Let’s face it: Nurses can be pretty tough on physicians. They often paint physicians as self-centered, egotistical, golf-loving know-it-alls who care more about their new toy in the parking lot than the patient down the hall with a cough. Of course, there are two sides to every story. Physicians spend half of their 20s cooped up studying. Physicians work long, hard hours. Physicians hurt, too. Let’s take a closer look.

Physician morale has decreased significantly over the past 10 years, with the most affected group being doctors between the ages of 50 and 60. Physicians work harder than ever before, yet their profit margins are shrinking due to decreased reimbursements and escalating malpractice insurance costs. Many are still paying off tremendously high college loans. Reimbursement rates for medical care are cut back every year, and insurance companies index their reimbursements accordingly. More office staff is needed to get insurance approval and physicians have to spend less time with their patients.

Studies show that with every additional year of medical school, physicians’ empathy decreases. As residents, most physicians worked more than 100 hours each week. With minds that worked like ACLS flow charts in a time-constrained environment, they simply didn’t have time to process emotions. Feelings take time. In addition, doctors were taught to focus only on the clinical signs and symptoms and not on the whole patient. Today, several universities are trying to improve physicians’ empathy by adding classes in narrative medicine, journaling, and spirituality.

Physician autonomy is threatened as nurse practitioners replace many of the same jobs that only physicians used to do. Gone are the days of the caduceus sign on every physician’s license plate and free parking–we now live in a litigious society. The “culture code” for physicians in our society is that they should be heroes–and if they can’t save us from death or disease, well then, they must be negligent.

Because of access to the Internet, patients come into their doctors’ offices telling them what to do, and so doctors spend a great deal of time discussing the volumes of Internet information found by their patients. A tremendous amount of publicly available data has replaced a long-held, sacred trust. In addition, technology is advancing so rapidly that doctors need to constantly educate themselves on new techniques, equipment, or procedures while working more than they did 10 years ago.

And what are the top five things that make physician leaders want to pull out their hair?

1. Case managers who are more like bean counters put on Earth to make money for the hospital.
2. Doctors who moan and complain in the doctors’ lounge, but are like sheep when it comes to speaking up and facing challenges.
3. Personal injury lawyers (enough said.)
4. Nurses who engage mouth before brain.
5. Hospital administrators who put numbers first and patients second.

Editor’s note: This article uses an excerpt from Stressed Out About Communication Skills and a column from HealthLeaders, an HCPro publication.