciation for your team and colleagues should be an ongoing priority.  No one wants to feel replaceable.  People desire to feel valued, respected, appreciated, understood, and heard, especially during demanding work periods.  A simple way to achieve this is to offer gratitude for a job well done and acknowledge their hard work.   

Work-Life Balance 

The younger employees we profiled earlier desire and highly value work-life balance.  Contrasting this with my father’s generation (born in the 50s) demonstrates a stark shift in values.  From age 15, my dad committed to working every day he was asked, seeking minimal benefits, scheduled time off, retirement plans, pay increases, or even appreciation from his bosses.  His work ethic was deeply rooted in the teachings of his parents – you work because that’s what you do.  My generation (born in the 90s) is somewhere between that and this newer generation that seems to care more about their free time than their job responsibilities. 

As management, I think we can appeal to this mixture of personalities by having a flexible scheduling option, allowing employees to take time off without feeling burdened, and refraining from excessive demands during their downtime from work.  Encouraging a healthy balance between work and personal life is a valuable motivator, both externally as employers and internally as providers.  I plan my life around my work schedule, but I don’t stop traveling and making memories with my family.  We make time for the things we value, creating some balance in our lives.  Recognizing the value in activities beyond work is critical for preventing burnout and dissatisfaction, as no one wants to work all the time.  Business owners and employees must work together to find a healthy work-life balance and normalize it within the company.  

Professional Development  

I believe we are naturally inclined to desire personal and professional growth.  Unfortunately, many employers don’t provide their employees enough opportunities for advancement, which leads to dissatisfaction.  In our organization, we actively address this issue by incorporating initiatives such as ongoing education, advanced training, and opportunities for leadership positions.  As part of our quarterly employee reviews, we recently asked them what skill/area their manager can help them with for education advancement.  We hope that if we find out what they want more of and try to give it to them, they will want to stay with us longer and pour back into the company. 

The early feedback on this initiative has been positive, and the beauty of it lies in its simplicity – a willingness to ask and then make an effort to fulfill those desires.  Providing individuals with opportunities to learn and grow is a powerful form of empowerment.  This investment contributes to increased autonomy and nurtures better, more confident, and ultimately more productive providers.  Such initiatives create a positive feedback loop where empowered providers contribute to the growth and success of the company. 

The Role APPs Have in Healthcare 

Over the last ten years, APPs have assumed a more prominent role across the healthcare industry (4).  APPs are increasingly more represented, particularly in urgent care and emergency rooms.  In specific settings, they serve as substitutes for physicians, while in others, they collaborate closely, aiming to enhance overall team productivity.  An APP’s particular role in the healthcare system affects job satisfaction.  Those who desire increased autonomy and responsibility will flourish in roles that allow them this freedom.  A mismatch between the role you want and the role you have will diminish feelings of satisfaction.    

     My previous ER experienced a significantly increased volume over the past two years.  The most financially responsible decision would have been to push APPs to run the fast-track area, seeing all the lower acuity patients while physicians saw the higher acuity cases.  However, since their group’s inception, they have allowed their APPs to see both high and low-acuity patients, as no ER provider wants to see only coughs and colds during their shift.  This method has undoubtedly increased the satisfaction level of the APPs, contributing to their low turnover rate over the years.  Although redirecting APPs to lower acuity patients could be more financially beneficial to the physician group, it would negatively affect their employees’ job satisfaction.   

So, Is Enough Ever Enough? 

What is enough, anyway?  For some, achieving “enough” might be having autonomy, improving their skill, and becoming a top performer.  Others may have “enough” in their job because they find meaning in their connections with their patients.  “Enough” is dynamic, varying from person to person and situation to situation.  Answering this question by focusing on the factors we talked about above is not enough.  Each case is unique and personal.  I think speaking to each of your providers and regularly discussing their motivations and satisfaction is essential.  Embrace open dialogue, be receptive to feedback, and acknowledge managerial shortcomings. 

In reality, turnover is expensive, and every provider will struggle with satisfaction at some point in their career.  We must fight burnout, encourage a positive work-life balance, create teamwork, and recognize the importance of autonomy and professional growth to our employees.  As providers, we are equally responsible for shaping this perspective alongside our employers.  Acknowledge that there is no perfect job, and every role has its own pros and cons.  To feel satisfied and have “enough,” I encourage you to advocate for yourself on the things that you find important.  Create the type of environment that you want to work in, and be a part of the change in healthcare, not a part of the problem. 

Conclusion 

I hope that some of the insights here resonate with you.  I believe that pursuing job satisfaction is an ongoing journey- the outcome rests as much on our shoulders as individuals as it does on our employers.  Our role as medical professionals is one of responsibility and privilege.  The challenges we face are real, but I feel a strong duty to be positive and to try and change the current attitude in healthcare.  It’s partially why I left the ER job I loved and went into urgent care in a leadership position. 

I want to teach new providers the tools to achieve job satisfaction.  I want to remind those experiencing burnout to remember why they got into patient care in the first place. It is important to me to inspire others to make the changes that will give them fulfillment in their careers.  I want to do my part to make healthcare providers a little less unhappy. Subscribe below for more content.

  1. (n.d.). Depression, burnout, and professional outcomes among PAs. JAAPA. https://journals.lww.com/jaapa/Fulltext/2021/09000/Depression,_burnout,_and_professional_outcomes.7.aspx
  2. (n.d.). PA job satisfaction and career plans. JAAPA. https://journals.lww.com/jaapa/Fulltext/2021/06000/PA_job_satisfaction_and_career_plans.14.aspx
  3. (n.d.). Sage Journals. JAAPA. https://journals.sagepub.com/doi/full/10.1177/1077558717730157
  4. (n.d.). Increased reliance on physician assistants: An access-quality tradeoff? J Mark Access Health Policy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788342/