A common discussion in the Medical Community is the issue of physician burnout. Signs of burnout often include physician cynicism, callousness, sarcasm and feeling ‘put upon’ by our patients. This problem affects all specialties of Medicine and as many as 40% of physicians. The causes are many, to include working ‘full steam ahead’ at all times, the seriousness of the job, fear of lawsuits, long hours, bureaucracy, government regulations, decreasing respect for physicians and progressively longer and more detailed progress notes. Physicians are now required to be coding experts and have to be able to type. Decreasing insurance reimbursement, leading to the need to see more patients and spending less time with them, is a common complaint. Rushing a patient visit in order to see enough patients is often the only way to generate adequate income to the practice. As a result of all of these issues and more, physician satisfaction has gone down significantly. Physicians don’t have enough time to leave work and ‘recharge their batteries’.
The ‘old timers’ that trained us many years ago, were often considered to be ‘married to their job’ and other life responsibilities took a very distant second. My Attendings in Residency (1992-1995) seemed to never go home. They seemed unconcerned about their families at home or need to otherwise have balance in their lives. It was a badge of honor to only concern oneself with patient care and nothing else. Doctor’s were admired for complete dedication to their job, regardless if this meant divorce or not spending any quality time with their children. Hobbies and other outside interests were not valued. In highschool, I overheard one woman who was divorced from a Urologist say to her daughter, “don’t ever marry a physician, you will never see him.”
Our more recent generation of physicians understand that it is not just unwise to ignore their families but irresponsible. These doctors have made a commitment to their spouses when they got married and made a commitment to their children when they decided to be parents. Furthermore, it is well known that exercise, time with family and outside interests, reduce the degree of physician burnout. The doctors who can accomplish this feat are happier at work, more satisfied with their job and have much less depression.
Studies have also recently been done to try and determine what measures can be made to reduce the burnout and depression rate. In a recent Medscape study, two such approaches were evaluated. One intervention was to educate the providers on stress management and communication skills. The other intervention was focused on reducing the paperwork and administrative requirements of the job, as well as reducing the patient load every day. The latter approach was more successful but did not reduce the burnout rate significantly. Some doctors gave the advice, to leave work at 6pm and do not do any work outside the workplace. I am not sure how this is accomplished since many of us have access to our work via home computer. We have to review labs, ER reports and daily phone calls when we get home from a long day of seeing patients. If we stayed at work completing this work, we would never be able to leave at 6pm which violates the first recommendation.
I was in a staff meeting with the hospital Administrators who had suggestions as to how to decrease our workload. I did not believe that their suggestions would be helpful since much of doctor’s work needs to be done by the physician. I have to ‘lay eyes’ on much of the work sent to me . If our office staff streamlines the flow and work at our offices and completes much of the administrative tasks, we are still faced with an overwhelming amount of work each day. I have attempted a new approach. I have been seeing patients for cash which allows me to see fewer patients and I can write shorter, more pointed notes. Less labs are ordered and need reviewed and there are less phone calls. Unfortunately, it has been difficult to convince patients to pay cash to see me and the idea has been hard to ‘get off the ground’.
I don’t know the answer to our current problem of burnout but retiring sounds like it would be effective.