Will the Affordable Care Act worsen physician burnout?

As the Affordable Care Act (ACA) is implemented, many physicians are beginning to take stock in their own professional and personal lives.  The practice of medicine is a privilege but it is also an occupation that can consume nearly all aspects of a physician’s life.  In the past I have struggled with my own “work-life balance” and I have shared my thoughts on burnout in my previous blogs.

As a healthcare provider, I am absolutely dedicated to my patients and their well being.  However, with the new demands that the ACA places on physicians, it may be difficult for many healthcare providers (including myself) to continue to find balance. Loss of balance will ultimately increase physician burnout rates and place an already burdened healthcare system under even greater stress.

Physician burnout rates are currently at all time highs.  Symptoms of burnout include emotional exhaustion, feelings of depersonalization and a low sense of personal accomplishment.  According to a 2012 publication in the Archives of Internal Medicine, physician burnout occurs at much higher rates than other occupations.

In fact, American Medical News reported that nearly 50% of all physicians suffer from the symptoms of burnout.  Decreasing reimbursement, increased workloads and loss of autonomy have fueled much of the current discontent.  Now, the ACA will add millions of newly insured patients to the system along with more paperwork, restrictions and mandates/benchmarks in order to obtain better reimbursement levels.  I am afraid that many providers may be so focused on “checking boxes” for the government that they forget about the patients.

Additionally, physicians will be asked to see more patients in less time.  As I mentioned earlier, reimbursement levels continue to fall and overhead costs continue to rise. Many private practices have given up their autonomy and “sold out” or integrated with large health systems in order to survive.  Now, with the ACA, there are going to be more patients and thus more efficient throughput required in physician’s offices.  There will be a consistent need for additional staff to manage the increased patient volumes as well as the government mandated paperwork.

However, most practices are finding it financially non viable to hire additional workers. Ultimately, the shortfalls in staff affect the very people the ACA is established to protect–our patients.

In preparation for the implementation of the ACA, many practitioners are already making changes.  As reported on FoxNews.com, many internists are considering giving up their primary care practice in favor of boutique like practices that focus on hormonal therapies or weight loss.  As reported in Forbes in January 2013, one in ten physicians are moving into concierge medicine where they charge a limited number of patients an annual fee up front for 24-7 access to care.

One of the basic principles of Obamacare is access to care — unfortunately, many primary care physicians are leaving the marketplace just as demand is increasing to an all time high.  Physicians that leave traditional practice cite numerous reasons for their exit and many suffer from burnout.  Most of us who have chosen a career in medicine do so because of an interest in serving others–selfless behavior throughout one’s career.  Service to others in our daily practice provides enormous fulfillment and improves job satisfaction.

But now, with the ACA in effect, we are no longer able to spend as much time in the service of our patients — we spend more time with government forms, rules and regulations and are paid little or nothing for the increased administrative duties.  The ACA is now one of the primary drivers of healthcare provider burnout and will ultimately result in a physician shortage in the US.

The idea of providing affordable healthcare to all citizens is an important goal.  However, haphazard planning and rushed rollout will most certainly doom the ACA to failure.  Unfortunately for all of the uninsured, lawmakers (including our president) have focused more on legacy (and what the history books may say about their time in office) rather than on producing real healthcare reform that has a chance to succeed and serve those who need it most.

Key components of an effective healthcare system reform include provisions that satisfy the needs of patients, payors/insurers, hospitals (and other centers for care), as well as physicians.  Physicians and other healthcare providers are key components to the delivery of quality care — although it appears that our current reform has not accounted for nor planned for physician attrition due to burnout.  Failure to provide adequate resources and support for care providers will not only result in quality providers leaving medicine but may also discourage bright young college students from entering the noble profession of medicine in the first place.  As many physicians continue to “run for cover” there appears to be nowhere left to hide.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • NewMexicoRam

    Why not?
    Everything else is.
    I’m so tired of all this crap. It won’t be long and I will be looking for something else to do. About 1500 patients will need to find another doctor in a doctor-needy communtiy.

    • Deceased MD

      Well I’m already deceased so I’m way passed burnout. But seriously, that is absurd that you are feeling driven away from a doctor-needy community.

      • NewMexicoRam

        Isn’t it?
        70% Medicare. About 15 % Medicaid.
        In the 18 years following the year 2000, Medicare payments to me will have increased a total of 8.5%.
        And with all the new quality measures to meet, it’s getting very tiring.
        Not enough people with high income in this area to attempt a retainer practice.
        The hand writing is on the wall. It’s just a matter of when.

        • Deceased MD

          That’s so sad and disturbing to hear but it’s not the first time I’ve heard it. A good friend of mine was in a rural area as well and around 5-10 years ago had to leave that practice. It’s very disturbing what’s happening. Beyond words.
          How do you feel ACA is going to affect you? Again my sincerest apologies to you from Medicare (since you will never hear it from them).

          The AMA had the gall to write in the last RUC article that they have increased payment by some bread crumbs to PCP’s. Eye roll.

          • NewMexicoRam

            I appreciate the advice, friends.
            Our family just loves Albuquerque, the climate and people, but the time to change may be upon us.

          • Deceased MD

            Albuqueque is mostly medicare? No or little private insurance? Or are you off in some remote part of New Mexico? Anyway to hear that and for your patients as well.

          • Guest

            What area are you practicing in? I agree that in Abq there are very few affluent people but in the NE heights where I grew up there were plenty of insured, upper middle class people.

            Funny thing is my specialist friends in Abq are doing very well. At least the cost of living is relatively low.

        • buzzkillerjsmith

          If you have 70% Medicare and 15% Medicaid, you are doomed to dissatisfaction and burnout. My advice is to get out. You’ll wonder why you didn’t years ago.

          I was in a Medicare and poverty practice in Oregon for a while. I’d be dead by now if I had stayed.

          My view is that we docs are not responsible for the failure of this society to develop a first-world medical system. I’m tired of cleaning up America’s mess.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    There is a brand new RAND report done with the AMA titled “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy”.
    Not sure if it’s ACA per se that is causing this, or just the specter of it, but the problems they found are along the same lines and then some.
    http://www.rand.org/pubs/research_reports/RR439.html#key-findings

    • southerndoc1

      Another study where the authors correctly identify the problems, but are terrified of goring any sacred cows: their “recommendations” are feeble in the extreme.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        I would like to see the following multi-payer (including CMS) experiment:
        Take 100 primary care practices of all sizes – 50 private and 50 owned by systems. Have a control group that is similar in characteristics.
        Remove all regulatory requirements (incentives and penalties) from the first 100 practices, including MU, PQRS, P4P, etc., remove all prior authorization and insurance interference, and increase the fee for service pay to PCPs by at least 50%, while requiring that nobody sees more than 20 patients per day.
        Leave the control group as is today with no constraints.
        Take a baseline of health status and cost of care for all patients, adjust for whatever needs adjusting, and come back in a year and then again after two years and measure both costs and outcomes for all groups.
        Let the chips fall where they may.

  • southerndoc1

    “But now, with the ACA in effect, we are no longer able to spend as much time in the service of our patients — we spend more time with government forms, rules and regulations and are paid little or nothing for the increased administrative duties. The ACA is now one of the primary drivers of healthcare provider burnout”
    Those trends have been underway for two decades, thanks to government regulations AND private insurer rules. I haven’t seen anything so far that is specifically a result of the ACA. Examples please.

    • buzzkillerjsmith

      “However, haphazard planning and rushed rollout will most certainly doom the ACA to failure.” -Dr. C.

      Oh, ye of little memory. The same thing was said when the feds rolled out the Medicare Advantage plans not too long ago. The web sites crashed and were slow. But guess what, after a few months people were doing OK with it. I make no comment on the merits or demerits of MA. That is a different topic.

      Dr. C. doesn’t like the ACA so he drums up reasons not to like it.

      Southerndoc gets it, as usual. The experiment is about to be done. We will know the results in time.

  • http://www.thehappymd.com/ Dike Drummond MD

    The feared patient tsunami on the horizon is just a virtual threat at the moment. It causes a general increase in the background stress levels but no actual changes in patient flow or the day to day.

    The most recent major increase in the stresses that lead to burnout has be the implementation of EMR’s and the huge shift from private practice to docs being employees with their schedules driven by the profit motives of the organization. Some of my clients have to learn 3 EMR systems … one for the office, one for the hospital and one for the surgicenter. Of course, none of them talk with each other.

    We shall see if the patient tsunami ever materializes. The exchanges have to function, people have to sign up and then they must utilize for all of our fears to be realized. If/when that happens we will see just how medically underserved the USA has been all along.

    My two cents ( if I make it past the new moderators here on the site)

    Dike
    Dike Drummond MD
    http://www.TheHappyMD.com

    • Suzi Q 38

      “…….My two cents ( if I make it past the new moderators here on the site)”

      You noticed that, too.

      It makes one hesitant to post…why bother if it will just get removed?

    • buzzkillerjsmith

      I too am not that worried about the flood of pts into my office. We have only so many appt times. Of the course the ER docs might be shaking in their boots, who knows?

      EHRs and being employed are huge problems.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Dr. Reznick, I’ve been meaning to ask this for quite some time, but why are you bothering with MU and all these things in a concierge practice?

    • Steven Reznick

      Florida is a ” Medicare” dependent state. Huge senior population and Medicare here is the highest payor. There are numerous in state initiatives to outlaw or do away with concierge medicine. Keeping on track with MU and PQRS gives me and my associate flexibility to change our model of business if the morons in Tallahassee legislate us out of our business model. Remember this is the land of the hanging Chad and Stand Your Ground

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Oh, I see. Well, I certainly hope you are able to stand your own ground…. :-)

  • Dave Mittman, PA, DFAAPA

    If you are not practicing with a really good, clinically excellent PA or NP (not a new grad) go hire one.
    I can say from personal experience that we can really make a difference, add a colleague, give you someone who can allow more home time, CME time, travel time and make the practice money.
    Dave

  • ceblen

    It’s all in one’s perspective. I think that it is true that the autonomy of physicians is being undermined and also the autonomy of Medicare patients who have paid into the Medicare system, a social program that has often been robbed blind by some of the physicians and other providers because of for-profit incorporated clinics and physician’s practices who treat Medicare patients as “product” for profit, and who sometimes have more loyalty to their corporations than they do to their patients.
    Haven’t the AMA and the physicians, themselves, especially the specialists who have engaged in profitable over treatment of Medicare/Medicaid patients for many years (because they could under the Age Discrimination Law) asked for what is happening with CMS Reimbursement protocols.
    Isn’t it obvious that when BIG Insurance invaded original Medicare to gain access to the Medicare purse, it was inevitable that the physicians and hospitals would have to suck it up and move over and stop the over treatment for profit that has so endangered our Medicare Program for the elderly.
    Yes! it’s going to be painful for the new doctors who haven’t lived in the “bubble” and who haven’t acquitted any kind of wealth and they, like many Americans, may have to take a cut in their take-home checks.
    But, it is my opinion that really good physicians don’t go into Medicine for the money; they go into it because they are good at it and feel fortunate to be able to do something that they love to do. They i contribute to the public good as well as their own private good.—and sometimes for the specialists —this translates to houses and cars and living very high on the hog.

  • http://benfanning.com/ Ben Fanning

    Some good points, Kevin that shouldn’t be overlooked in the rollout of the ACA. With more awareness, can we reap the benefits of this new system and protect physicians’ well being?

  • Neuroscientist

    Good points. Will most of the physicians resurface as private care providers who will not take insurance or medicare and therefore be a true business?

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