Decrease burnout through a better understanding of who physicians are

Physician a burnout has great current interest.  Many authors are worrying about burnout and therefore writing about this problem.

What are the common root causes of burnout?  Primarily burnout comes from loss of control and overwhelming undesirable activities.

Burnout occurs when the job becomes overwhelming.

Burnout likely is increasing because many physicians feel that they do not control their lives.  Too often the current finances of medicine “force” physicians to spend inadequate time with patients.

Administrators often encourage this behavior.  Too many administrators have examined overhead and income, and their analysis argues that physicians should spend less time with each patient.  But good physicians know that their professional responsibility requires more time with each patient.  This conflict, in my opinion, leads to burnout.

I write often that our payment system is flawed.  While I have not been this explicit before, I would argue that our payment system, especially for outpatient internists and family physicians, is a leading cause of burnout!

Physicians are high achievers.  We want to do our best possible job.  When external forces prevent us from doing the job properly, then we have psychological distress.

Talk with a physician who leaves the “grind” and turns to retainer medicine.  These physicians are much happier with their patient interactions.

Some physicians will develop burnout in any situation.  Most of these physicians have chosen a specialty that does not fit their personality.  Obviously if the specialty does not fit the physician burnout is inevitable.

But we can and should decrease burnout through a better understanding of who physicians are.  Therefore I accuse both CMS and the major insurers of a major unintended consequence.  We have too many physicians leaving or avoiding outpatient practice because they have developed burnout, or they understand that the job as currently constructed would cause burnout.

Until we improve the working conditions for family physicians and outpatient internists we will continue to promulgate this problem.

If my diagnosis is correct, then the treatment is clear.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • Samir Qamar

    Direct Primary Care, when set up as independent practices, decreases reasons for physician burnout. Though there is still a respectable load of patients (compared to concierge practices), the load is typically half the national average. Revenue stream is increased, paperwork is minimized, and patients are better cared for due to visits being longer and having better access. As a DPC provider myself, the difference is nothing short of impressive. DPC practices and concierge practices were borne out of a need to find more satisfying ways of practicing, and they will explode in number over the next few years. I predict, in fact, that these types of practices will become the norm in primary care private practice.

    • Margalit Gur-Arie

      I’m starting to think that you are probably right, if we stay the current course. DPC and community health centers will be the majority, with retail and virtual outlets to close the availability gaps.
      I’m not sure I like the prospect of this though….

  • Dike Drummond MD

    There are two courses for the primary care doctor

    - Become a supervisor of multiple midlevel practitioners in a high volume, high overhead practice

    - Step out into direct patient care in a concierge or ideal practice model

    The coming doctor shortage will drive both of these options. As a patient you will need to decide whether or not you can afford to pay to see your doctor. If you can’t … then you probably won’t see them unless you are very ill indeed. Here is my full blog post on this coming primary care “fork in the road”.

    Dike Drummond MD

  • buzzkillersmith

    I think Dr. Drummond might very well be right, although my crystal ball is cloudy.

    What I have seen over the years is that large institutions like multispecialty groups or hospitals don’t care about our professional satisfaction. Professional satisfaction has no place in a business school curriculum. We are widgets, widgets that get paid, certainly, but not widgets from whom the deciders take advice.
    I used to think that when doctors see things that are messed up, they could put up with it, change things, or leave. Now I think the only options are putting up with it or leaving. Kinda like guys that work on the factory floor.

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