The epidemic of physician burnout is heartbreaking

The epidemic of physician burnout is heartbreaking

Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.

The burned-out physician is exhausted — mentally and physically — and often no longer able to find empathy or connection with patients. The question of how to escape from what has become a highly unpleasant situation becomes a frequent one. Given the high demands of the profession and serious consequences of mistakes, the burned-out doctor is a potentially impaired one. And the impaired physician is not able to maintain the unflappable, perpetually cool under fire, always objective, professional and yet compassionate demeanor that is expected by society. Worst of all, the impaired physician is at great risk for developing depression, suicidal ideation, or a serious addiction.

The doctors who contact me report feeling beaten down by an increasingly hostile work environment. They say that they don’t have time to take care of patients the way they envisioned when they decided to apply to medical school. Many describe feeling betrayed by a system that they say seems focused on achieving the bottom line with little regard for the impact on both doctors and patients.

Most of these doctors report spending a significant amount of their time dealing with the electronic medical record and documentation. The ratio of time spent on doctor-patient interactions compared to physician-computer ones appears so horribly skewed that it has reached the point of complete dysmorphia. These good physicians call me when they feel like they can’t continue any longer in the profession. They want to quit medicine. They report a loss of joy and meaning in their work. They describe the toll that the profession has had on their mental health, physical health, and personal lives. And most wrenchingly, they don’t see an end.

What can we do?

There are no easy answers to the complex issues that threaten our profession. However, I am increasing convinced that we must have an open and frank dialogue about the problem, and that doctors must demand and advocate for a work environment that supports and nurtures the doctor-patient relationship. At the University of North Carolina at Chapel Hill, we are trying to address this issue. The Taking Care of Our Own Program seeks to increase awareness, and provide education and treatment for distressed physicians. The program has had an over 200% rate of growth in the first year, reflecting the enormous need for this type of service. We are eager to collaborate with others who are interested in tackling these critical issues.

Samantha Meltzer-Brody is a psychiatrist and director, Taking Care of Our Own, University of North Carolina, Chapel Hill, NC. This article originally appeared on The Doctor Blog.

Image credit: Shutterstock.com

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  • SteveCaley

    Many physicians turn to an inner refuge, a dysfunctional way of life that is particular to physicians, namely – the residency mindset.
    “They can always hurt you, but they can never stop the clock,” was one of the sayings bouncing about during my residency. Many physicians have the ability to curl up and survive, like someone lost in the winter forest. Life becomes an endless winter.
    I found that residency took a sharp turn from integrity to autonomy, from participatory medicine to compulsory obedience, in the 1990′s. This disaster has been brewing since then.
    To steal a concept from JFK – “Those who make life unbearable, make death desirable.” Ethicists and psychiatrists may debate the principle of whether rational suicide exists; but it is a relief turned to by many physicians in grave extreme.
    It is my personal observations that many children with a relatively functional schizophrenic parent often gravitate towards computer programming and the rational sciences – those things which respond with predictable order. The spirit of the EMR seems a feeble and failed attempt to reach to an order that does not exist. The term is “pareidolia.” Our medical records system seems based on irrational and magical base, heaped up with reassuring code and symbol, as dense and meaningless as a poor homeless psychotic’s thousand-page essay on nothing.
    Much of medicine seems to be insane, not in the model of thought disorder, but in the model of “Lewis Carroll,” i.e. an irrational set of rules. When what is intuitively sensible and humane diverges so far from what is expected, a great “community-spirit” of despair seizes everyone, and is hard to shake off with out heartless cynicism. In our world, God is not Dead, but merely Stoned. Humor Him. (The right word abovewas Weltanschauung, but that sounds so smarmy in a sentence.)
    The greater one visits the problem, the more thorny it becomes. It has no boundaries; it has a malignant edge to it, and penetrates into everything.
    That is our chore for the future – to become humane, or to become an anthropological relic in the history of failed cultures.

    • Suzi Q 38

      “……It is my personal observations that many children with a relatively functional schizophrenic parent often gravitate towards computer programming and the rational sciences…..”

      I am so glad that you said that..” it is your personal observations…….”

      There is no concrete or solid study that I know of that comes to the conclusion above. If there is, please let me know, as that would be interesting. So many parents have children who are interested in computer programming. These children often become “computer engineers.”

      As far as I know, the parent(s) of children who gravitate towards computer programming and the rational sciences are no different than any other parents.

      Your comment, based on admitted personal anecdotal observation is somewhat odd.

      • Patient Kit

        Suzi, I think Dr Caley meant that he’s noticed a pattern of kids with a schizophrenic parent being attracted to computer science and other rational science. I don’t think he meant the reverse that all of the people who work in computer science have a schizophrenic parent. It makes sense to me that those who grow up with chaos and the irrational would be attracted to fields that are more ordered and rational.

        • SteveCaley

          Exactly, Kit. All grammars, whether natural language grammars or computer languages, have rules of order and hierarchies. Grammars are largely deterministic; a spoken sentence in a language or a command in a computer language is either interpretable or uninterpretable.
          Perhaps it is comfortable for people who grow up with those with thought disorders, to speak in a language that is determinate based only on observable structures, and not subject to the vagaries of the mind. Perhaps not.
          The concept stands, whether or not referenced.

        • Suzi Q 38

          I found his point interesting, as your viewpoint is as well, but I was curious as to what is the basis for such a strong conclusion.
          I think that i should be allowed to ask and to challenge such a “blanket” statement.
          Thank you for your reasoning and explanation.
          I still do not agree with his assessment, and am curious where he discovered this theory or ideation. If it is anecdotal, it is just interesting conversation. If it is part of a study, this may make the argument of his conclusion stronger, depending on how the study was conducted.
          I do not believe all studies as well, but it is at least a starting point.

          • Patient Kit

            Suzi, of course, you are more than “allowed” to question and challenge anything here. I never meant to imply otherwise. As a patient who frequently asks questions myself, I would hope that all who choose to participate in the discussions here on KMD feel free to express their thoughts, ideas and opinions.

            My only intention in my response to you was to say that I thought you might be misinterpreting Dr Caley’s post. I do not think he was saying that he thinks anyone interested in computer technology must have a schizophrenic parent.

            He did raise an interesting topic for discussion though. In my personal experience, I too have observed some kids who grew up with the chaos and irrational behavior of mentally ill family members being drawn to careers that involve more logic and organization. And it always made sense to me because many people who feel out of control seem to seek ways to feel more in control — often irrational ways of controlling such as extreme eating disorders. Some is a key word in what I just said though. Even any good study wouldn’t prove all.

            Interestingly, at the same time, I’ve also known many who grew up with creative artist parents who ended up embracing the relative irrationality of much creativity themselves. The children of artists did not seek less chaotic, more stable lives for themselves.

            Which brings us to that famous fuzzy fine line between creative and crazy, between eccentric and delusiional, between genius and sick. And, of course, it’s possible to be both.

            Keep expressing yourself freely. KMD would be both boring and unproductive if we all stopped questioning and challenging.

          • Suzi Q 38

            Thank you Kit,

            I appreciate your explanation, which makes a little more sense, but does not give me any more than an easy, non verifiable, answer to a direct question.
            Where is the information derived from, and, if there is data, where is it? if the answer is “This is just what I think,” that is fine, but say so.
            If you want to say something like: “Alcoholics are spouse abusers,” or “people who like mathematics are borderline schizophrenics,”
            then back your words up with information.

            You are great about providing us with information when we want it or the topic warrants it.

            I am just requesting the same from Dr. Caley, possibly in the form of an article from a psychiatric medical journal. I will even take one sponsored by a drug company, LOL.

            Interestingly enough, aside from the enjoyably written posts, he has not provided any such information, even when directly asked.

            Maybe you can help him out and find it for him.

            Of course I am allowed to question and challenge anything here. That is the least we all could do to ensure validity.

            At this time, I do not consider his statement valid at all…just an anecdotal, interesting, thought, that has no medical basis.

          • Suzi Q 38

            “..I do not think he was saying that he thinks anyone interested in computer technology must have a schizophrenic parent….”

            Correct, but he did say this:
            “….It is my personal observations that many children with a relatively functional schizophrenic parent often gravitate towards computer programming and the rational sciences…..”

            In a “nutshell” (pun intended), what is he saying or inferring?

            I am just curious where he got this information.
            Does he practice psychology or psychiatry?
            If it is just personal experience, how many patients were borderline schizophrenic, and how did he verify that they (the children) later became computer engineers or worked in the rational sciences?

            Of course I have not found this to be true, as I do not know very many functional schizophrenics. I wasn’t able to think to ask the one I do know because she doesn’t have any children.

            My point is the likelihood of such is not believable.

            Moreover, we expect more out of doctors who make such statements. Not because we think they are lying, but the statement is somewhat or very farfetched, so we are so interested that we want more information.

      • SteveCaley

        Suzi, I would like to sidestep the principal criticism with a reference to Thomas Sowell’s The Einstein Syndrome. The topic is interesting, but it is not in need of critical scrutiny as your last comment(s). I am not bothered by the particulars of your statement, as rather the commonly-held suppositions upon which it rests.

        There is no concrete or solid study that I know of that comes to the conclusion above. Your comment, based on admitted personal anecdotal observation is somewhat odd.

        You have captured the gist of our awful, machinelike approaches to knowability in these comments.

        If an “Authority” has conducted a “Study” in which the p-values are dutifully reported, and the alpha- and beta- constants are dutifully mentioned in the publication, well then…it must be real.

        The actual human observation of a thing is immaterial; it is somehow a quantum minuscule, a thing of no meaning; an incidental. Only when a Community of the Blessed has voted in a national conference on the Name of the Rose, can it thus smell so sweet.

        This is the direction of 21st Century medicine; I do not like it. Foucault’s Medical Gaze has come to fruition; now, there is no need to see the actual, incidental patient. see [The Birth of the Clinic: An Archaeology of Medical Perception]

        “Telemedicine” is now something that can be done remotely, with AI algorithm; for 21st Century medicine ends the focus on the individual, unpredictable patient, and speaks in grand terms of Health Theory, as updated by the Wise in annual meetings.

        The word “odd” rings loudly and sourly; it is a word with its own set of connotations. Webster’s has odd as “strange or unusual : different from what is normal or expected, happening in a way that is not planned or regular..” In reference to people, it has the tang of eccentricity, of the schizoaffective and schizoid personality disorders.

        In America, the expression of unnormative opinions sets people on edge. “People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority.” Hickey; or Ancowitz, cit. from Wikipedia.
        Opinions are subject nowadays to the scrutiny of the Audience; not in a dialectic, speaking to the truth or falsity of the argument; but rather, like the Weighing of the Heart in Egyptian thanatology. Are they close to normative, and if not, if novel, are they properly referenced, and assembled from certified thought vendors under subcontract?
        Medicine, whatever that is, is defined as an Ideal (as Plato puts these things,) which it is not. The commonality of processes, and their assembly into overarching things such as Diseases, is merely a nominalist footnote, not a glimpse at Reality.
        Factory medicine cares for widgets, and recognizes people only to the degree that they resemble an ideal Medical Form; they are the “kidney in room 312.”
        So I admittedly observe; and I will kindly welcome any suggestions to my oddity or familiarity of thought; the score does not bother me much, I do not shake in judgment; I expect shall not be fed to Ammit; that only happens to Public Personas and I am not Dr. Oz or Dr. Phil.

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

          You may not be, but please do write a book….

        • Patient Kit

          “In America, the expression of unnormative opinions puts people on edge.”

          Wait! Odd is bad and “normal” is good? We really do live in a different world here in NYC. Maybe it’s the New Yorker in me or the creative circles I travel with in this city of eccentrics (no Wall Streeter here), but I never associated “odd” or different as bad or inferior. I value creativity and thinking, especially thinking outside the box. You might have observed that I’m not very hesitant to express my dissenting, sometimes very unpopular opinions here on KMD. That’s who I am in real life too. Many have come to NYC from more conformist small town America. You would probably thrive here. Maybe you should put us on your list of options, Dr Caley. You would be very welcome here.

          As for astute observation vs evidence-based double blind scientific studies, they’re both important. Science has it’s major role in medicine but science is not everything because medicine deals with people — individual odd humans — and there are many unmeasurable and mysterious things. Ironically, some treat science like it’s their religion. Like nothing unprovable is true. Making order out of chaos is not necessarily a good thing. I can’t prove it (!) but the irrational might be “the norm”.

          Embrace your differences and don’t give up hope on humanity, Dr Caley. I think we have a huge fight on our hands but I’m not nearly as hopeless as you sound sometimes. The world needs people like you.

          • SteveCaley

            Thank you, but yet, social convention and form exist and are rigidly observed in NYC as much as in any other human society. Sit on the subway, and scootch up very close to the nearest person, at Japanese social distance, thighs touching. Rub their thigh just above the knee, at the bend – that’s a friendly gesture in China. Ask them, “so where are you off to now, mate?” in a friendly, nonthreatening, smiley way.
            This might get you clocked. Even the bums will move away from you.
            In the everyone-all-jammed-together Asian societies, these actions are relatively banal; in the American fight-or-f*** society, they are clear signals provoking a rapidly accelerating engagement, likely of the hostile sort.
            I did spend a quite pleasant summer in Manhattan at NYU, in a dorm just north of the Arch, and enjoyed it immensely – the swath from the East Village to the West was delightful.
            But still, the straightjacket fits a little better, as it is a bespoke design and has nicer fabric; it has a nice drape to it, one wears it well. Not off the rack, as they say on Seventh Avenue.
            I say that the worship of “Scientifically-derived authority” is at its greatest point in eighty years, across society and especially in medicine. Yes, there are colorful clothes and spontaneous dances in the Park in Washington Square. But everybody, everybody, knows that they are on camera, and the Gaze never ends….

          • Patient Kit

            Well, I do love my city but if whether you can put your hand on and rub a stranger’s thigh on the subway is your litmus test, sure, we have our conventions in NYC. I ride the subway every day between Brooklyn and Manhattan (and have done so for decades) and I talk to plenty of strangers while commuting. Just this morning, a guy I didn’t know touched my arm to get my attention so he could offer me his seat. I didn’t even consider whacking him for touching me. ;-) I said thank you and was happy to sit down. By coincidence, I sat down next to another stranger guy who happened to have very nice thighs. But I didn’t try to touch them, LOL!. I think New Yorkers really get a bad rap and are unfairly stereotyped. I’ve been the recipient of countless random acts of kindness here and I’ve helped my share of strangers myself.

            Of course, there are people who are always “on”, performing and competing and there are parts of NYC that do demand conformity. As you said, all cultures have their rules in order to balance the rights and needs of the group and those of the individual. But there is a huge amount of room for individuality and diversity here, if that’s what you want. One summer at NYU, while nice, is not a good indicator of what life in NYC can be like.
            I agree with a lot of things you say. But I’m not nearly as ready to give up on humanity.

          • SteveCaley

            I have great affection for New York and New Yorkers – it takes a certain suavité to get about the City, but how fun and fantastic it can be! (Especially if one is white, rich and connected, but that’s another rap…)
            But the information pipeline there is almost as bad as Washington DC. Reality passes through so many reflections that what is seen on Park Avenue may not be exactly what is really going on in Pocatello, Idaho.
            American Indians, for example, are used to this – they’ve had centuries of dealing with the BIA, in various forms and incarnations. Last presidential election or so, the Insane Clown Posse ran through a nearby reservation, and wanted to talk about dreamcatchers and sacred tribal rites and such. All the Indians wanted to talk about is improving VA care on the Rez, because in lots of tribes, a majority of the residents are veterans. You want their vote, don’t talk about the Great Spirit. Talk about the mundane things of jobs and healthcare, you’ll get listened to.
            {PS: The old NA/AI debate on what to call our indigenous populations is a bit of a distraction; let’s not go there. Support the reform of the Tribal Trust Fund and continue the improvement of the IITF, and then you’re talking sense.}

          • SarahJ89

            Oh, I’ve done that, during a visit to the Big City, two hours from my rural home. Not touching, but making conversation on a subway platform with a young mother. I realized my mistake after she moved away from me on the Group W bench.

          • Patient Kit

            I don’t understand where this comes from. I’ve been riding subways and buses in NYC for decades and I make frequent eye contact and conversation with my fellow commuters without negative outcomes. The subway in NYC, btw, is perfectly safe for a woman to ride alone at midnight. I’m lucky if I can find a seat on a subway train at midnight these days. The subway was dangerous decades ago when they were uncrowded late at night.

          • SarahJ89

            I think she experienced my conversation as intrusive, although it was pretty normal for where I live. I felt badly because I’d obviously violated the social rules and certainly didn’t mean to be annoying. You live and learn. Smiling, nodding, eye contact is okay. Several minutes of conversation during a long wait is not.

          • SarahJ89

            I live in the country. We just think of “odd” as “our neighbors.” Or, as my fence guy put it, “I’ve lived in town and I’ve lived out of town. I find the further I get from town, the stranger my neighbors are.”

        • Suzi Q 38

          Dr. Caley,

          I definitely appreciate most of your posts, but did not agree with this one:
          “……It is my personal observations that many children with a relatively functional schizophrenic parent often gravitate towards computer programming and the rational sciences…..”

          To which I responded:
          “There is no concrete or solid study that I know of that comes to the conclusion above. Your comment, based on admitted personal anecdotal observation is somewhat odd.”

          And you responded again:
          “The word “odd” rings loudly and sourly; it is a word with its own set of connotations. Webster’s has odd as “strange or unusual : different from what is normal or expected, happening in a way that is not planned or regular..” In reference to people, it has the tang of eccentricity, of the schizoaffective and schizoid personality disorders.”

          “….So I admittedly observe; and I will kindly welcome any suggestions to my oddity or familiarity of thought; the score does not bother me much, I do not shake in judgment; I expect shall not be fed to Ammit; that only happens to Public Personas and I am not Dr. Oz or Dr. Phil….”

          Such “drama” Dr. Caley….
          Webster is also right: “Odd = strange or unusual…” Meaning your statement about many children who gravitate towards computer sciences and the rational sciences have a parent who is a functional schizophrenic was “strange, different, and unusual” because it is a statement of personal anecdotal observation rather than a factual one.
          I am very interested, as our son was and still is fascinated with computers, games, and programming, and neither my husband or I are schizophrenic. Yes, your statement was uncharacteristically “different.”

          • SteveCaley

            Lovely conversation, I’m enjoying it greatly.

            There is a lot to touch upon. Drama, a wonderful work, carries the sense of being hyperbolic or grandiose in communication. I am not trying to convince by rhetorical flourishes here; I just hate drab prose.

            Let’s see…“your statement about many children who gravitate towards computer sciences and the rational sciences have a parent who is a functional schizophrenic was “strange, different, and unusual” because it is a statement of personal anecdotal observation rather than a factual one.”

            That is a statement with piercing implications. To observe and state one’s is said to be odd, strange, different and unusual.

            It is a collision of eras – empirical observation of appearance ought not be noted, as it is not founded on pre-existing fact.

            Aristotle’s error, stating that men have more teeth than women, could have easily been scientifically dispatched by counting Mrs. Aristotle’s teeth – so mentioned Bernard Russell, whom I greatly admire as an empiricist.

            In medicine, observation and interview go together. One of the toughest things to learn in our society is how to see and hear – obviously not the simple sensory acquisition, for these are the skills of the animals.

            “Theory is wonderful, theory is marvelous. But there has never been a theory that has been capable of making a fact vanish” – (or something like that). Jean-Martin Charcot, neurologist and instructor of Sigmund Freud

            Observations are merely that – whether or not they are consequentially attractive. They do not need to be pursued out to an authoritative Other to determine whether they are acceptable. This may sound like quibbling; I don’t believe it is.
            “Theory or statement” are opposite ends of the field. When Wolfgang Pauli was hired by the electric company to study the most efficient light bulb, that banal challenge led him to a catastrophic conclusion – that, given all we know, light cannot come from a light bulb in the manner that it actually does. He came to this point and sat in great frustration. There were no publications on the matter. And his further pursuit of the matter only made it worse. When once Physics was fat and sassy and knew everything about the universe, ten years later, it was in shambles – anything could be true!
            Strictly speaking, you are falling into a logical fallacy:
            1) Many A cause B.
            2) Therefore, B is caused by A.
            Example:
            1) Many homes are burned down by forest fires; many of these forest fires are caused by lightning strikes.
            2) The New York Fire Department then should be putting lightning rods up to decrease the frequency of fires in Manhattan.
            I observe a correlation, that may be causal or not, between A and the presence of B. That does not by any means say that B is largely or mostly caused by A.

          • Suzi Q 38

            “…..Observations are merely that – whether or not they are consequentially attractive. They do not need to be pursued out to an authoritative Other to determine whether they are acceptable. This may sound like quibbling; I don’t believe it is.
            “Theory or statement” are opposite ends of the field. When Wolfgang Pauli was hired by the electric company to study Edison’s light bulb and develop the most efficient light bulb, that banal challenge led him to a catastrophic conclusion – that, given all we know, light cannot come from a light bulb in the manner that it actually does. He came to this point and sat in great frustration…….”

            “Theory or statement” are indeed on opposite ends of the field. My words are purposeful in that they leave you with full latitude to find a way to define and prove or disprove your strange statement or personal theory, which is not even remotely scientific at this time.

            I do not believe you are in similar scientific circles as Edison or Pauli…who were working with a certain goal in mind of improving a concrete thing that already exists.

          • Suzi Q 38

            Hi Dr. Caley,
            My response to the above was written this morning. I thought it was posted, but I can not find it.

      • JR DNR

        I’m with you on this one. I think that perpetuating stereotypes (with or without evidence) can be hurtful to those who are stereotyped.

        I do have Schizophrenic relatives (by marriage) and I don’t find this statement to reflect them.

        • SteveCaley

          Help me understand your point. What is your point?

        • SteveCaley

          I am sorry. I understand that my commentary on this site has caused controversy and complaint. I do not wish to trouble people by posting here. I will stand down from the site.

          • JR DNR

            I’ve caused controversy and complaint here too. You can’t change your mind if you never speak your mind.

          • DeceasedMD

            No! Don’t leave. Come back. I have so enjoyed reading your most deep and insightful thoughts. I chuckled when I read about tour comments on children of schizophrenia having jobs with more order to the universe- like computers as i have observed the same.
            Seriously I do hope you have not abandoned ship and will come back!

      • SarahJ89

        Suzi Q,
        I think there probably is a connection. I went in the opposite direction, losing my above average math abilities in the wake of serious family disruption. It’s only been in the past two years I’ve come to understand that life was so chaotic and without reason in our home that I simply could not tolerate the notion that there *is* reason, logic and order in the universe–but not for me. I simply blocked out all math. I can easily see another person clinging fiercely to the order and rationality of math or programming in the face of the same situation.

    • Chloesbrother

      Beautifully written, and so true!

    • SarahJ89

      “Many physicians have the ability to curl up and survive, like someone
      lost in the winter forest. Life becomes an endless winter.”
      This is a perfect description of one sequala of abuse.

      I encourage any doctor in survival mode to do something, anything, to break up the ice pack setting in around him or her.

  • David Mokotoff

    As a burned out and now retired doc I would suggest that the answer is for doctors to unionize. Only by striking back at the evil empire of the government-insurance-malpractice triad, can any meaningful relief be found.

    • Suzi Q 38

      I think that they should unionize, too.
      I can not venture to guess how long it will take or what else has to happen before the doctors really do it.
      The nurses strike sometimes….

      • James O’Brien, M.D.

        I’m not sure doctors would have the stones to strike.

    • buzzkillerjsmith

      Yep, but as Dr. O’Brien well says, most of us are good little boys and girls. Non-rebels with a cause.

      But it is definitely worth a try.

      • SarahJ89

        That’s so weird. Doctors (primary care) were the original small business entrepreneurs, the essence of independence. Think back to the independent practitioners of more than 40 years ago or so. Did anyone tell them what to do, how to run their practices (beyond the basics of essential care)? They seemed like pretty independent thinkers to me.

        If I am correct, what has happened? If I’m wrong, I hope the older docs here can tell me what hasn’t changed.

        • buzzkillerjsmith

          Very good point The dinosaurs were a different breed but now they are gone. The semi-dinosaurs like me are having a hard time getting used to the paddock. The birds, which evolved from the dinosaurs but which are very different, are mostly songbirds. The chirp some but don’t cause much trouble, and they stay in the cage.

          Sexist alert: The feminization of medicine is a part of this, both a cause and a result. Women are more tractable than men are, at least in the workplace. They are also more interested in being employees as they have better things to do in life than running businesses. I’m speaking in averages here of course.

          • SarahJ89

            When I taught the primary school teachers had the attitude that our Teachers’ Association was somehow there to serve the children and parents. The high school teachers were more in tune with the fact it was our union, although a lot were still stuck in that service mode.

            At one meeting we were actually discussing changing the name to Teachers’ and Students or some such. I said this was our union. We looked out for the students all day every day. There is an existing PTA to look out for the students. I don’t have a bit of trouble having a union to look out for my interests. Nowadays I would also point out this is good role modeling. At any rate, we kept the original name and purpose.

            We females are trained to accept lower wages and a host of undesirable attitudes from an early age, as men are trained to be “good providers” and probably a bunch of other stuff that isn’t in their best interests. When I got my first job minimum wage was $1.35 an hour. The boys my age scoffed “I wouldn’t take a job for less than $2.00 an hour.” I clearly remember thinking “I won’t live long enough to make $2.00 an hour.” It was never going to happen for me because I had those pesky ovaries. I was very aware the boys I knew were not better workers or smarter or more talented.

            In the end, faced with a system over which I had no power I simply adjusted. Later, in my twenties, I remember applying for a job in a bank. They wanted a man permanently, but were willing to hire “a girl” for the summer, at a greatly reduced wage. I never thought to question it. I’d learned my lessons well. This is how you end up with lower wages and poorer working conditions when women enter an occupation. One solution is to stop training us to accept these conditions and teach us the skills we need to negotiate fairly. Raising this tide will raise everyone’s boat because we really are all in this together.

            I cannot watch the TV show Mad Men because I find it so depressing to remember what it was like to be female in those days–to be systematically discounted, to have innuendoes and jokes made behind (and not so behind) your back as you focused on your work, to be grappled in the supply room and then denigrated and retaliated against when you “couldn’t take a joke.” Those were decidedly not the good old days for many people. (OT: I noticed lots of smoking but no ash trays. How odd. Everyone had ash trays everywhere. All living rooms featured a large standing ash tray with a glass insert. I didn’t see a single ash tray in the one episode I watched, just lots of smoking but no ash flicking or stubbing out of butts.)

          • buzzkillerjsmith

            We’re not people. We’re murderous apes. Always have been.

            Training most women to be more hard-nosed won’t work. It’s the lack of testosterone that is the main thing here. Plus all that oxytocin is really holding you all back.

            Of course there are lots of scary females out there. Ex-cheerleaders and sorority gals come to mind.

            Female legal semi-equality is an aberration, a temporary thing in a few countries. It will not last. Interestingly, empowerment of most men will not last either. The men who are the most willing to kill or be killed and who are best at killing will win out in the long term. I’m just glad that in this time and place most of those guys are in finance. Marginally less dangerous.

            But I always like to end on a positive, so I should say that (young) women are less likely to be murdered when their tribes are destroyed. Good work if you can get it!

          • SarahJ89

            “I’m just glad that in this time and place most of those guys are in finance. Marginally less dangerous.” Love it.

            But I do believe there are a LOT of behaviours that can be pinpointed and changed, including negotiation skills.

            In the end you are quite correct: the bottom line is physical power over others. But I’m not willing to simply accede to that any more.

  • Thomas D Guastavino

    Lets be frank here. Why would anyone put up with a situation that is physically and emotionally draining? The answer is that they are trapped and cannot leave. Although there are many types of traps the one that physicians are in are likely contractural or financial. You can get out of a bad contract if you are financially stable. Therefore, the best way for a physician to avoid burnout is to become financially independent. I had this epiphany 10 years ago and resolved to separate my financial from my professional future. It took 6 years but once achieved a remarkable transformation took place. Because I could afford a salary cut I stopped seeing high risk, low reimbursement patients. When my practice was considering buying an EHR system that was terrible I stated I would never use it and would quit first. ( That decision in retrospect, was absolutely correct).
    There are many other examples but point is made. I also became a much better physician because I was able to much more calmly devote my time to those patients I choose to treat.
    If you are a physician who is already financially stable I salute you. Today it has become a necessity.

    • PoliticallyIncorrectMD

      “Why would anyone to put up with a situation which is physically and emotionally draining ?” My parents taught me the answer to this question long time ago – it is called RESPONSIBILITY!

      • Thomas D Guastavino

        My parents taught me that if you acted responsibly you will be rewarded, not punished for it.

        • PoliticallyIncorrectMD

          So, do you only act responsibly when you are rewarded for it? Interesting!

          • Thomas D Guastavino

            Certainly you don’t expect to be punished for it, do you? Interesting!

          • PoliticallyIncorrectMD

            Responsibility is not conditional. People are usually responsible in spite of other things, not because of reward. And, yes I would prefer to be rewarded. But if I am not or if I am “punished” for it sometimes, that does not make my responsibility any less.

          • Thomas D Guastavino

            So….if someone claims you have a responsibility to do something you must do it without question?

          • PoliticallyIncorrectMD

            Nobody can make you responsible, it is your own decision. Having said that, when one becomes a physician they accept (or at least I think they should accept) some responsibility that comes with it. This is exactly what I was referring to earlier while talking about right motivation: when many decide to become physicians they see compensation, lifestyle and prestige but unfortunately do not see a responsibility.

          • Thomas D Guastavino

            Please define “some responsibility”

          • PoliticallyIncorrectMD

            Responsibility = the state or fact of having a duty to deal with something or of having control over someone.

          • Thomas D Guastavino

            So in your mind the slaves should have stopped complaining and pick the cotton because the plantation owners told them they had a responsibility to do so?

          • PoliticallyIncorrectMD

            Slaves did not choose to be slaves. You made a choice to become a physician. Nobody twisted your arm. Again, back to what I said earlier: if you focused on responsibility, not on rewards when you entered the field, you might have been not so burned out later.

          • Thomas D Guastavino

            I was not aware that you choose to be a physician it required you to be a punching bag.

    • PoliticallyIncorrectMD

      “I also became a much better physician because I was able to much more calmly devote my time to those patients I chose to treat.” I wonder based on what criteria you chose those worthy of your attention? Was it based on their problem / condition / need or on the size of their checkbook / effort-to-payment ratio? You honestly think cheery picking you patient makes you a better physician?

      • Thomas D Guastavino

        I refer you the article I wrote on KevinMD titled “Medicine is like BlackJack, Physicians need to count cards” As I said, it is a warning, not a recommendation.

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

    “There are no easy answers” is true AND there are answers, tools, techniques that work to find flexibility in your practice to be more productive, more efficient, share the load more effectively with your team, conquer EMR and find more life balance. You just have to stop the magical thinking that there is an easy answer in the first place. Here is a missing piece of awareness for doctors.

    Most of the most vexing challenges we face are NOT PROBLEMS. This includes Burnout, Work-Life Balance and EMR. None of these are problems. Here is what I mean.

    Problems have solutions. When you apply a solution to a problem what happens to the problem? … it goes away … right? Here is a classic medical example of a problem. A pointing abscess. What is the solution? Drainage, I&D, … Steel. You drain the abscess and your problem is solved.

    There is no one step solution to Burnout, Balance and EMR. Nothing will drain the pus (so to speak) and make them go away. That is because each of them are a DILEMMA. You don’t solve a dilemma. You balance between the two horns. You develop a STRATEGY to address it and maintain that balance. Strategies have multiple parts and you must pay attention to them regularly.

    So there is no magical I&D for burnout. Each of us must build a strategy to address our own stresses – multiple things we do regularly to maintain balance. In the answers below you will see comments on becoming financially free or bringing in a physician union. Those might very well be part of a burnout prevention strategy and they won’t be sufficient all by themselves. Think strategy and let go of the magical thinking of the easy solution. Get started on building your strategy today. Stop hating EMR and dedicate yourself to becoming a power user instead is a good place to start.

    My two cents,

    Dike
    Dike Drummond MD
    over 117 ways to prevent physician burnout in the MATRIX Report here
    http://www.tinyurl.com/bpmatrix

    • Chiked

      You sound like you have an MBA. Anyway, bottom-line, physicians are burnt out….and it will only get worse for the foreseeable future. Strategies work when you have time. Physicians are out of time and need a solution like yesterday.

    • southerndoc1

      “Stop hating EMR and dedicate yourself to becoming a power user instead is a good place to start”

      And not using an EMR is an even better place, but we’re not allowed to talk about that . . .

      • James O’Brien, M.D.

        Power user of EHR?

        Is that like being a power viewer of Dora the Explorer? Or a power reader of Jackie Collins novels? (which are at least titillating) Or a power driver of a Trabant?

        No, when something is mindless, stupid, not functional and horrible to read, it needs to be eliminated.

        It is not the fault of the user when they are forced by government to use a terrible product. That is the Soviet mindset. You should learn to love your 2 cycle engine car and there’s something wrong with you if you complain.

        Bull.

        Physicians are going to continue to suffer if these EHR hacks and lobbyists have their way and we keep going along.

        I adopt by refusing to take insurance that requires it.

        • SteveCaley

          Or, as Dr. Win Smith put it –
          “But it was all right, everything was all right, the struggle was finished. He had won the victory over himself. He loved Big Brother.”

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

      “apolitical”???

      • ninguem

        I dunno Margalit, you’d have to ask the author…….

        How’s St. Louis these days…..apart from the now-infamous suburb?

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

          It’s fine now… Was a bit scary there for a while… We’re not used to so much media attention in flyover country :-)
          There is (finally) an emerging sense that education is a huge problem here (school district there lost accreditation this year), and lots of good people are stepping up to the plate. Hopefully something good grows from this horrible event….

          • Patient Kit

            We are going through something similar in NYC this summer since an NYPD officer killed Eric Garner, an unarmed man who was only selling loose cigarettes. (A legal pack of cigarettes costs $14 here so there is a big underground economy selling them cheaper.) There was a large, totally peaceful protest this past weekend. Not anti-police in general. Just seeking justice for the victim who was unjustifiably killed by one specific police officer when he put him in a chokehold and refused to let go until the man was dead, even though the man was begging for mercy and repeatedly pleading that he couldn’t breathe. My mom lives near Orlando and Sanford, FL, where 17-year old Trayvon Martin died two years ago. It happens way too much in this country.

      • Thomas D Guastavino

        Read the article. From the standpoint of a physician who had to take ER call I can tell you that the scenario as described is very real, not political. No where is the entitlement mindset more obvious then the emergency room.
        I to have recently retired. There are many things I will miss, and many things I will not. At the top of the list of things I will not is having to cover the ER.

    • JW

      It’s kind of unfair to assume that everyone who is released from ER didn’t have a legitimate need to be there. I have been in ER for urgently-needed IV fluid replacement, for which I tried to go to Urgent Care but it wasn’t available there, and they sent me to ER, saying that was the only place I could get IV fluids. It’s possible I might have recovered faster and needed to come to ER fewer times if they had admitted me to the hospital, but this wasn’t discussed for some reason I still don’t understand.

      I’ve been sent to ER from Urgent Care for other reasons, too, because they simply don’t have the same resources to check things out quickly, in case it turned out to be something that did require an operation or whatever.

      I personally don’t complain and do keep in mind that there are almost certainly people there in more immediate need than me.

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

    Is it just me, or is this burnout epidemic correlating very nicely with the CorpMed employment epidemic?

    • Chloesbrother

      It is NOT just you. We have defaulted every decision to the Lilliputians of corporate medicine.

    • SteveCaley

      Burnout just means the realization that, after years and years of training, there is no cheese.

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

        Which leads me to question if “burnout” is even the correct term to describe this phenomenon? I mean we wouldn’t describe the mental/physical status of child laborers in sweatshops as “burnout” would we?

        • southerndoc1

          Exactly.

          The same analogy has come to mind when I try to understand why I find the work of Dr. Sinsky and others so objectionable – How to Bring Back the Joy in Child Labor. These people are working really, really hard to avoid dealing with the underlying problems that are destroying physicians today.

        • Patient Kit

          I’m not comfortable with comparing American doctors with severely exploited and abused child laborers, many of whom have never known anything else, some of whom have not been emotionally burnt out but have been burned to death when they were literally locked into the factories they slave in making cheap products for insatiable American consumers.

          No matter how exploited many of us feel by our employers, in and out of medicine, we don’t all work in dangerous sweatshops. We do have choices and options. And many of us have both known and imagined better times. That said, the workplace conditions of most American workers, including doctors, have severely deteriorated in recent years as employers gained more and more of the power in the employer-employee relationship. It got as bad as it is today because nobody cared until it effected them.

          If we define burnout as physical and/or mental collapse caused by overwork and stress, I think docs are burning out. But they’re also extremely disillusioned and suffering from deep deep senses of betrayal because they had such different expectations of what practicing medicine would be like.

          The difference between us and enslaved child laborers is that we know things can be better, we can envision things being better. We just have to start doing something together to make them better. A child laborer can’t do that for his or her self. No matter how bad it feels at the moment, we are not as powerless as child laborers.

          • SteveCaley

            But there is no quantifiability of desecration of the human spirit, denigration and contempt for humanity. Enumeration and comparison of cruelties are not statistically meaningful concepts. The diagnostic habit of rating evils is a fatuous exercise. How does, say, Robin Williams’ suicide compare to the suicide of a Central Valley fieldworker? What results from our scrutiny of one suffering versus another?
            There is only one moral metric to use when wickedness is afoot, and that is distance. Find the nearest evil that you can do something about, and hit it. Relieving human suffering is what this job’s about, really.

          • Patient Kit

            In general, I agree with you that there is little purpose in competitive pain. For example, I see no purpose in debating whether victims of the Holocaust of WWII or American slavery had it worse or whether it’s worse to have a stroke or cancer. I tend to hope that any specific individual pain we suffer will give us a window into better understanding or at least recognizing others’ different kinds of pain, of which there are far too many versions in this world and also far too much pain inflicted on each other. I continue to be shockable about what humans are capable of doing to each other.

            That said, I think there are some things that really shouldn’t be compared even if they are not being equated. And really, there is no connection between children who are forced into slave labor and what American doctors are currently experiencing in their careers.

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

            It was not meant as a comparison or to imply some sort of equivalency between these two situations.
            It was meant to point out that “burnout” may not be a proper description for adverse reactions to purposefully exploitative work environments.

    • ninguem

      Not just you, I think you’re absolutely right.

    • SarahJ89

      Sure looks like it to this old lady.

  • PoliticallyIncorrectMD

    Here is an idea… Burnout has nothing to do with outside factors. It is commonly the result of internal dissatisfaction with one’s job or mismatch between expectations and reality. Example? Physicians all over the world work longer hours, for much less compensation, with significantly more restricted resources. Are they frequently burned out? I doubt it, and I’ve known many from variety of different countries. Perhaps the way to stay happy practicing medicine is entering the field for right reasons and remembering why you do what you do.

    • lurking for answers

      I was wondering if there were specific generations, and if they were more prone to “burnout.”
      I totally agree about the unattainable expectations not matching the reality: work, marriage, adulthood, etc. Thanks to wherever the expectation comes from, we now do expect our doctors to be “super-human.” They come swooping in the save the day, no emergency is untreatable, no disease unbeatable, and the vast sum of human knowledge can be found inside their tireless brains. Not only are they superior in knowledge, but compassion as well; always treating all comers with righteous indignation of the horrible social situation that created the medical nightmare they live inside.

      What few acknowledge is that doctors are human, very flawed, with needs and independent thoughts and ideas. They get tired, work too hard, care too much and sometimes don’t care at all. They wanted a career and maybe prestige and ended up feeling enslaved by what they thought they loved most. This was not what they expected. Superiority in all things both academic and moral is what society expects of them. This is real, and painful, and HARD!

    • MarcGarfield_DPM

      Most of went in to health care for all the right reasons. Now the rules have changed. Doctors have invested 300K into their education and 500k-1mil indebtedness into a business that up until the last few years yielded a secure income going back for several generations and a career the provided the highest sense of accomplishment and personal fulfillment .
      Now doctors already invested in decades of education and large sums of money are facing mandatory compliance with corporate and government protocols that compromise the very standards of care they hoped to provide.
      So from now on remember that going into medicine cannot be as an independent agent to steer your patients away from disease and injury using years of experience and education. Now you go in to check off the most boxes in your EMR so that you can prove yourself to be a power user of health technology. I think I am feeling trapped!!

    • DrTWillett

      The dissatisfaction is related to external pressures, though. Liability and workload (# patients per time period and complexity) are controlled externally, and they are intolerable in our ‘free market’ economy.

      • PoliticallyIncorrectMD

        Agree… But one’s priorities determine the degree of control i.e. you don’t have to see more patients if your compensation is not your priority.

        • Thomas D Guastavino

          Perhaps we should make having a trust fund a requirement for accepatance into medical school.

          • PoliticallyIncorrectMD

            There is nothing wrong with making a living being a physician. However, if you make it your priority, you’ll fail miserably (of course, blaming lawyers, politicians, bureaucrats and everybody else all along). Even Dike Drummond MD © will not be able to help you.

          • Thomas D Guastavino

            Funny, Most people consider making a living was a necessity. Only a lucky few have the luxury of being able to prioritize it.

          • PoliticallyIncorrectMD

            Yep… Funny… For most people making a living is budgeting so the can survive from the paycheck to the paycheck. For some it is being top 10% earners in the country.

          • Thomas D Guastavino

            If by “most people” you would include “most physicians” I would agree.

          • PoliticallyIncorrectMD

            Don’t know where you practice, but most of physicians where I am at don’t quite live from paycheck to paycheck. And this is not just my opinion. Look at published data.

          • Thomas D Guastavino

            There is actually published data identifying how many physicians are living paycheck to paycheck? Please let me know where I can find it.

          • PoliticallyIncorrectMD

            No… But there is published data on physician incomes. Given that most of the people (physicians or not) have similar basic needs, we can extrapolate how easy it is for someone to get by. Anticipating your questions, I do think physicians deserve to be compensated well. However, I think claiming that physicians straggle financially from paycheck to paycheck is a stretch. I think you’ll have hard time making your case in from of millions of families surviving on 30K a year.

          • Thomas D Guastavino

            I believe there is data on how many physicians have gone bankrupt, how many have committed suicide, how long it takes to pay off their student loans, the amount of delayed gratification, the list goes on. Physicians may have higher incomes then the average person but that does not mean they have it easy. Frankly, those of us who have had to make those sacrifices to get where we are getting a little fed up with the idea that if we expect to be fairly compensated for the the work we do we cannot be good doctors. Worse, we have to put up with condescension from those physicians who never had to worry about finances. As I said before, maybe should we make it requirement for admission to medical school to have a trust fund. That should effectively screen out those who you consider to be the unworthy to be physicians.

          • fatherhash

            I suppose “fairly compensated” is in the eye of the beholder. I think PIMD is merely saying that he wouldn’t make a big sob story out of how bad doctors have it financially.

            Yeah, I lost my 20′s in training, therefore started income production later, and incurred a huge loan debt…But my medical income is way way more than adequate to get ahead of those financial hits. And no trust fund, BTW.

          • Thomas D Guastavino

            And if your “way way more then adequate” income were to drop due to reimbursement cuts, or expenses rise, such s a big jump in MP insurance, to the point where you could not get ahead of those “financial hits”?

          • fatherhash

            My way way more than adequate income is still way way more than adequate income after the reimbursement cuts to cover my expenses….just not feeding my stock portfolio the rich diet it used to get.

            I suppose it’s perspective as PIMD was saying. I’ll have to wait a little longer before upgrading my 2008 BMW, boo hoo.

          • Thomas D Guastavino

            I congratulate you on your success. However, the point of this article was to point out that many physicians have not been as lucky as you and are in fact, “burning out” just attempting to stay afloat. Physician do go bankrupt. If reimbursement and expense trends continue as they have been this problem will effect more and more physicians. Maybe when it reaches you, you will take notice.

          • fatherhash

            Yeah, I’ll keep a good eye out for these anecdotal examples of frugal doctors making $200k and going bankrupt.

          • Thomas D Guastavino

            Google physician bankruptcy. It would be a good place to start looking.

          • PoliticallyIncorrectMD

            I have to admit – this is quite a show you put on. “Orthopedic Surgeon is Straggling to Survive!” Very impressive! Though I am not quite sure what audience it was intended for. Are you appealing to me, a fellow physician, first generation immigrant, NOT independently wealthy, with about $250K of initial student loan debt, the only bread winner for the family of 6 (kids ranging from toddlers to freshman in college), NOT practicing one of those highly paid subspecialties – and still making very comfortable living and being happy every day I go to work? Or are you making your case in front of an average middle class American making a small fraction of your income? In either case, I don’t think you’ll get a lot of sympathy. Your argument does not even path a common sense test. Lets assume you owe 350K in student loans (which is much above average). Even as a fresh out of training generalist you can easily find a job paying about 200K a year. Many jobs will pay your tudent loans off. But even if they do not, by your own admission, one can live of 50K a year (most of people do with much less). That lives you with 120K after 40% taxes (highest bracket) – 50K = 70K a year to pay off your student debt. So in 5 years you are debt free! But no, you are too good to take that job in underserved area that would pay your student loans off! And no, you are too
            free spirited to work for a healthcare system, so you choose to open an independent practice and invest another 500K (at least) in it. Of course, driving used economy car is much above your status and you just have to buy that 750K house you deserve and you’ve always dreamed about. Calling it “making a living”? Surprised you are straggling having ends meet? Perhaps you failed the victim to your own choices!

          • Suzi Q 38

            You forgot to add that the specialists make more than the generalists, so they should have less to complain about.

            Combine this with the fact that there are a good number of physicians married to other physicians. They may have double the $350K salary, double the loans, but they live in the same house…shared living expenses.

            I think it is tragic that so many doctors are depressed, but what is causing their depression?
            if it is work, wouldn’t they try to change their working situation?

            If they do not have the freedom to do this because of the bills that they have, they should work harder to pay off all of the bills. They certainly have the income to do so.

            If it is financial, maybe look at the big things first.
            The big, expensive car, or house. Get rid of the expensive things. Downsize.

            My last point is that there are other professions which incur such debt, yet the job market is slow and the income for a job in their field is far less.

            In a perfect world, we would give everyone a raise. That would be nice for all. I just don’t see it happening in the near future.

          • Thomas D Guastavino

            First, I never said I was struggling. I was responding to this article about physician burnout. Obviously you do not recognize or you are indifferent to the fact that some of your colleagues are struggling. I don’t understand your callous indifference.
            Second. You have a list of assumptions about me to prove your point, none of which are true. I refuse to even go there,
            Finally, I need to ask if it is you who is putting on a show. Do you really believe what you are saying, or are you just trying to see what kind of reaction you can get?

          • PoliticallyIncorrectMD

            I do recognize that some of my colleagues are “struggling”. My point is (in this and earlier posts) that the “struggle” is related to the mismatch of the expectations and the reality. Since the reality is very hard thing to control (somehow this thought makes many physicians very uncomfortable), the expectation need to change. I understand that present trends will effect many physicians. And I am not indifferent, that is exactly why we are having this conversation.
            The assumptions I made were not of you, but rather of a generic physician. I apologize if you took them personally. They were only intended to illustrate the point. You have to admit that in general they are quite accurate.
            Lastly, I am not putting on a show. I do what I preach and quite happy doing it, though I have to admit that occasionally I get irritated by some physicians whose priorities are misplaced (generically speaking – not a personal comment).

          • Thomas D Guastavino

            First, “Orthopaedic surgeon struggling to survrive, very impressive” Certainly sounds like a personal jab.
            Second. “Struggle”

          • Thomas D Guastavino

            First, “Orthopaedic surgeon struggles to survive, very impressive”. Certainly sounds like personal attack. However, I will accept your claim that your comments are meant to be generic.
            Second, A “struggle” can also ensue when reality is accepted for what it is and you implement a plan to face it. That is exactly the point I was trying to make when I wrote my first response to this post that started “Lets be frank”. The best way to avoid burnout is for a physician (or anyone for the matter) to find a way to separate their financial from their professional future, and yes , this does involve giving up the fancy house, cars, and country club membership. Once you achieve this you have the luxury of avoiding those aspects of medical practice that cause you the most stress, most likely to lead to burnout, such as covering the ER or taking on high risk patients. Unfortunately for some this is interpreted as abandoning patients when in fact it has become necessary for survival.

          • PoliticallyIncorrectMD

            So not “covering the ER or taking on high risk patient” is now “has become necessary to avoid burnout”. Interesting take! So I gues police oficers should not be chasing criminals to avoid being shot at and firefighters should avoid entering burning buildings to avoid being ingured. How about politicians passing ill intentioned laws to avoid loosing their compain contributions? Let all of us abandon our responsibilities in the name of “avoiding burnout”! Great treatmnet plan for our social ills Dr. Guastavino!

          • Thomas D Guastavino

            I am sure that if the police noticed an increase in gun violence, or firemen noticed an increase in the number of fires they would not just sit by and do nothing. You would be hard pressed to find a physician who is not stressed by the worsening conditions in the ER, a problem being made worse by physicians like you who feel we should do nothing.

          • PoliticallyIncorrectMD

            Where did I say we should do nothing? I said we shouldn’t refuse ER call or taking on high risk patients in the name of avoiding burnout! Look at your own statements: every time you claim you are doing something for common good (colleagues, patients) you in fact just arguing for your own benefits / interests? Don’t you see it? I think everybody else do! Leave alone ethical aspects of it! Even from the practical perspective, how do you expect to unite people behing your cause when the only thing you are interested in is your own benefit ?

          • Thomas D Guastavino

            Sorry, did I miss something? The only solution you have seemed to offer is for physicians to ignore the mounting problems, ignore the reimbursement cuts, and to adjust their lifestyle and lower their expectations. I have also said that I personally was not struggling and not at risk for burnout so how can my my motivation be my own benefit?

          • PoliticallyIncorrectMD

            I think you missed a lot ! Let me try again : ) We need to stop worrying about ourselfs so much and start taking those ER calls and high risk patients and then maybe we will get enough public support to change things.

          • Thomas D Guastavino

            So….once again, your solution is to ignore the mounting problems, ignore the reimbursement cuts, , adjust our lifestyles, lower our expectations and you expect the public will then rally to our cause?

          • PoliticallyIncorrectMD

            Realizing that you are not the center of the Universe would be a good start ; )

          • Thomas D Guastavino

            Again with the assumptions and personal attacks???

          • PoliticallyIncorrectMD

            What assumptions? What personal stacks? Your every post is about how YOUR reimbursement is cut and how YOU are not treated fairly and how YOU burned out (and that YOU is collective)! What about the PATIENTS? Or are they irrelevant when YOU have so much at stake?

          • Thomas D Guastavino

            OK, I will try this one more time. How many times have I said that I was not, struggling, I was not burning out. This article was about the worsening problem of physician burnout and one possible explanation as to why and what to do about it. The sad reality is that we tried it your way and the powers that be interpreted that as passive acceptance of the status quo. Thats precisely why the situation continues to deteriorate. You are right about one thing. In the end it will be that patients who will suffer the most.

          • Thomas D Guastavino

            Again with the assumptions and the personal attacks??

          • fatherhash

            Doesn’t seem like you owe an apology for that….you didn’t misread anything. Guastavino clearly said “those of us who have had to make those sacrifices to get where we are getting a little fed up with the idea that if we expect to be fairly compensated for the the work we do we cannot be good doctors. Worse, we have to put up with condescension from those physicians who never had to worry about finances.” He obviously was trying to make a sob story about how bad physicians like him have it financially…and then to have to put up with condescension from others(who he assumes are all physicians that have trust funds).

            He only backtracked to then exclude himself out of those struggling because you made the obvious observation that it’s somewhat laughable for an orthopedic surgeon to complain about their finances.

          • PoliticallyIncorrectMD

            I appreciate your support : ) Nice to know that some of my colleagues share my views. As to my apologies – my goal here is not to win an intellectual duel. I am trying to make a point that we as a group will not regain public’s support / trust unless our priorities change. And without public’s support we will continue to be abused by administrators, insurance companies, politicians, etc. Having said that, I would not particularly mind if some of us will get fed up and go for bigger better things, freeing the space for people with different mentality : )

          • Patient Kit

            A better idea is to subsidize medical education in this country and take education debtload out of the equation of what doctors feel they need to be fairly compensated for the rest of their lives. Rather than recruit trust fund kids to medicine, we need to open up the option of a career as a doctor to all who qualify in the important ways — intellectual capability and true desire to treat and help patients. Taking the med school debt issue off the table would be a very good use of tax dollars in the long run.

          • Patient Kit

            I agree. There is a huge difference between literally struggling to survive and struggling to maintain the lifestyle that you and your family have become accustomed to (and wanting more).

          • Thomas D Guastavino

            The problem is, and always will be, who decides where the dividing line should be.

          • fatherhash

            seriously?….you think most physicians live paycheck to paycheck?

          • Thomas D Guastavino

            Please see my previous reply to PoliticallyIncorrectMD.

          • PoliticallyIncorrectMD

            I would give several votes up to this comment, but I am only allowed one : (

        • DrTWillett

          not entirely up to us to decide- I tried to cut back on hours but was not allowed to. Try to limit patient volume, but schedule gets overridden. Totally not in control of my own schedule!

          • PoliticallyIncorrectMD

            Are you in control of changing your work setting / employment ?

          • DrTWillett

            Yes- I have quit twice, but options are limited, and my colleagues with more debt/responsibilities to others were unable to do so. I consider myself lucky to be able to leave those settings, but where else to go?

    • James O’Brien, M.D.

      But American physicians have higher expectations of what they will do and earn than anywhere else.

      As you know, reality – expectations = happiness.

      Many of the medical students who write article here are in for a world of pain…

      Those who have suggested FMGs from poor countries who practice in the US will be the most able to weather the changes are probably right.

      • PoliticallyIncorrectMD

        Completely agree!

      • Suzi Q 38

        “…….Those who have suggested FMGs from poor countries who practice in the US will be the most able to weather the changes are probably right.”

        You are right about that because the pay is very low in other countries.

    • Thomas D Guastavino

      Interesting take. Would you blame the woman who married the man who became abusive because she got married for the wrong reason? Would you blame the combat soldier for the PTSD because they entered the military for the wrong reason?

  • Joe

    I didn’t read all the responses, but one factor that makes it worse is the burned-out physician’s paranoia and fear over people knowing they are burned/burning out. Everyone wants to look good in front of their colleagues. Nobody wants to be seen as “weak.” This makes the confrontations in the above post worse when they finally blow up. It comes down worse for my female colleagues. They push extra hard to get past any potential discrimination and so stretch themselves even farther past the breaking point because they are worried that showing they are tired will undo all of that initial struggle.

  • James O’Brien, M.D.

    http://www.huffingtonpost.com/2014/08/19/internet-outage-doctors-records_n_5689260.html

    “Power use” that.

    You are offering Stepford Wives advice to doctors.

    Complaining about EHR is not playing the victim. Playing the victim is claiming superior moral or social status because one has been abused. No one is looking for that. We just want a product that works. And a health record with a narrative.

    However, demanding that someone “power use” a defective product is enabling abuse. This is not helping, it is piling on.

    It’s basically, chill out comrade, take this for a spin on the Autobahn and let the wind blow in your hair…

    http://content.time.com/time/specials/2007/article/0,28804,1658545_1658533_1658030,00.html

    In related news, we should learn to love TSA pat downs and body scans.

  • southerndoc1

    I’ve made sure I don’t have to use an EMR, so I’m happy about that.

    My concern is with the OP and others like her, who see the problem and see the cause, but don’t seem willing to do more than put band-aids on gaping wounds. Are we really comfortable with accepting 50 – 75% burnout rates as mere collateral damage in the war to “reform” medical care?

  • James O’Brien, M.D.

    http://townhall.com/columnists/michellemalkin/2013/10/23/dont-forget-obamacares-electronic-medical-records-wreck-n1730172/page/full

    Note the comments of Dr. Zwerling, who apparently tried to create a functional EHR but wasn’t well connected enough with the Mulligan Messiah.

  • James O’Brien, M.D.

    All cars have faults.

    A Tesla or an Audi A6 is still better than a Corvair. Your point is frivolous. The answer is NOT to continue driving a car that is unsafe at any speed.

    It doesn’t mean we should be happy with a piece of garbage that is EHR. There are better EHRs out there but if a hospital bought a terrible one, it’s not like the physician can shop around.

    You didn’t read my posts. I don’t use EHR. I won’t be following your advice.

    You are piling on and giving very bad advice. Which is basically suck it up and put on a happy face. Try that with a patient who tells you they were abused by a spouse. They will never come back. It’s also condescending and callous.

    BTW, what is your background in dealing with mental health issues?

  • PoliticallyIncorrectMD

    Interesting thoughts … coming from somebody whose business is “saving” physicians from a burnout. Ironically, your own existence proves my point – if physician can be “motivated” or “coached” to have less burnout, then it is not about external factors, but about attitude. The thing that makes me lough is that adult, mature, educated people need someone like you to help them to deal with reality.

    • southerndoc1

      “The thing that makes me lough is that adult, mature, educated people need someone like you to help them to deal with reality.”

      You come across as quite self-righteous and condescending.

      • PoliticallyIncorrectMD

        And?

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

      I never used the word “saving”. I help people recover from burnout and that always requires a dual focus. You must simultaneously change who you are being AND what you are doing. This is not about “motivation”, it is about making meaningful changes in your skills and actions to move towards a more ideal practice. Otherwise you will stay trapped in Einstein’s definition of insanity.

      Your chortling at having a coach is just one facet of the “never show weakness” programming of our medical education. If you were to complete that dark little thought … it would end in a harsh judgment of anyone who asks for help or support as somehow being a sign they are a failure. It is this attitude that leads to the isolation and occasional suicide of some physicians. A sad truth. You demonstrate it beautifully.

      At some point we all need coaching and support. That is you learn anything …. and how we became physicians in the first place .. yes? At some point you will need it to.

      Keep breathing,

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

      • PoliticallyIncorrectMD

        Let me complete that “dark little thought”… I never implied that asking for help is a sign of weakness, neither I pass a judgement on those who do… To the contrary, I suggested that people are intrinsically strong, smart and mature to successfully deal with whatever obstacles life throws at them (frequently with help of friends and loved ones). What I object to is self-proclaimed “experts” creating a self-serving paranoia and trying to convince everybody that they (the experts) are the only ones having the magic pill to salvation, while degrading people’s own ability to be happy and successful. May I need some help in the future – absolutely! …as I had many times in the past. However http://www.thehappymd.com (so conveniently advertised with your every post) would be the last place I’ll be looking for it.

  • PoliticallyIncorrectMD

    I am not “kicking folks while “they’re down”. I am suggesting that much of what physicians consider “down” around here is in fact “up” for the majority who does the same work worldwide. Guilt inducing ? Absolutely! Based on logical fallacies? Not quite! Recently, on this very forum I was told by one of the frequent physician visitors that most of the people go into medicine because “it is interesting” and because “you are payed well”. Perhaps if people would enter the field to take care of others, there will be less disappointment and less burnout! The same person told me that such motivation is only good for personal statements to get into medical school.

    • southerndoc1

      “Perhaps if people would enter the field to take care of others”

      Many of those who most want to take care of others are also those who are most crushed and destroyed by the bureaucratic busywork forced on physicians today. Are we to tell them that their reasons for entering medicine just weren’t “right” (pure) enough?

      • PoliticallyIncorrectMD

        I am not here to judge others whether they are are right or wrong. I am merely offering an explanation of why there might be such crisis with physicians burnout in the US. I made my choices in life and I feel happy and not burned out. I’ll be happy if those who take my approach feel the same. If you know better and you have the answer – good for you, no argument on my side.

      • SarahJ89

        Exactly. Most doctors I know (okay, the ones I’m willing to see more than once, maybe) really do seem motivated to be helpful. Granted I pretty much stick to PCPs, not the highest paying end of the ballpark.

        There are few things more gut wrenching than being systematically prevented from doing what you were hired to do. And I see that happening in the medical profession.

      • PoliticallyIncorrectMD

        Seriously… I honestly don’t get it… There are physicians who venture to go to Africa, treat Ebola infected patients ( for free might I add), get infected, survive … and sill happy doing what they do. There are physicians who work in clean air conditioned offices, get payed reasonably well (more than many they treat), sleep in their own bed at night and unfortunatelly have to deal with idiot administrators and spend some extra time doing useless paperwork – and they feel “crushed and destroyed”. Really?

  • SteveCaley

    Exactly. Sometimes Manhattan (sorry, K.) is one of the most provinicial places, because the world is divided into Jersey and Beyond Jersey; and everything Beyond Jersey is Pocatello, Idaho in some version or another.
    The New Yorker is read in Santa Fé, but the Santa Fé Reporter, probably not so in Manhattan.
    Our species is a tribal one, and we congratulate ourselves on our fortune at being at the center of the universe, whether in our own burg or metropolis. How fortunate we are! I’m sure that the cows are not resentful of the fences, for they only remind the herd of where they do not wish to go.
    Disfrute las montañas de Dios.

    • Patient Kit

      I’m not saying that NYC is perfect or immune from convention. Even some artists where a uniform. But I visit suburbia often enough to feel the difference. All communities have their rules. But rules are made to be broken and there is plenty of room here for intense individuality, if that’s what you want. If you live in a straightjacket here, you’ve chosen to do so. It’s not a given.

      You know I like you, Dr Caley, but your persistence in identifying NYC as Manhattan is making me want to scream. Rich, white Manhattan, including Park Ave and NYU is not NYC. Unfortunately, that part of NYC is the only slice that many less adventurous visitors see. There are 4 other boroughs and 8+ million people living here. NYC is not a Woody Allen movie. Everybody knows that my beloved Brooklyn is the center of the universe, not Manhattan. ;-)

      • SarahJ89

        Ah suburbia. You’re comparing the ultimate conformist experience with the anonymity of urban living. Small town living requires a certain skill set in order to get along over time. I’ve often noticed suburbanites moving in lack those skills and spend a lot of energy trying to change what they don’t understand instead of developing them. I’m sure I’d be equally at sea in suburbia. Living out of town requires other skills, many of them practical, but it brings a lot of freedom because everyone is too busy with their own life to bother with yours.

        • Patient Kit

          I should definitely be more careful not to lump rural and small town life in with what, in my experience, can be a prison of mindless conformity — suburbia. But city living doesn’t have to be as anonymous as non-urban people think it is, although it can be if that is what you want. For example, just last week, while I was galavanting around this town of 8+ million peeps, I ran into someone who swims at my YMCA at a free and very crowded Cassandra Wilson jazz concert at Lincoln Center. Then the very next day, I ran into another person I see regularly at the Y on the other end of Brookllyn while we were both swimming in the ocean off of Brighton Beach. After my surgery, the greengrocer down the block sent one of my neighbors home with an armload of fresh flowers to give to me with his get well wishes. I could go on and on. We do have neighborhoods and community in this big city. If that’s what we want. I think suburbia is the place I couldn’t survive. One of my all-time favorite TV shows took place in rural/tiny town Alaska — Northern Exposure. I think both the city and rural ends of the spectrum probably both have much more room for individuality than suburbia does.

          • SarahJ89

            My observation of big cities is that, indeed, they do have neighborhoods and people do get to know one another over time. What is a big city but a very large collection of villages, really? I think I could live in a large city much more easily than I ever could in suburbia. I always feel like a space alien in the manicured enclaves of suburbia.

            I loved Northern Exposure. Big crush on John Corbin’s character.

      • buzzkillerjsmith

        Right now I’m looking out my window at almost nothing. No nearby trees (on the prairie), no roads (I’m looking the other direction) , no people, not even a coyote or a deer. I can see the first western foothills of the Bitterroots over across the Idaho border. And there are some trees over there.

        I pity those who do not live in eastern Washington.

        • Patient Kit

          Pity is a strong word. To each our own. If everyone loved your neck of the woods as much as you do — it would get way too crowded for you. ;-) Personally, I have Mermaid blood. I don’t think I could live anywhere not near an ocean. Brooklyn is essentially the west end of Long Island. Montauk is the east end of Long Island. I love them both. Just got home from swimming in that ocean.

          • buzzkillerjsmith

            It was a joke.

          • Patient Kit

            I know. And I was kinda joking back with you, hence my little winky emoticon. But, at the same time, I also thought you actually like East Washington/Idaho. There is this tiny puebla in Mexico where I love to go. I wish people would stop telling others about it. The buzz (!) got about about Brooklyn and there was no stopping the steady stream of newcomers. ;-)

    • joe_bob_gonzales

      I will borrow your phrase about cows and fences, if you dont mind. very nice line.

      and yes, one of the joys here is sitting on the porch, book in hand, watching the clouds build over the mountains.

      although I do miss the ocean.

      ah well.

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

    Actually Dr. D, according to the annual primary care surveys done by the Commonwealth Fund, the most “dissatisfied” physicians can be found in Germany, which is worse than the US in this respect. No idea why.

    The UK docs are amongst the most content. Perhaps because GPs in the UK are mostly private contractors for the NHS and are not employees. They work in small practices (18% of GP practices are Solo) with an average panel of about 1,500 patients, and are being paid rather well, through a mixture of capitation, bonuses and fees.

    Also, I seriously doubt that we are drifting towards single payor with any measurable speed…

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

      Hey Margalit – yeah, we can split hairs all day. The key point is from 25 – 75% of all doctors are burned out today all across the world. And it is so avoidable. Burnout is common and at the same time it is not normal … it is preventable and treatable.

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

  • buzzkillerjsmith

    Dr. Guastavino makes the critical point here. Burnout results from not being in control of your own life, not being able to self-protect from occupational ravages. And money concerns are a big reason docs put up with occupational ravages.

    Of course docs just out of residency are in big debt and oftentimes don’t have a lot of choice. Maybe they just weren’t thinking ahead. Going to a private medical school is something that a young person should think twice about. It might not make financial sense for future primary care docs. In any case many young docs (not all) feel as if they have to work for the CorpMed slavedrivers because they need the money. This too is especially bad in primary care.

    It is crucial to pay off your debts as soon a possible. Don’t buy a new house or a new car or a new family. Pay off the debts. Then live well within your means and go part-time if you want to.

    This is pretty simple stuff but hard to put into practice. A lot of docs earn 300k per year and spend 90% of that or more.

    Old-fashioned greed is another factor here.

    The open-and-frank dialogue stuff that Dr. M-B writes of won’t work because suchlike dialogue will not lead to changes that will increase CorpMed’s profits.

    • SteveCaley

      The open and frank dialogue has been out there for fifty years. Doctors get 49% of the vote, it seems.

      • buzzkillerjsmith

        Exactly.

  • SteveCaley

    Thank you, brother. This a system out there operating healthcare is blind – it tramples on what it needs the most. I believe that of the very fundamentals of civilization, caring for the sick and injured is certainly one of the core abilities and measures of that civilization, along with feeding the hungry and caring for the suffering.
    We are a fault-finding society, and relish blaming the victim as much as the perpetrator – accuracy is not all that pertinent when it comes to human vindictiveness.
    Somehow, we have come from the respect and admiration of the healer who heals, and are petty, resentful critters who wish to kick the healer when the magic does not flow right all the time.
    Perhaps read “Dr. Theodore Dalrymple,” our colleague from England, on the decline of medicine there as a marker of decline of civilization. “Life at the Bottom” is a fine but painful book.
    Take care of that soul – you’re still needed, although our society is a blind helpless thing that does not know what it needs. AR-15 and HMV’s for the local police, sure; that’s “homeland security.”
    But no great empire fell from without; they ended long after their fall from within. We seem to be trying that again.

  • buzzkillerjsmith

    I for one would be interested in more info about burnout among UK docs. Got any?

  • Suzi Q 38

    I agree that the Dr. Caley is eloquent.

    “….We forget that evidence is only evidence, not the absolute truth….” True. I would like some truth.

    If a physician says that all physicians are “different” and have at least one functional schizophrenic as a parent, would you accept that as true or remotely believable?

    • BC

      “making statements that are not proven or remotely accepted with anecdotal stories or articles, really have little purpose, except for interesting conversation”

      I think that *was* the main purpose – to make his post more interesting. We just happened to get sidetracked into a tangential debate. If he was citing this “personal observation” as a way to support a certain public policy or how we treat patients, then I agree we should ask for some actual evidence. Sometimes asking for “proof” or “data” becomes a quick and easy way to rebut any statement that one does not agree with or find irritating/offensive. Again, a lot of it depends on the context of the conversation.

      • Suzi Q 38

        IMHO,
        stating that one of us parents of children who have an interest in computers are functionally schizophrenic is a strong statement.

        If he was slightly “ruffled” or offended when I called his statement “odd,” then he needs to reverse the situation an have some empathy for another person he just inadvertently called possibly a parent with functional schizophenia, LOL.

        For years people used to say this and that.

        If I saw a gay young man, is his sexual identity so because his father was absent and he was raised by his mother??? I think not.
        Sadly, there are people who think that this is so.

        This is a website that may have those of us who want a few answers, rather than “blanket” acceptance of truth merely because a good physician like Dr. Caley believes this to be true.

  • SarahJ89

    Can I like this 1,1000 times? Please???

  • buzzkillerjsmith

    Not giving a rat’s behind, a characteristic I also share, is a critical for life success. Not trying to control what you can’t control, but you know that.

    You’re right that it can’t be taught. You either have it or you don’t.

  • Suzi Q 38

    “….I love the hell out of being a doctor; I hope that flame will not burn out. But it certainly may; I am not powerful enough to stop it.”

    If you love being a doctor, the “flame” would not extinguish if you keep working at keeping it alive.
    “One door closes and another one opens.” Find the strength from within.

  • jpsoule@hotmail.com

    Steve, you are wrong.
    Of course we all use defense mechanisms to survive the slings and arrows of life and medicine.
    Why not? As long as one knows their mortality, who are you to say Tom is just ‘lucky’, and not very talented and mindful?
    John

  • Patient Kit

    If “security” is the issue, it’s been a long time since I believed that “security” and “safety” were anything but an illusion for any of us. People seem willing to give up a lot to hang on to those illusions though. I was here in NYC on 9/11 and I’m amazed at how much freedom people were willing to give up in order to feel safe. Logic tells me that nobody can really guarantee our safety and believe me, logic does not always speak to me. I think it’s similar in the work world for most people. For a number of reasons, there is no such thing as job security anymore. Like safety, security is an illusion. And if they really are not real, we should be careful about what we give up for those illusions. It’s not just healthcare and medicine that has changed. Our whole world has changed. And if we don’t like it, we can change it again. But not overnight, not instantly, not in time for some of us. The question then becomes: Do we care about fighting for a better world for our children, if we might not be able to change things in time for ourselves?

  • JW

    Is there nothing doctors can do to cooperate, to get enough power together, to take on insurance companies and the other powers that be?

    I would sign a petition, to make it illegal for anyone without a medical license (and who is not the patient or guardian where applicable) to make decisions that have the effect of practicing medicine, and for better working conditions for doctors, nurses, etc., or whatever it takes.

    I get the idea that medicine is micro-managed by accountants, and doctors work too long of hours and nurses don’t get meal breaks.

    As a patient, that makes me uneasy. I get cross and illogical if I haven’t slept or eaten, or if someone is continually making minor decisions that I’m competent to make and are in my job description. If someone is giving me critical advice and deciding whether and what treatment to offer, and writing stuff in my chart (or using an EMR that doesn’t facilitate taking good notes) that could affect whether I continue to have insurance, or administering medication they have to calculate a dose of, or running an IV line, or whatever, I want them happy and thinking carefully and compassionately.

    As a person, that makes me sad. I would like everyone to have reasonable working conditions and to have a say in their own destiny.

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