Designing To Keep Doctors In The House
Some insightful observations by physicians are making me rethink some current facility planning assumptions.
The Wall Street Journal recently published an essay adapted from the book “Doctored: The Disillusionment of an American Physician” by Dr. Sandeep Jauhar, director of the heart failure program at Long Island Jewish Medical Center. In the essay, Jauhar eloquently describes the loss of his and other physicians’ professional ideals, citing a 2008 survey of 12,000 physicians in which only 6 percent described their morale as positive.
Jauhar continues to describe the factors for this decline in morale: decreased income, increased paperwork per patient, increased inpatient volume, and decreased patient encounter time.
Meanwhile, the essay describes, physicians are encouraged to order more tests that may be unnecessary and are “increasingly perceived as bilking the system”—lowering physicians’ status in the community. He quotes one doctor: “I wouldn’t do it again, and it has nothing to do with money. I get too little respect from patients, physician colleagues, and administrators, despite good clinical judgment, hard work, and compassion for my patients.”
This is a huge reversal from the halcyon days of the mid to late 20th century when medicine was considered the most noble of professions, worthy of years of schooling and internship and subsequent college debt. Of course, there was a downside to this “god-like” status, including physician arrogance, perception of infallibility, and unrealistic demands.
In my early years of architectural practice, I endured some of the most boorish behavior imaginable from physicians who lacked respect for hospital administration and, in turn, the design team. In many cases, their personal needs supplanted those of their clinical team and were not patient-centric in the least.
Based on the current attitude of health systems towards physician needs, this perhaps is “payback” time. Many physicians have bemoaned the loss of a private office, especially one close to the work setting. Rather, physicians today are more likely to be sharing hoteling space with clinical and ancillary support staff in team rooms, which may improve discipline cooperation but decrease privacy.
While this is proven to be space and operationally efficient, since private offices sit idle much of the day, the move also sends a message to physicians that they don’t hold an exceptional status. In many cases, separate physician entries, parking, lounges, and dining areas are also gone—duplicative space in healthcare settings is expensive, after all.
However, Jauhar acknowledges that the “growing [physician] discontent has serious consequences for patients.” To start, a shortage of physicians—especially in primary care where physicians also face lower pay, long hours, and too many patients/too little time—is looming. This will likely lead to a shortage of valuable one-on-one time between doctors and patients.
Another consideration is that unhappy doctors make for unhappy patients. Most of the questions on the HCAHPS concern whether there was a perception of positive, consistent, and clear interaction between the patient, physician, and other clinical staff. Health systems can suffer major financial penalties from Medicare if ratings don’t meet acceptable thresholds, not to mention that clear communication can be a key factor in lowering hospital readmission rates.
For healthcare facility design, it may not be readily apparent how support spaces for physicians improve the patient and family experience, but there is indeed a correlation.
We may have gone too far in the elimination of physicians’ perks in the name of efficiency and cost containment. In a future of diminishing resources, this will be a challenge but an important consideration if we are going to keep doctors in the house.