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· Any issue or matter that causes a delay in medical specialists' schedules was considered demotivating. Specialists referred to these issues as "stuff that slows you down." Examples that were mentioned were: meetings, turnover time, or general logistics in patient care (i.e., patients not showing up or when the specialists were not called at the point when a patient shows up to the clinic). These events decreased their feelings of autonomy because they have no control over the events or their schedule, nor do they feel like there is enough time to manage all the different tasks, to the point where even negative effects on their emotional and physical wellbeing are mentioned:
· "There are days where it is just one struggle after another, where I feel I do not have control of the practice that I would like to have." (Medical specialist no. 9)
· "When you do surgery, there is that time in between surgeries. It is a very long time, and things do not really move along. You spend a lot of time waiting for things to happen. You can do other things, like your paperwork, but it does make for a long day. That part of waiting around, doing paperwork, these inefficiencies, that part is no fun." (Medical specialist no. 10)
· "Sitting in meetings, all meetings. All meetings that are not directly related to my research or patient care I find very irritating. It gives me headaches." (Medical specialist no. 1)
· Demanding patients can also be categorized under this theme. The specialist seems to experience a loss of autonomy, as the patient did not take their advice (in this case, a referral to a different specialist). There also seems to be a lack of relatedness, as the patient and specialist find it impossible to come to a shared decision. Finally, there seems to be a lack of competence, as the specialist does not know what to do next and cannot provide the care they would like to provide.
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· Administrative tasks are considered a burden. The bureaucracy and "daily grind" of administration, phone calls, a focus on patient satisfaction, and measurement take away time from patient care—what specialists actually want to do. Specialists refer to "the paper jungle," which decreases their feelings of autonomy.
· "I do not feel like I am doing a lot of the stuff that I was hoping to do when I started medicine." (Medical specialist no.7)
· "The demoralizing aspects are the amount of administrative and bureaucratic…the burden that does not add anything to the quality of our outcomes. You are spending all this time looking at computers and satisfying what the computers want you to do." (Medical specialist no.12)
· The administrative activities are not seen as relevant to the ability to provide the best quality of care. Some of these tasks may be irritating or start out irritating, but when dealing with those days, they become demotivating or even demoralizing.
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· As mentioned before, medical specialists enjoy the challenge and the puzzle of treating patients. However, when their decisions regarding patient treatment lead to poor outcomes, it is considered highly demotivating. There is a feeling of a loss of competence, as apparently, the specialist was unable to complete this challenge and rise to the occasion. All specialists stated this same feeling:
· "The hardest part is, sometimes, we guess wrong, and we end up not giving people a successful procedure, or it just does not do what we want to do, or we need to revise it, and they have to go through more stuff." (Medical specialist no.8)
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