Full disclosure: this is my first foray into this arena. The arena of physician burnout and its related effects, that is.
And let me start this by saying I’m not a physician – I am an everyday businessman, father, husband, brother, uncle, cousin, an all-around “normal” person, watching his adult children grow up and “launch.”
I’m also in the relative “later stages of life” – in my mid-to-late-middle-age you might say – and I’ve just spent a bit more than a year helping a close family member navigate some challenging health situations.
The journey all started with a major diverticulitis attack a couple of days before New Year’s Eve (2014), two major (related) surgeries in June and September, two systemic infections, multiple pulmonary emboli, a slight case of pneumonia, afibrillation (and all the side effects of heart issues), a cardioversion procedure , and, for added good measure, a couple of bouts with the flu. His energy level is still quite low, but for the most part, he’s healing up quite well, and returning to normalcy (whatever that represents).
During this timeframe (about 14 months) we’ve interacted with many medical professionals (all manner of physicians and surgeons, nurses, PAs, imaging technicians, blood-lab personnel, etc.) – closely – that helped keep this person literally alive, and actually helped him thrive.
Every day, we all drive by doctor’s offices, hospitals and rehabilitation centers, chock full of patients in all stages of life, and in all states of health. There are doctors with great empathy and those that, let’s say, lack bedside manner.
One overriding point to all this is, most physicians are very self-confident. Simply put, they have to be – they hold the lives and well-being of (on average) 2,200-2,500 people in their hands. Research shows that most GPs have about 2,200-2,500 patients in their “panels.” (based on a computer model designed by Dr. Sergei V. Savin, PhD, Columbia School of Business).
Some thoughts and opinions:
– Some have been led to believe they are even at god-like levels in terms of their chosen profession. And you know what? That’s OK by me – I want someone looking after my loved one (and me!) that is confident in his/her ability to help, and to make the right call under some very tough circumstances, and not always with all the facts at hand.
But there are always two sides to every coin, or two edges to every blade. Choose your analogy.
The incredibly sad thing is, physicians kill themselves literally at double the rate of the general population – about 400 a year commit suicide. That’s equivalent to one graduating class of medical students from one medical school.
Each year. And some would say that’s underreported.
According to several research studies (http://www.medscape.com//features/slideshow/lifestyle/2014/family-medicine) reaching back to the 1980’s, about 1 out of every 2 physicians is suffering at least one effect of professional burnout, as judged by the Maslach Burnout Inventory (MBI) test and results.
This figure was confirmed by a study recently released by VITAL Worklife Solutions in St. Cloud, Minnesota. The study I’m referring to was co-authored and co-sponsored by VITAL Worklife Solutions (http://vitalworklife.com/) and Cejka Search (http://www.cejkasearch.com/).
These two organizations repeated a survey they took in 2011, and found some startling results.
One out of two (it’s actually 46%) doctors is feeling some level of workplace stress.
Compare that to…
I know that in today’s society, professional burnout is rampant across the board, for many reasons – the requirements of working people have doubled or even tripled over the last 10-15 years due to the Great Recession, the housing bubble burst, the .com economy experiencing a huge fallout, extended high unemployment/underemployment rates, and so on, and so on.
Some research estimates that up to 84% of all working people are looking to leave their current jobs for another (as reported by CBS News, based on a study taken in 2012 by Right Management: http://www.cbsnews.com/news/84-percent-of-workers-looking-to-leave-their-jobs/), because they felt that they have fewer career opportunities with their current employer, and feel that they are still doing the work levels of 2, 3 and even 4 people than their work levels prior to the Great Recession.
But also in today’s world, employed people are somewhat glad to have their jobs – any job – rather than be unemployed. But as you will see in a moment, that is changing.
Again – that’s 84% of all (surveyed) employed people that are looking to move…
In fact in an article in Forbes Magazine in March of 2014, 2.457 million people quit their jobs (http://www.forbes.com/sites/ericjackson/2014/05/11/the-top-8-reasons-your-best-people-are-about-to-quit-and-how-you-can-keep-them/). That’s about 30 million people a year that are quitting their jobs.
The pre-recession-era figure was about 3 million a month.
The low, during the Great Recession, was 1.67 million “Quits” per month (according to the Bureau of Labor Statistics).
And you know what? This pressure is real. But when we look very closely, most of the professionals that are burned out do not have positions that literally impact the saving of lives every day.
We non-physicians have golf outings (not as many as we used to have, admittedly), lunch dates with friends, dinner with their significant others, movie nights, and so on. We have opportunities to share our work frustrations and concerns with people that care about us. We can “get it off our chests,” so to say.
What is the physician to do?
Doctors cannot share case contents freely, due to professional privacy commitments, contractual commitments like HIPAA – and hey – they aren’t supposed to feel that way, anyway.
And the cases they see daily – cancer patients, broken bones, torn ligaments and muscles, depression – these people in general are in pain. Things are not going well for them. All of these are very negative interactions. Even depressing in their makeup you might say. Negative interactions – by nature. On most days, the doctor hears only the bad things going on in the lives of others. It has to impact them somehow, because they are, after all, human beings.
Simply put, their emotional bank accounts are overdrawn on a daily basis. When was the last time you visited your doctor to tell him or her that everything was fine? You would both consider this a waste of time and money, frankly. But emotionally, how and when does your doctor get a chance to hear from you that things are OK with you? That life is treating you well? That you’re feeling good? To hear you tell a joke or two? Share a smile? A thought or two about your local hockey team? What’s his/her favorite car? What are his/her hobbies?
Now add to all that, the pressure they are being put under to see more patients every day, and to document more closely those patient interactions. And then know that they will see reduced payments resulting from governmental, insurance company, ACA mandates, and the ever-rising expectation level of patients and medical-practice leadership teams.
When we walk in their shoes, it’s akin to us being asked to do more with less. We all have our limits as human beings. But again, our professions probably do not include the saving of lives on a daily basis.
On top of all this, they see increasing costs of remaining in business – tort/medical malpractice costs and lawsuits, increased taxes on their office space, new equipment to purchase, new medications to understand, and staff demands for higher pay and benefits… The “out-go” is quite astonishing when given full consideration.
Do more with less, indeed.
The siren call of industry beckons, with it’s clean, sanitary labs, research assistants, and “normal” working hours. And the pay isn’t too bad, either, relatively speaking.
Now, marry all of this to the absolute mountain of debt according to a Physician’s Foundation study and report from the Association of American Medical Colleges in March of 2011, that average debt load is over $150,000. Most physicians incur this debt while attending medical school, residency, and internships. Given all that, it becomes no surprise that fewer and fewer bright people are looking to become doctors – it’s just not the profession it used to be.
Document, document, document
Physicians spend a greater proportion of their time on their computers documenting case notes, pre-certifying patient therapies, refilling prescriptions, and entering ICD-10 codes than ever before.
That time that could be spent on seeing patients or researching a confounding case, but instead they must meet these requirements of the government, or insurance companies. And remember – all insurance companies have their own procedures, forms, terminology, and rules, which only adds to the confusion and frustration.
You may ask yourself “why don’t they just hire a person to do all that for them?” And that’s a fair question, but let’s think about it for a moment – who can do this work better? The person that actually DOES the work, or someone else taking dictation from them? Will he/she remember everything that happened during the visit during dictation? Will the transcriptionist have the shades of meaning at their fingertips?
And at a very base level, given that their payouts are being reduced daily, how can they afford extra staff?
I know that given what we see on television and in the movies about rich doctors, that last thought may be suspect in your mind. But think about the spectrum of all livelihoods – we all fall somewhere in that spectrum. There’s only one Warren Buffet or Bill Gates in this world, and only one “poorest person on earth.” Everyone else falls somewhere in between.
Regarding insurance companies – while generalizations are dangerous – for the most part, the people that answer the phones these days are maybe high-school graduates being paid minimum wage, working in a bullpen situation, and reading from scripts on their computer screens. They have no medical training to speak of, and (anecdotally) don’t enjoy their jobs. When job satisfaction is suspect, then commitment to doing it well falls into that line as well. They are not normally empowered to make decisions that do not fall within some very strict guidelines.
And remember – the guidelines are set up to save the company money, and are not necessarily in the best interest of the patient.
So when so the physician, who’s had many years of training and experience has to explain to this “customer service” representative about why a person needs yet another expensive blood test to see how the prescribed medications are impacting the liver and kidney functions, well… Let’s just say, it’s not the best use of valuable time, which only adds to the frustrations of the day.
Put yourself into their shoes for a while. In your own job, how do you feel when you’re challenged by a person with much less experience, knowledge and training? For all of us, it can be frustrating; for a physician, it can be simply overwhelming.
It’s all on a spectrum, and it’s all relative.
Next post: a closer look at the numbers, and research abstracts, links, and opinions on the physician burnout phenomenon.