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DESCRIPTIONPhysician burnout. Thursday, November 20, 2014 Seth D Bilazarian, MD DrSeth@pmaonline.com. Physician burnout. Nearly 46% percent of 7288 surveyed physicians said they experienced at least one symptom of serious burnout, according to a study published in the Archives of Internal Medicine . - PowerPoint PPT Presentation
Physician burnout*Seth D Bilazarian, MDDrSeth@pmaonline.com
Physician burnoutNearly 46% percent of 7288 surveyed physicians said they experienced at least one symptom of serious burnout, according to a study published in the Archives of Internal Medicine. Compared with workers in the general population, physicians had an 8.6% higher risk of emotional exhaustion and 10% higher risk of overall burnout. Arch Intern Med 2012; DOI:10.1001/archinternmed.2012.3199.
Defining burnoutWhat is it?Should we care? As individuals?As a profession?As a society?Why is it happening?
Burnout and satisfaction with work/life balance among US physiciansBurnout among physicians was measured using the Maslach Burnout Inventory (MBI)45.8% of physicians reported at least one symptom of burnout The MBI has three subscales to evaluate each domain of burnout:Emotional exhaustionDepersonalizationLow personal accomplishmentArch Intern Med 2012; DOI:10.1001/archinternmed.2012.3199.
Lay press articles The root ofphysician burnout- The Atlantic The physician burnout epidemic: What it means for patients and reform - The Atlantic
The widespread problem ofdoctor burnout- NYTimes.com
Doctor burnout: Nearly half of physicians report symptoms USA Today
Is your doctor burned out? Nearly half of US physicians say they're exhausted Time Healthland
Shortage of physicians?"By 2015, the US will be 62 900 doctors short, and the future looks even worse," Archambault said. "By 2025, the estimated shortage of doctors will more than double, as baby boomers require more care and Obamacare grants more insurance cards. Seeing a doctor in a reasonable amount of time may be a thing of the past, unless meaningful consumer-directed reform is passed soon." Romneycare hints at future doc shortage. BostonHerald.com
Six in 10 physicians would quit todayDoctors are working less, seeing fewer patients, and many would quit if they could, a sweeping survey of 13 575 physicians from across the nation shows.
A Survey of America's Physicians: Practice Patterns and Perspectives was commissioned bythe Physicians Foundation. It is the latest and perhaps the largest and most comprehensive of a number of surveys that have identified wide, deep, and increasing discontent among the nation's physicians regardless of their age, gender, specialty, location, or employment status. A Survey of America's Physicians
Changes in patient-physician interactionEMRPatient autonomy: Can a patient demand care the doctor feels is inappropriate? Patient satisfaction?Appropriate-use criteria and Choosing WiselyPatient-centric care
Changes in the lawACA or ObamacareRomneycarePhysicians' reaction to itPhysicians being blamed for the inefficiencies and inadequacies of the healthcare system
Cardiologists speaking after SCOTUS upholds ACA Almost universally praised aspects of it (universal coverage)Almost universal in expressing uneasiness, poorly articulated views about Impact on societal costsPractice and delivery of medicineImpact on American medical innovationdrugs and devicesClumsy
The Anti-ACA viewThis bureaucratization will amplify everything patients and businesses despise about the current system: the unintelligible $103 234.61 bill for a turned ankle, the doctor who can't take a phone call because of how the hospital schedules shift.Why aren't mom's eight specialists aware of each other's existence? Why is healthcare mostly conducted via a pad and pen and beepers and fax machines in the iPhone era? Why are there so few geriatricians when the first wave of baby boomers is already turning 65? Why is it still so hard to find usable information about quality and prices?Cheesecake Factory Medicine WSJ August 27, 2012
Doctors who view medicine as a calling are more satisfied (part 1)They feel better about caring for patients with complex conditions such as obesity and alcohol addiction than other physicians, research shows.The reasons that drive doctors to practice medicine can have an impact on how satisfied they are caring for patients with challenging conditions, says anArchives of Internal Medicineresearch letter published online August 27.Researchers analyzed data from a national survey of 1504 primary-care physicians. They found that doctors who see medicine as a calling are more likely than other physicians to be satisfied treating patients who are obese or addicted to nicotine or alcohol.Doctors who view medicine as a calling are more satisfied. amednews.com
Doctors who view medicine as a calling are more satisfied (part 2)Of the three conditions, physicians were most satisfied treating nicotine dependence (62%), followed by obesity (57%) and alcoholism (50%).Physicians who are unhappy with their career choice are less likely to be satisfied treating those disorders, and they often blame patients for their conditions.The findings are significant, given high rates of burnout in the profession, said study coauthor Dr John D Yoon, an assistant professor in the University of Chicago's Section of Hospital Medicine and associate faculty member at the MacLean Center for Clinical Medical Ethics.http://www.ama-assn.org/amednews/2012/09/10/prsc0910.htm
Changes in response to legal and financial pressures by the healthcare systemFamily farm vs ADMA1 Deli vs Cheesecake Factoryhttp://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
Anti-Cheesecake viewPolitical counterpoint to the Big Medicine piece of Dr Atul Gawande in the New Yorker
The highlighted aspects are the corporatization of medical practices and the payment advisory board."The 'most important institutional change' after ObamaCare passed in 2010: the independent payment advisory board composed of 15 philosopher kings who will rule over US healthcare."
The unknown aspects of who, what, and why and perceived hazards of this decision-making process are discussed.
"The longer-run danger is . . . cost board starts to decide what types of care 'work' for society at large and thus what individual patients are allowed to receive."'"The Cheesecake Factory is a great place to eat but you probably wouldn't want to be operated on thereespecially if it's run by the government."Cheesecake Factory Medicine. Wall Street Journal
Big medicineCheesecake Factory: Where they fall shortNo discussion on inelasticity of pricing (high-end restaurants don't cost the same as fast-food restaurants)Not responsible for patient's care before and after interactionsRestaurants are incentivized to capture as much business as possible but are not required legally or expected ethically to serve all comersThere is no defensive-medicine equivalent in the dining industryThe problem of poor coordination as described is real and serious but this has been foisted on doctors ("Too many cooks spoil the pot") but we are complicitI didn't have as good a meal as Dr Gawande did
Should we care about burnout?"Ultimately resistance that is not addressed creatively can frazzle nerves . . . and overly burden. . . . Prolonged contact with conflict and criticism wears them down, robs them of joy. Many . . . simply want out"Leadership Essentials by Greg Ogden and Daniel Meyer p 154
What's frustratingEMR has several advantages but reviewing it is time consuming"Where's the beef?"Oversight in the office ICAEL, ICANL 48-hr turnaroundHospitalappropriate-use criteria, malpractice, public reportingDaily practice hospital computer systemsnot ready for prime time order preop antibiotic, nine signatures prior to cathPost hoc scrutiny
Is life is easier?Night float, hospitalists, nocturnistsExclusive: Nocturnists on hand for the critical hours. news-press.com
Relevant articles in the AtlanticThe Physician Burnout Epidemic: What it means for patients and reform
The Root of Physician Burnout
The root of physician burnout "Incentivizing with money is a self-fulfilling prophecy ofcynicism. We must promote compassion, courage, and wisdom among our physicians before we "make a sordid business of this high and sacred calling." Reducing dissatisfiersReduce stressors by cutting back on working hours, relaxing intrusive oversight, and finding ways to lift the burden of "busywork" from the shoulders of physicians. Fair payEnhance fulfillment Focus on the work itself.Do physicians recognize what they find most fulfilling? What does their best work look like?Are they making full use of their knowledge, skills, and innate abilities?Are they growing and developing as human beings?Do they feel that they are making a real difference in the lives of their patients and communities?
The widespread problem of doctor burnout (NY Times and the Atlantic)Almost half complained of being emotionally exhausted, feeling detached from their patients and work, or suffering from a low sense of accomplishment.She feels increasingly frustrated with what she calls the "bureaucratization" of medicine and resents spending "more time filling out forms than caring for patients."
The widespread problem of doctor burnout. New York Times
Dave Scott (Cornwall Bridge, CT)Burned-out doctors will not question or fight the system. They will cheat to survive. And those who profit from the system as it is will want to leave burned-out doctors as they are. Unburned-out doctors would try to change things.
If you want to find out why doctors are burned out, figure out who benefits from burned-out doctors. Those who benefit from burned-out doctors would be those whose routines and practices would be disrupted by doctors who weren't burned out, who were still trying and caring. Burning people out gets rid of their idealism, and medicine is one of