Physician burnout

[q-school]

burnout is increasing without question.  i don't do a lot of social media so i wouldn't know whether that part is increasing.

i do know that a lot of adverse stuff is currently being assigned to burnout as the root cause.  whether that is accurate or not is unknown.

tardiness, crankiness, poor chart completion rates, ignoring emails, skipping meetings, ignoring pages.  poor outcomes.  poor decision making.  reluctance to accept change.

[LizOB]

EJ at Dads, Dollars, and Debts wrote:

I think we are talking about it more and researching it more. Happiness permeates through so much of our conversation with administration it kind of makes me want to revolt. It is good to be happy but it is not the end all be all in medicine.

 

I do think things like vanishing small practices (increased number of employed physicians (and thus low control of your life)) and EMR with patient emails (which did not exist when I was in medical school or residency in the 2000s) have contributed to dissatisfaction/burn out. Maybe part time physician work is the future.

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Your staff needs to screen your patient emails! Mine does, and I only get 1 or 2 per week sent to me because it's something they can't answer

I'm only 3 years out of residency, but I know my dad (semi-retired EM) has definitely gotten more burned out over the years- the ER used to be high-acuity patients and now it's full of BS and patients/family yelling that they had to wait for 3 hours to be seen for a URI.

Personally, I think having a good job situation makes a huge difference. I'm making the best of the EMR and have a bunch of shortcuts that help me do things quicker. I also don't have a jam-packed schedule. By 5:00 I'm generally done with all my patients and all the notes so I get to leave and don't have work to finish at home. If I wanted to cram in more patients I would make some more money, but at the cost of always having work hanging over my head- no thank you!

[EJ at Dads Dollars and Debts]

Agreed. At my old job my MA would screen everything and I would get few messages. At my new job, the MA does not do much of this (but I am pushing for a change in culture). It does make life much nicer.

[q-school]

LizOB wrote:

EJ at Dads, Dollars, and Debts wrote:

I think we are talking about it more and researching it more. Happiness permeates through so much of our conversation with administration it kind of makes me want to revolt. It is good to be happy but it is not the end all be all in medicine.

 

I do think things like vanishing small practices (increased number of employed physicians (and thus low control of your life)) and EMR with patient emails (which did not exist when I was in medical school or residency in the 2000s) have contributed to dissatisfaction/burn out. Maybe part time physician work is the future.

Click to expand…

Your staff needs to screen your patient emails! Mine does, and I only get 1 or 2 per week sent to me because it’s something they can’t answer

I’m only 3 years out of residency, but I know my dad (semi-retired EM) has definitely gotten more burned out over the years- the ER used to be high-acuity patients and now it’s full of BS and patients/family yelling that they had to wait for 3 hours to be seen for a URI.

Personally, I think having a good job situation makes a huge difference. I’m making the best of the EMR and have a bunch of shortcuts that help me do things quicker. I also don’t have a jam-packed schedule. By 5:00 I’m generally done with all my patients and all the notes so I get to leave and don’t have work to finish at home. If I wanted to cram in more patients I would make some more money, but at the cost of always having work hanging over my head- no thank you!

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 come back in ten years and let us know how you feel about burnout and managing schedules when all your patients are still here plus they tell all their friends and their family members about their amazing doctor.

it is certainly clear that people who trained in an era of EMR don't complain about it as much and seem to be better at using them.

 

[GXA]

My residency spent a lot of time talking about burnout 15 years ago.

Productivity has decreased with EMRs and things have certainly become more frustrating with red tape, but do we do some of this to ourselves to maintain our incomes?  Would we be happier paying a scribe $10-20 an hour out of our own pocket if our employer won't pay for it?  Feel overwhelmed every evening shift, what if you had two physicians there each making half as much so you only had to see half the patients?  How about a slow rural ED which may pay less, but is a pleasure in which to work?

[nachos31]

I think Antheus nailed it with that description. The powers that be keep on talking about burnout and that they need to help docs increase resilience, which is a ridiculous way of looking at it. It kinda falls under the blame the victim mentality.

Overall, the lack of satisfaction with the job for reasons mentioned including loss of autonomy, less time with patients, EMR burdens, debt load, etc. The whole drive to make patients customers and constantly seek their approval is another.

Part time work would be great if it came with only partial debt getting there...

[VagabondMD]

nachos31 wrote:

I think Antheus nailed it with that description. The powers that be keep on talking about burnout and that they need to help docs increase resilience, which is a ridiculous way of looking at it. It kinda falls under the blame the victim mentality.

Overall, the lack of satisfaction with the job for reasons mentioned including loss of autonomy, less time with patients, EMR burdens, debt load, etc. The whole drive to make patients customers and constantly seek their approval is another.

Part time work would be great if it came with only partial debt getting there…

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I agree. Rather than reducing or stopping the beatings, the solution is for the docs to buy better armor. Makes little sense. 10-20 years from now, I predict many will look back on this era and wonder what the ************************ people were thinking, foisting all of this crap on the MD's plate, without providing the tools, staff, and support for much of this non-doctoring scut work.

[Donnie]

Crixus wrote:

Burnout is increasing in all fields. A byproduct of over-financialization. Everything has been collateralized. Too much debt to be serviced. It’s all right there hitting you in the face everyday if you care to recognize it. The Zombie Central Banker Apocalypse.

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I agree that burnout is happening in all fields (not really with the rest of the post).  I believe it is a function of increasing technology which prevents people from leaving work at the office.  Everyone is expected to be "on call" 24/7 these days.  Email, smartphones, and remote computing are great from an efficiency standpoint, but pretty horrible from a work-life balance standpoint.

[resident_1]

Have you read this. 35yo anesthesiologist jumped from roof of hospital parking garage

http://nypost.com/2017/08/07/bronx-doctor-brings-shotgun-and-knife-to-hospital-but-only-kills-himself/

 

I think burnout has been around for some time. Statistics have come out for many years about increased suicide rate in our field.

[MrsIMDoc]

I think the overall attitude towards doctors has also changed, adding to burnout.  I had a patient threaten my life in the past month over opioids. Physicians have been killed by angry patients and family members.  Here is a recent one:

https://www.washingtonpost.com/news/to-your-health/wp/2017/07/29/a-doctor-was-killed-for-refusing-to-prescribe-opioids-authorities-say/?utm_term=.98bc5790e22a

The respect for physicians continues to go downhill adding to burnout.

[djohnflatfeecfp]

https://www.nbcnews.com/better/health/sick-doc-cases-doctor-burnouts-are-rise-it-s-serious-ncna815936

 

 

[Miss Bonnie MD]

Apparently ************************ has frozen over since Dermatologists are feeling burned out too ...

[nishant144]

I think the two biggest contributing factors (of many) for physician burnout are:

1. loss of physician autonomy

2. increased awareness

[Zaphod]

nishant144 wrote:

I think the two biggest contributing factors (of many) for physician burnout are:

1. loss of physician autonomy

2. increased awareness

Click to expand...

Greater pressures all around as that article states, and of course from ourselves. The feeling its all an uphill battle, that (right or wrong) that everyone disrespects you, political pawns, etc...

Dont know what the specialty break down is but some of those docs know an alarming number of drs who've committed suicide. Im sure we all know too many.

[MPMD]

The article posted about the dark side of medicine was certainly sad. That said he seemed to be in a terrible practice environment which was the main issue for him. Not sure if it's just the way it is where he lives the language sounded like the UK? I mean not being able to book your own cases, having an OR control that doesn't account for time to flip the room, and basically on call 24/7 for ER cases even on a day with OR and clinic? That just sounds like a terrible job. I know lots of sub specialty surgeons who don't live like that.

Shifting gears: Potentially unpopular opinions about burnout ahead.

1. EMR: It's really bizarre to me that the EMR is so frequently blamed as a cause of burnout. Do people think that we should still be on paper charts in 2017 when we do basically nothing else on paper? EMR has revolutionized the legibility and portability of patient information. How many older docs out there say the EMR is a big cause of their workplace stress and then go spend the rest of the day on their iPad? There are some good and bad products out there but both Cerner and Epic are actually very decent systems. They both have their own issues but overall they are fine.

2. Loss of autonomy: I've never been quite sure what this means. Medicine is a science and things like guidelines exist for a reason -- they usually represent the best available evidence. Increasingly we know a pretty reasonable scientifically based treatment option for people and yes, I guess that decreases our ability to make up our own.

3. Administrators in suits ruining everything: I've been on staff at 5 different hospitals in my career thus far and this statement has never been accurate. The vast majority of people in hospital admin are a) responding to forces outside their own control and b) nice people who genuinely desire physician input. If you buttonhole one in the hallway to say that things like LWBS from the ED doesn't matter you're not going to get a good result. If you spend a few hours learning about the actual things affecting your healthcare system you can understand where they are coming from.

4. New forms, boxes to check etc: Again, never felt like this was a huge issue even in busy EM practice. Yeah it was annoying that we had to fill out the full anesthesia H+P for procedural sedation but it didn't exactly ruin my day. This complaint always begs the question that these docs, if freed from the chains of paperwork, would be spending all that free time at the bedside being Marcus Welby. Basically every doc I know spends as little time at the bedside of patients as they possibly can. Yeah we try to be nice and make connections and I am as guilty as anyone of sitting in the ED bay with the old lady shooting the breeze for 30 min but for the most part we are in and out. If all the forms go away the vast majority of docs are going to spend the extra time reading Fox or CNN, not forming deeper bonds. Ask yourself, when a patient cancels in clinic or when the ED is dead do you spend that extra time taking a more detailed history?

5. High stress at work: If you're an acute care doc (EM, surg, anesth, crit care, cards, nicu, etc) this is just unavoidable. No way to change the fact that we have to make tough decisions and see sad cases. Everyone sees sad cases even those in the most benign outpt fields. The secret is to try to have some healthy coping skills I guess. This is one of the reasons I preach the gospel of WCI far and wide b/c you need to have your outside life lined up reasonably well for this not to get to you.