Medical Oncologists Job Satisfaction - Assignment Example

? Medical Oncologists Job Satisfaction in the Light of Medicare Reimbursement Cuts, New Legislation such as the Sunshine Act, and Burnout due to Work/Family Conflict. 1. Introduction The attitude that individuals have regarding their work is job satisfaction. According to Burke, 2004, p.311, “the term job satisfaction refers to the feelings that people have about their jobs”. In the healthcare environment it is the physicians along with the nursing professionals that are most important to the delivery of patient care, because of their deep involvement in it. The levels of job satisfaction have a strong influence in the efficient performance of job related functions. In the case of the physicians and nursing professionals the lower the levels of job satisfaction, the less efficiency in the delivery o patient care, and lower the patient satisfaction in the care received (Burke, 2004). It is for this reason that more than four decades earlier a key factor in health care delivery was the emphasis in attempts to increase the job satisfaction levels among physicians and nursing professionals, with a lot of concentration on financial rewards and improved working conditions. Evidence from studies subsequently has shown that these efforts have not produced the desired results. Over the past decade physician job level satisfaction has declined significantly, and is gauged by the lack of willingness to repeat their studies in medicine, were the option available to them (Burke, 2004). A key dimension that has emerged in the delivery of healthcare currently is the requirement for lowering the costs in the delivery of care, but at the same time maintaining higher levels of quality in the delivery care. In addition there are changes that have occurred in the market place involving increase in competition and legislative financial pressures that are consistent with the requirement for lowering costs and increasing quality in the delivery of healthcare. Though there may be several other factors that contribute to job satisfaction among physicians, it is the impact of these two demands that are putting physicians in a bind and a major cause for the decline in job satisfaction among physicians (Burke, 2004). Medical oncologists in their practice face constant exposure to the suffering of their patients, loss of patients, and the grief of the survivors, and are expected to provide relief in all these circumstances. In other words the normal practice of medical oncologists is stressful (Cherny & Catane, 2004). In addition to work pressures, medical oncologists face added financial stress coming from legislative action that will cause cut in Medicare re-imbursement from 2012 onwards (Walsh, 2011). 2. Aim of the Study The aim of the study is to evaluate job satisfaction among medical oncologists in the face of the increased challenges that they face in their practice of health care. 3. Objectives of the Study This study has three objectives, which are: 1. Evaluate the impact of Medicare reimbursement cuts on job satisfaction among medical oncologists. 2. Evaluate the impact of the Sunshine Act on job satisfaction among medical oncologists. 3. Analyse the impact of burnout due to work and family conflict on job satisfaction among medical oncologists. 4. Significance of the Study The elderly population in the United States of America (USA) is growing, which will place increased demands on providing care for their health needs. The incidence of cancer is known to rise with age. In addition, derived from the benefits advances in medical science there is and increase in the survivorship of cancer patients. Hence there will be increasing demand for medical oncologists to meet the health care needs of the general population, as well as the growing elderly segment. In a recent study conducted by the American Society of Clinical Oncology there is already a shortage of medical oncologists that will only worsen over the next decade. The study forecasts that in 2020 12,547 oncologists will be added to the strength of practicing medical oncologists. However, there will still be a shortfall of medical oncologists in the range of 2,550 – 4,080 numbers (HCPro, 2008). The shortage of oncologists will become more acute due to the effects of burnout on the profession. The ASCO study reveals oncologists that feel frustrated over their work and have lower levels of job satisfaction will spend lesser years at practice, and retire at a much younger age, than others more satisfied at their jobs (AAMC Center for Workforce Studies, 2007). In the light of the expected shortage of medical oncologists it becomes important to uncover and plug any drainage of the current workforce of Medical oncologists earlier than they are expected to retire. This study by evaluating the impact of Medicare reimbursement cuts, the Sunshine Act, and work and family conflict contribution to burnouts among medical oncologists hopes to contribute towards the objective of greater understanding on job satisfaction levels among medical oncologists, and thereby the causes of probable early retirement. 5. Literature Review Oncology centers are part of the healing environment of the health care system. The health care healing environments are being negatively impacted by the financial pressures that are the result of several legislative actions. In the face of financial exigencies professionals involved in the care of those suffering from life threatening illnesses may tend believe that resources required for implementing care strategies are no longer available and give attempts to do so frustrating themselves and the patients (Olson, 2001). The passing of the Patient Protection and Affordable Care Act (HR 3590) (PPACA) have brought fresh financial challenges to medical oncologists in their practice of offering relief and care to cancer patients. Even prior to the passing of this ACT, medical oncologists were under substantial financial pressure due to the Medicare Modernization Act, and this ACT only brings the financial pressure near to the breaking limit for medical oncologists. In the typical cancer care model for cancer patients in use currently, cancer patients visit their medical oncologist at their private –practice office, which also is the point of health care, where they are provided with their required infusion treatments. These private-practice offices of the medical oncologists also hire infusion nurses. The infusion drugs are purchased and administered by the infusion nurses on the advice of the medical oncologists. The user of this service is then billed for the infusion drugs and the services rendered. According ASCO almost 80% of the cancer patients in USA receive their cancer related health care services in this manner. This scenario is bound for change, as this model of private-practice office tries to remain viable in the face of the challenges imposed by the Medicare Modernization Act and the Patient Protection and Affordable Care Act (HR 3590) (PPACA).The challenges faced by the private-practice office model of medical oncologists emanate from the changes that are proposed in the reimbursement for chemotherapy drugs, changes that are proposed in the reimbursement of professional services, and the attempt to have these health care providers more closely aligned to accountable care organizations (ACOs) (Ferris et al, 2010). Payment received for drugs from cancer patients by medical oncologists include costs incurred acquiring, handling and administering the anti-cancer infusions. Legislative action now makes it practically impossible to recover all these expenses and the revenue that medical oncologists expect as a part of keeping their practice financially viable. More than 70% of the medical oncologists in USA purchase their requirement of oncology related pharmaceuticals from the Integrated Oncology Network. Evaluation of these purchases shows a drop in these purchases due to the poor financial health of medical oncology practice and shifting of treatment to hospital environments. Estimates from surveys show that in 2009 18% of cancer patients were shifted by medical oncologists from receiving required treatment at their offices to the hospital environments for the treatment (Ferris et al, 2010). This scenario has developed since reimbursement from insurance companies for drugs used by medical oncologists have dropped below the actual costs that they pay for the drugs, unless they purchase these drugs in very large quantities to avail of discounts, which is beyond their capabilities. Patients are not happy about the change in environment in receiving their cancer treatment, as they feel the loss of the personal touch of their medical oncologist. Explaining of the situation makes them understand the situation, but does not reduce the feeling of deprivation of an essential part of the care that they expect (Johnson & Won Tesoriiero, 2007). It is not merely the access to drugs in an environment that they would like that is felt by patients, but on the whole access to the advances in medical science and technology in cancer care is quite often denied due to the high costs involved in it (McCormack, 1991). The extent of the likely impact on the financial fortunes of the medical oncologists can be seen from the proposal to cut payments to physicians at an annual rate of about 5%, starting from the year 2012. Taken in total, the result of the proposed cuts in reimbursement to physicians will amount to a reduction of 31% that has resulted in the claim of the American Medical association that by 2013, Medicare reimbursement would be less than fifty percent of what they were getting in 1991 (Walsh, 2011). According to estimates between 50% and 70% of all community medical oncologists in smaller hospitals or centers of excellence are facing financial troubles, because of the rising costs in the purchase of drugs and overhead expenses and cuts in reimbursements (Chesanow, 2011). The Physician Payment Sunshine Act (PPSA) is a part of the PPACA, and became law on March 23, 2010. In essence the Sunshine Act requires that physicians, physician groups, and teaching hospitals as health care providers have to declare any receipt of payments and gifts received in the practice of health care. The purpose behind the Sunshine Act is to make transparent any association between health care providers and other associates of the health care industry like pharmaceutical companies, so that patients and research participants are aware of association (Novartis, 2011). Health advocacy organizations (HAOs) play an important influential role in the development of health policy, and have a close association with the pharmaceutical industry and their marketing objectives. There is a financial relationship between the HAOs and the pharmaceutical of which not many HAOs bring to light in their public disclosures. If transparency is such a key issue in the providing of health care services, then it should also be a key issue in health care policy development. in the interests of legislators, regulators, and public being aware of conflicts of interests and biases of HAO advocacy disclosures of pharmaceutical companies to HAOs should also become mandatory (Rothman et al, 2011). Stress at the job lowers job satisfaction and enhances the conflict between work and family and the probability of burnout. Medical oncologists feel stressed at normal work due to the probability of all their efforts in providing relief to their patients meeting with poor outcomes due to the nature of the disease of cancer that causes them to witness a lot of loss of life and suffering. There is an increased chance of feeling bereft of capabilities to effective at their providing of care and stress in the job. Along with this is the increased in time and effort that they have to spend with patients leaving little time for the family and socialising bringing about conflict between work and the family (Lie, 2009). Path analytic tests conducted to find out the influence of burn-out on work-family conflict support the view that burn out strongly influence work-in-family conflict and family-in-work conflict and that there is stronger influence, when there is higher social supervision, enhancing the chances of intention to quit the job (Thanacoody, Bartram & Casimir, 2009). Over the last two decades there has been a rise in the prevalence of psychiatric morbidity and emotional exhaustion among cancer professionals. The rise in psychiatric morbidity is about 27%, while the rise in emotional exhaustion is approximately 32%. Multivariate analysis has demonstrated that enhanced job stress in the absence of balancing job satisfaction is the cause of the decline in mental health, with particular emphasis on medical and surgical oncologists. Increase in regulations that may appear beneficial to the patients may be the cause of the increased job stress, since no protective measures for increased job satisfaction for oncologists are provided in these regulations. The combination of increased job stress without the benefit of job satisfaction and the personal suffering of oncologists is leading to an increase in burnout among these health care professionals (Lanceley, 2008). 6. Research Methodology The study will employ a mixed methodology by collecting both qualitative and quantitative data. The qualitative data will be secondary data as compiled through a literature review. Themes obtained through the literature will form the basis for eliciting the quantitative data. The quantitative data will be from primary sources and will be collected using the e-mail facility. The primary sources will be the medical oncologists themselves. Random selection of medical oncologists from the database of medical oncologists in the USA will be used to avoid bias in the participant selection. The sample size will consist of 100 medical oncologists willing to participate in the study (N=100). The sample size is important to the reliability of any study and there are computational tools available for deciding the appropriate sample size in studies. Thos study has not used any computational tool, and instead arrived at a convenient sample sixe, based on the scope and the resources available for the study. The author acknowledges the limitation of sample size in the study. The survey or questionnaire created on the basis of the literature review will be e-mailed to the willing participants, with an explanatory note. Any queries will be answered prior to the completion of the survey forms. The survey forms are the data collection sheets. 7. Analysis of the Data The data received from the data sheets will be entered into a personal computer and collated. SPSS statistical software will be the program used for analysis of the data to provide the results and findings of the study. 8. Ethical Consideration All ethical guidelines of the conduct of research in the health care sector will be followed 1. Any required administrative sanctions will be sought and received before commencing the study. 2. All participants will be recruited on a voluntary basis after explaining the nature and purpose of the study and providing all clarifications. Participants will be allowed to withdraw at any stage of the study. 3. Professional ethics will be maintained by the research team at all stages of the study. 4. Data collected will be for the purposes of the study only. 5. Data will be collected in such a manner as to ensure anonymity and confidentiality of the participating (Data sheets will be coded). 8. Organization of the Report Chapter -1 : Introduction Chapter -2 : Literature Review Chapter -3 : Research Design and Methods Chapter -4 : Data Collection and Analysis Chapter -5 : Results Chapter -6 : Discussion Chapter -7 : Conclusion, Recommendations and Future Work Chapter -8 : Ethical Considerations, Limitations and Acknowledgements. Literary References AAMC Center for Workforce Studies. (2007). A Report to the American Society of Clinical Oncologists (ASCO) from the AAMC Center for Workforce Studies. Retrieved May 31, 2011, from Web site: http://www.asco.org/ASCO/Downloads/Cancer%20Research/Oncology%20Workforce%20Report%20FINAL.pdf Burke, R. J. (2004). Job Satisfaction. In Michael J. Stahl (Ed.), Encyclopedia of Health Care Management (311-313). Thousand Oaks, California: Sage Publications, Inc. Cherny, N. I. & Catane, R. (2004). Psycho-oncology and communication. In Franco Cavalli, Heine H. Hansen & Stan B. Kaye (Eds.), Textbook of Medical Oncology, Third Edition, (399-412). Abingdon, Oxfordshire: Taylor & Francis. Chesanow, N (2011). Five Ways to Control Oncology Drug Costs. Retrieved May 31, 2011, from Medscape Business of Medicine Web site: http://www.medscape.com/viewarticle/736849 Ferris, L. W., Farber, M. G., Guidi, T. U. & Laffey, W. J. (2010). Impact of Health Care Reform on the Cancer Patient: A View from Cancer Executives. Cancer Journal, 16(6), 600-605. HCPro. (2008). Survey Reveals Competitiveness of Recruitment. Physician Compensation & Recruitment, 9(6), Retrieved May 31, 2011, from Web site: http://www.themedicusfirm.com/files/N_survey_reveals.pdf Johnson, A. & Won Tesoriiero, H. (2007). Doctors Quit Injecting Drugs Over Costs. Wall Street Journal, New York, p.1 Lanceley, A. (2008). The Impact of Cancer on Health Care Professionals. In Jessica Corner & Chris Bailey (Eds.), Cancer Nursing: Care in Context, Second Edition (pp. 153-171). Garsington Road, Oxford: Blackwell Publishing Ltd. Lie, D. (2009). Part 1: The Case of the Emergency Department Physician Who Burned Out: Risk Factors, Impact, and Early Interventions. Retrieved May 31, 2011, from Medscape Internal Medicine Web site: http://www.medscape.com/viewarticle/712294 McCormack, J. (1991). Denials Limit Access to State-of-the-Art Cancer Treatment. Hospitals & Health Networks, 65(11), 56. Novartis (2011). The Physician Payment Sunshine Act Patients Want to Know. May 31, 2011, from Web site: http://www.novartisoncology.us/reimbursement/pp/sunshine_payment/index.jsp Olson, M. (2001). Healing the Dying. Second Edition. Albany, NY: Delmar, Thomson Learning, Inc. Rothman, S. M., Ravies, V. H., Friedman, A., & Rothman, D. J. (2011). Health advocacy organizations and the pharmaceutical industry: an analysis of disclosure practices. American Journal of Public Health, 10(4), 602-609. Thanacoody, P. R., Bartram, T. & Casimir, G. (2009). The effects of burnout and supervisory social support on the relationship between work-family conflict and intention to leave: a study of Australian cancer workers. Journal of Health Organization and Management, 23(1): 53-69. Walsh, T. (2011). Medicare Reimbursement Cuts Could Hit Physicians Hard. Retrieved May 31, 2011, from AmerOnc Web site: http://www.ameronc.com/news-41093.html Read More