Most physicians continue to report overall career satisfaction, but
increased public and patient expectations and administrative and regulatory
controls contribute to perceptions of increased time pressures and erosion
of autonomy. Increasingly, knowledgeable patients armed with information from
the media, as well as guidelines developed by health plans, government, specialty
societies, professional organizations, and advocacy groups, confront physicians
with a bewildering array of new expectations and demands. Although physicians
are spending more time with patients than in earlier periods they feel themselves
on a treadmill. Strategies to ease pressures include increased use and enhanced
scope of nonphysician clinicians, adoption of information technology and disease
management programs to reduce errors and to increase efficiency and quality,
and thoughtful practice design. Use of such strategies, combined with leadership
and a clear sense of direction, can empower physicians, provide them with
expanded knowledge and expert systems, and relieve some practice burdens and
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