Physician Burnout – I Think I Have It

I’ve been doing some thinking about physician burnout lately.  Partially because it’s a big topic in medicine, but more so because I think I might just have it.

Anymore, my enthusiasm for going to clinic seems to be dwindling.  It has nothing to do with the patients.  They are what I enjoy about medicine.  The frantic conveyor belt pace of medicine is what is eroding my enthusiasm.  Patients are packed into little 15 minute time aliquots irregardless of their complexity.  Add in documentation and EHR time and you’re scrambling to stay remotely close to on time while trying to deliver quality care.  The stress permeates through the entire organization effecting everyone from physicians to the front desk staff.

Physician burnout is a real problem.  Data from the Mayo Clinic and AMA show burnout increasing from 45% in 2011 to 54% in 2014.  Over half of practicing physicians are not happy with their career.  That’s not good.  A 2016 Physician’s Foundation survey of over 17,000 physicians found that:

  • 49% often or always experience feelings of burn-out.
  • 48% of physicians plan to cut-back on hours, retire, take a non-clinical job, switch to “concierge” medicine, or take other steps limiting patient access to their practices.
  • 80% of physicians are overextended or at capacity, with no time to see additional patients.

There are countless articles outlining the various reasons for physician burnout.   Reading these articles and talking to practicing docs about physician burnout there are several common themes:

  • Regulation and government interference – insert value-based care, bundled payments and MACRA
  • EHR, MU, and the decline of the physician-patient relationship
  • Loss or perceived loss of autonomy
  • More work, less fun – work-life balance mismatch
  • Intrusion of third-party payors into clinical decision making

But what if this is simply a self-limiting problem?  Aren’t these ‘experienced’ physician problems?  What if you don’t know any better?  It seems to me that if the only healthcare system you’ve ever known revolves around the EHR and measurable metric mayhem then that should be your normal.  All we need to do then is wait for the old guys to give up and retire and middle of the road guys to give in and assimilate.

Well, not so much.  Turns out that younger docs are feeling the burn also.  They feel unprepared coming out of training to deal with the business aspects of medicine.  Seventy-one percent of physicians describe “patient relationships” as the most satisfying aspect of medical practice.  But more and more, physicians are being asked (and occasionally forced) to be businessmen as well physicians.

I recent attended a conference where the one of the speakers discussed the Quadruple Aim.  Everyone knows the triple aim of improving patient care, improving population health and reducing costs.  I think everyone agrees these are great goals.  However, the unintended consequence of these efforts has been the plummeting of physician job satisfaction rates.  Therein lies the fourth element of the quadruple aim – physician engagement.

It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change
– Charles Darwin

The big question is how do we pull this off?  How do we engage physicians and turn the trend around?  Change.  We need to change things.  Unfortunately, change is what is driving a lot of the feelings of burnout.  Physicians hate change.  Some actually fear change.  Nonetheless without some degree of change we will reach a crisis point as physician’s retire early,  decide to leave practice for other careers or possibly watch the number of new physicians decline.

Something has to be done about EHR’s.  I think it’s pretty clear that they hold enormous potential to improve care and streamline care delivery.  The monkey wrench is the burdensome regulations governing their use.  Meaning(less) use, PQRS, etc. add too much administrative bloat to the documentation process and have not been convincingly shown to improve care.  In some cases, the opposite has been the case.  The EHR is the biggest culprit in the the erosion of the physician-patient relationship.  Physicians look at computers not patients.  Medical scribes have become a common place unintended add-on to the intimate clinic setting.  This brings an unneeded third party into the the mix and is clearly not what the promise of EHR implementation intended.  Remove these unwanted restrictions.  Let true innovation in medical technology flourish.  Otherwise we are all eventually going to turn into little Epic EHR data entry robots.

We need to do something with the regulatory alphabet soup.  MACRA, MIPS, APM, PQRS, QRUR and MU to name a few.  From a November 2016 MedAxiom blog post: “In the past month alone, CMS issued 7,348 pages of new legislation…”  How are practicing physicians expected to keep up with this pace of change and keep current clinically?  Yes the spirit behind most of these initiatives is well intended.  I’m all in favor of moving from fee-for-service to a value-based care model.  It’s about time the patient became the focal point of care. However, these measures are unnecessarily complex and occasionally contradictory.  Each one increases administrative time burden without a tangible improvement in care.  Physicians don’t have the time or the desire to understand the minutia of these rules.  Not to mention the cost of these reporting measures.  How much you ask?  Estimates put the cost of quality reporting at over $40,000 per physician amounting to $15.4 billion annually.  So much for the third leg of the triple aim.

Cause I found a way to steal the sun from the sky
Long live that day that I decided to fly from the inside
– Shinedown

The most important next step is to stop complaining and work to fix the problem yourself.  Changing the legislation is obviously out of any individual’s control.  Not only that, even fast  legislative change moves at glacial speeds.  Identify those things you can change.  You do have the power to change your workflow, focus and attitude.  Fixing burnout starts from within.

For me, I think I’m on the upside of the bounce.  For some time, anything seemed better than continuing with medicine.  Should I transition to an administrative role, defect to the dark side (insert industry) or even take the big gamble and go all jeans and t-shirts full-time start-up dude?   When it comes right down to it, patient care is what keeps me in the game.  I have refocused my attitude on process change and improvement.  Forced change in medicine can be viewed as oppressive or, more productively, an opportunity for new innovation in care delivery.  That’s the direction I’m heading.  Wish me luck.

Cheers – Doc W

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