AVOIDING/REDUCING PHYSICIAN BURNOUT
There’s a pandemic quietly raging through the ranks of physicians and it’s not COVID-19. It’s burnout. Burnout is bad for physicians, as evidenced by alarming levels of alcohol abuse, drug abuse, and unfortunately, suicide.
Burnout doesn’t exist in isolation as it affects patients as well – it results in lower quality of care, lower patient satisfaction, and increased medical error. Burnout has reached such critical levels that a whole new branch of medical academia devoted to this crisis is gaining momentum.
Physician wellness is the ad hoc label for this burgeoning medical field of study – launched to address burnout. One high profile initiative in this field involved the recent teaming of the AMA (American Medical Association) with Northwestern Medicine in 2019 to launch the “Scholars of Wellness” program to address physician burnout within the Northwestern Medicine network of physicians. As part of the program, physicians from all specialties were called on to apply to become “Scholars of Wellness.”
The program aimed to “create a critical mass of wellness experts to drive meaningful change” by equipping the 10 participating physicians with the knowledge and tools needed to effectively lead a wellness project to positively affect the well-being within their teams.
By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction. The Scholars of Wellness program incorporated this guidance and the targeted solutions to provide these appointed Scholars of Wellness training and resources to help address burnout within their teams.
The Scholars of Wellness Program as well as similar programs are springing up all over the country because physician burnout is real and is now at epidemic levels. Add the most common causes of physician burnout to a connected world and now there are pressures that physicians didn’t face 30, or even 20 years ago.
Recognizing burnout is commonly cited as the first step in addressing the problem – not unlike the first step in addressing alcohol and substance abuse. And as far as recognition goes, burnout doesn’t start with a physician’s first job. It starts earlier than that. It starts in medical school.
According to an article in Medical News Today, physicians at all stages of education and training are at risk for burnout. Studies have found that 25 to 50 percent of medical students experience depression and anxiety, with up to 50 percent reporting symptoms of burnout. Unfortunately, up to 15 percent of medical students have even reported entertaining thoughts of suicide at some point during their medical school education.
The high demands of residency and fellowship training are reflected in the fact that more than 50 percent of residents report depression symptoms, with burnout rates as high as 75 percent.
The causes of burnout are numerous, but they can be grouped into three main categories:
- Time. A physician’s medical practice is volume-driven. The result is more patients per day but with shorter appointments. This has eroded the physician-patient relationship with many physicians harboring guilt for not providing the type of care that they trained in medical school to give and through an oath they had committed to providing. In addition, with the advent of connected devices like smartphones and tablets combined with extended on-call schedules and easily accessible electronic medical records means a physician’s workday never ends. This has all contributed to the erosion of a physician’s quality of life.
- Administration. Healthcare is one of the most regulated industries in the country. The list of regulations and acts a physician must comply with along with all insurance-related paperwork can be overwhelming. Red tape is cited by physicians as one of the main drivers of burnout because it takes time away from the patient – resulting in a lower quality of care and added pressure to stack more patients on the schedule throughout the day to make up for lost time doing paperwork that erodes billings.
- Patients. Patient satisfaction scores determined by various indices like CAHPS (Consumer Assessment of Healthcare Providers and Systems) are becoming increasingly common and significant in the U.S. medical system. Add to this the physician’s online reputation gathered from social media and various online rating systems and this puts added pressure – besides the physician’s own expectations and self-assessment – to provide quality patient care. Lotte N. Dyrbye, M.D., associate chair of staff satisfaction, faculty development, and diversity in the Department of Medicine at the Mayo Clinic, told Medical News Today that “between 2011 and 2014 the prevalence of burnout increased in U.S. physicians, even though work hours did not.” The implication is that the increased significance of patient satisfaction scores along with online reputation has taken an added toll on physicians.
Recognition is the first step to addressing burnout, but what about the solution?
For me personally, I’ve avoided burnout by taking the financial equation out of my medical practice. If you dig deep into the causes of burnout, you’ll notice that the common element in the various stress points experienced by physicians comes down to money.
You think to yourself, if I want to make more money, I have to see more patients during the day. On the flip side, to avoid losing money from government fines, civil lawsuits, reduced insurance reimbursements, etc. I have to take precious time out of every workday to deal with all of the red tape.
This lost time puts more pressure on seeing more patients, resulting in rushed appointments, which results in guilt for not providing adequate care – leading to stress from worrying about my patient satisfaction scores and online reputation. A hit to my satisfaction scores or online reputation could lead to fewer patients, which means less money and the vicious cycle goes on and on.
I get burnout just thinking of all the pressures physicians face in their practices. That’s why I made a determination early on in my career to pursue ventures and interests outside of medicine. To pursue my family, charitable and personal interests, it was imperative for me to take the financial element out of the equation of my medical practice. I had to break free from the pressure of the volume-driven aspect of the business.
Only by pursuing and generating multiple streams of passive income would I be free of the pressure to rely on billable hours for my income. Free from that pressure, I wouldn’t have to overbook my patient appointments and this would allow me to give my patients the adequate care they deserved.
At this time in my career, I successfully pursued and achieved multiple streams of passive income. These income streams are not tied to me going to my practice, they don’t even rely on me being awake and they allowed me to partially retire.
I now work only one day a week in the clinic (Wednesday) and take off as much time as I please – to renew, rejuvenate, spend time with my family, and to pursue my charitable interests focused on giving back to the community. Most of us got into medicine because we wanted to help people. Wouldn’t it be great to get back to that focus?
Wouldn’t you love to be in a position of working because you love your work and not because you have to work?
To avoid burnout, consider pursuing ventures outside of medicine. Develop other interests.