Physician Burnout: The Cost for Doctors & Patients
Burnout among medical professionals is at epidemic levels. The demands we make on America’s doctors are taking their toll. In 2019, more than 40% of American doctors were burned out. The symptoms include depression, anxiety, lethargy, and exhaustion.
Burnout is thinning the ranks at an alarming rate. If we don’t slow the spread, patients will soon find their doctors are gone.
Understanding the Symptoms
Burnout isn’t just stress, it’s stress on steroids.
Doctors find themselves at a loss, struggling to find purpose in their work. Their exhaustion is physical and emotional. Any sense of pleasure or accomplishment is diminished. Left untreated, the depression grows. It’s difficult to meet the demands of the job, which in turn deepens the depression.
When doctors are burnt out, they can experience depersonalization. Brief episodes of dissociation are confusing and provoke anxiety. Empathy for patients is stunted.
Burn out includes an element of shame which only makes matters worse.
What are the Stressors?
These are top concerns of doctors, according to Medscape. The first will surprise no one.
- Too much bureaucracy and paperwork.
- Working too many hours
- Lack of respect from administrators/staff
- Computerization of practice
- Insufficient compensation
- Lack of autonomy
- Decreasing reimbursements
- Lack of respect from patients
- Government regulations
It’s easy to understand how burnout builds. The physician feels overwhelmed by administrative tasks. A common gripe is “I spend more time in front of a screen than I do seeing patients.” Being forced to learn and use new technology adds to the burden.
The perceptions of disrespect pile up. The lack of control encourages futility. No one wants to be working longer hours for less money. It’s the perfect storm.
Doctors must understand this is not a statement on their abilities. It’s a condition that requires treatment.
For the sake of doctors, patients, and the healthcare system, intervention is required.
Burnout Escalation Factors
Doctor Shortages: The predictions have been around for years, but now the numbers are hitting home. Statistica.com reports the current number of active doctors in America at 870,900. A report from the Association of American Medical Colleges (AAMC) says the U.S. could lose up to 139,000 physicians by 2033.
If we lost that many physicians today, there’d be 15.9% fewer doctors.
There are already shortages in primary care physicians. By 2025, the number of new cancer patients will far outweigh the number of oncologists available to treat them. One in three doctors are over 65 and expect to retire soon. The impact of burnout is high – 23% of doctors regret their career choice.
Coronavirus: The COVID19 pandemic has taken physician burnout to a new level. Doctors are working insane schedules under challenging conditions. They live with the fear of exposing themselves and their families. They have to deal with shortages of PPE, testing kits, and ICU beds. Patient deaths are slow, lonely, and tragic. It all takes its toll.
There are rising concerns about suicides among medical professionals during the pandemic. Doctors have the highest suicide rate of any profession in the country. That was before the coronavirus. Something has to give, or we will lose the very people we need the most.
Limited Pipeline: While the number of doctors dwindles, so does the number of medical residencies. In 2020, medical schools are accepting on average only 7% of applicants. According to this chart, it’s going to get worse in 2021. It takes 14 years to become a licensed physician. It’s going to get worse before it gets better.
Declining Revenue: Reimbursements from government providers – Medicaid, Medicare, Tricare – are stagnant. In the past decade, they’ve risen by 0.4%. Denial of Claims cut into profits and pit physicians against their patients. No one wants to be in the collection business.
More and more medical practices are run by private equity investment firms. Private equity investors focus on shareholder value. Doctors work longer hours to meet financial goals but spend less time with patients.
Transparent Measurement: The healthcare industry embraces big data to follow every transaction. The health outcomes of every physician’s clinical care are transparent. Won’t that help identify doctors that make mistakes? It does. But does it help doctors to fix those mistakes or improve their services? Not so much.
Consider the pressure of every action at your job being monitored. These data help create comparative-performance reports – comparing one doctor to another. Insurance companies query doctors, questioning their performance in relation to other physicians. Some doctors are calling for cutbacks in what’s measured and how the data is used.
Financial Impact of Physician Burnout
The estimated loss to the healthcare system is roughly $4.6 billion a year. The model was focused on a reduction in clinical (billable) hours and physician turnover. They found that nearly half of US doctors have experienced at least one symptom of burnout. But that figure doesn’t come close to capturing a comprehensive number.
What they didn’t measure is burnout’s impact on physician performance. As we noted earlier, burnout isn’t just stress. It’s a lost sense of lost purpose, disconnection combined with depression and exhaustion. To assume there is no impact on function is inexcusably naive.
Quality of Care
Medical errors in the U.S result in up to 200,000 deaths each year. A study at Stanford attempted to understand the impact of burnout. They found that errors tripled in medical work units where physicians showed high levels of burnout.
In 2008, a study found the direct costs of preventable care errors was $19 billion. The equivalent cost in 2020 would be $22,749,998,839, based on inflation. If you include the indirect costs, the annual total escalates to $1 trillion.
There is no data available that tracks these costs to burnout, but there is no doubt it plays a part.
Busy doctors will tell you they have no time for Zen. But it’s time to make time.
As you review the suggestions below, there’s one consistent component. Hiring professionals is how you can dig out from under. Use your office staff to research vendors.
When you’re overwhelmed, the last thing you need is to take on a leadership role. Burnout feels like spinning a thousand plates on sticks. It’s easy to think if you let up for a second, they’ll all crash to the ground.
That’s not the case. Moving forward will involve letting go and allowing others to help.
Reduce Administrative Burden
- The biggest complaint physicians have is maintaining the EHR. Surprisingly, that’s a simple fix. Virtual assistants aren’t new and now there are medical virtual assistants (MVAs). They do real-time charting or transcriptions. These men and women have medical backgrounds with training in HIPAA.
Some of MVAs aren’t even people. Artificial intelligence is filling the demand for support in medical administration. They can do everything a human can do, including updating medical codes. These services are becoming more mainstream.
- The AMA has been working with the Centers for Medicare & Medicaid Services to overhaul (E/M) office visit billing codes. This is the first update of the codes in over 20 years. They roll out on January 1, 2021. There’s a guide on how to implement the changes If you bring on an MVA – this is their first task.
Look at Workflow
- How many tasks in the office take way too much time? The frustration levels for everyone rises when a simple chore is hard to complete. Doctors don’t have to handle the redesign. Put an office manager or PDA in charge. You can hire a facilitator to identify the issues and help the team brainstorm solutions.
- Too often technology gets installed without any timeline to upgrade or replace the system. Most clinicians had an EHR in place between 2010 and 2012. A lot has changed since then. The system is designed to pull in data from multiple sources.
As technology advances those integrations are more challenging for older systems. If your EHR is over 5 years old, it’s a good idea to bring in a Health IT consultant to assess the system. It’s also an opportunity to ferret out inefficiencies.
- COVID19 made telemedicine a standard practice in clinical care. eVisits and remote care monitoring can be transitioned to nurse practitioners and PAs. This maintains billable hours and continuum of care but takes some strain off doctors.
- Doctors are most comfortable helping others. They’re not as familiar with helping themselves. Once burnout sets in, incorporating changes – even small ones – can be challenging. It’s important to use a phased approach.
Individual burnout needs a mind and body regimen. If the chemical imbalance is clinical, medication may be an appropriate option. Take small steps to make lasting change.
- Exercise: Incorporate 30 minutes a day, even if it’s three 10-minute sessions. Bring hand weights into the office or a stationary bike.
- Elevate the surface of your computer to be at eye-level. Looking down all the time encourages neck strain.
- Ditch the diet Coke, the second pot of coffee or the afternoon Red Bull. The caffeine isn’t helping anything.
- Get outside. Go someplace beautiful, a park or garden. If that’s not possible, hit a museum and sit quietly in front of a painting or sculpture.
- Racing thoughts are not uncommon. Learning to quiet your mind takes practice but you don’t need to assume the lotus position. Apps like Calm, Headspace or Aura can help. Aura is designed for very busy people, with 3-minute sessions and sleep support.
- Food is a critical component of physical and mental health. Can you eliminate some sugar or swap out one burger a week for a salad? Since the coronavirus, food delivery is available almost everywhere. It’s only a question of what you pick.
- Your family is going through this too. If you’ve been avoiding a discussion about what’s going on with you, have it as soon as you are capable.
- Consider a wellness coach – like you might hire a personal trainer. It’s very difficult to shift priorities on your own. Having a coach for positive reinforcement can help you stay the course.
Don’t think of self-care as a burnout treatment, think of it as preventative care. The healthier you are, the better equipped you’ll be to handle the stress of your job.
The AMA has created a process to transform medical practices. The five steps are Research, Measure, Act, Recognize and Convene. The goal is to create an environment where you, purpose, and meaning is possible. The video below describes the steps of the process.
This is a process to help physicians avoid burnout while improving quality of care. The scope of the proposed changes are sweeping. Some are more suited for a hospital system than a medical practice. The Primary Care Collaborative has a list of resources for implementation. The AMA offers a Steps Forward educational hub with webinars and classes.
Improving the well-being of doctors, nurse practitioners, and PAs supports the quality of care. Efficiencies improve cash flow and reduce frustration. Everyone wins.
Burnout is a health crisis. Depending on the source, it affects anywhere from 43% to 77% of physicians. The pandemic has increased demand on doctors who are already stretched. Burnout is a signal of toxic dysfunction in the environment.
An intervention is needed, and it must start with our community. Medical professionals can acknowledge the strain were facing, even if not directly affected. Do something. Pick one thing. Be a resource for colleagues who are struggling.
The final takeaway is this: Burnout is frightening and confusing. Depression can be crushing. Dissociative episodes create doubt and diminish self-worth. There is nothing shameful about it.
The Physician Support Line is run by physicians for physicians. If things get overwhelming, call 1 (888) 409-0141 to reach a peer who can help.
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