I have been practicing family medicine as part of a large urban managed-care organization for about 15 years now. As part of my practice, I teach medical students and residents. And as a card-carrying member of Generation X, I often find myself right in the middle of the ebb and flow of the work-life balance and physician wellness discussion between my older Baby Boomer “workaholic” and “pay-your-dues” vocation-driven colleagues, and the millennial/Generation Y “my career does not define me” students and residents that I teach.
Like a crucial swing vote on the Supreme Court, many of us in Gen X now in increasingly influential leadership positions, who have originally chided our younger associates for that perceived lack of work ethic, are slowly but surely beginning to plant our collective flag on the side of changing the makeup of medical education and practice in the name of sustaining our very existence, especially in primary care.
A faculty colleague and I have lectured on numerous occasions about the differences in the generations when it comes to attitudes, communication and learning styles in the area of medical education and practice. Several years ago when we began our research in this area, it was commonplace to poke fun at millennials as indifferent, uncommitted, self-centered and too informal. We revered the boomer generation for their endless, tireless work, when medicine was still a calling, and the answer to every problem was to work harder, no matter the sacrifice.
In the few short years since, however, it is easy to argue that even the heartiest of boomers would agree that the fervor of their work would be difficult to sustain in today’s practice environment. I have witnessed them retire (often early) in droves in the face of increased bureaucracy, billing and coding requirements, increasing quality indicator measurements, and the documentation burden of the electronic medical record (EMR).
And in the students and residents I teach, I see in their faces, with each repetitive click of the mouse and keyboard EMR shortcut, their passion for medicine slowly fade. Many of them match in our residency program with their wellness accounts already in negative balance, or precariously close to empty — the product of an obsolete, hierarchical medical education system that still often relies on overwork and humiliation as a sort of rite of passage with no formal teaching on how to deal with emotions, time management, financial or business competence, or self-care.
What little they have left to give often evaporates in the face of endless utilization measurements, and required documentation for meeting regulatory mandates and Medicare coding. In the name of efficiency, my residents’ progress notes on the inpatient medicine service all begin to look frighteningly similar and generic. Often at the expense of learning why and how an ACE-inhibitor helps their heart failure patient, they are consumed in exercises of futile box-checking and the metrics game of whether or not they documented that the ACE-inhibitor was ordered upon discharge.
In other careers, millennials have proven they are not afraid to change direction, leaving jobs with previously unseen frequency, looking for something more fulfilling, a more fitting piece for that one part of many that makes up their whole being. And they are now proving they are not afraid to do so in the field of medicine, with dozens every year leaving medical schools and even residency programs before finishing. Countless others finish their training, only to never enter a traditional medical practice setting. Yet many more struggle and burn out in the early phases of a busy medical career before leaving it all behind, or, worse yet, ending their lives under tremendous financial burdens, fractured relationships and families, and unsatisfying work.
While quality and measurement and reimbursement are crucial and are here to stay, there has to be a better balance between the days of my boomer colleagues where they had the time and flexibility to delve into relationships with their patients, and today where the residents struggle to even make eye contact with the patient in order to stay on schedule and get their electronic charts completed on time.
Under the guise of burnout prevention, health care organizations, training programs, and medical schools need to realize that required meetings and sessions to learn how to unwind and de-stress are not the only answer. Though the effort is much appreciated, many of our newly-hired younger physicians eschew organized wellness gatherings in order to spend time with their families or simply just unwind. “More meetings is not the pathway to resiliency” is often what is overheard, when afterwards they’re thrown back onto the treadmill of an unchanged practice structure, or have to catch up from duties they could not complete because, ironically, they were learning about burnout. Many resort to part-time practice to just stay caught up, or use sick leave days to complete charting.
One of my favorite quotations reads, “You drown not by falling into the river but by staying submerged in it.” It’s time to climb out of the river of physician burnout. A culture of self-care, resiliency and wellness needs to start from day one in medical schools, long before a physician first enters medical practice. Medical schools and residency programs are now rolling out wellness curriculum requirements. The misery of berating and belittling trainees in traditional medical education needs to stop. Physicians in training no longer should be taught to hide their emotions. They need to learn how to face them head-on. They need to know that in an industry held to a standard of perfection, it’s OK to be vulnerable.
For many reasons mentioned above, many of us have been separated from what has been the why we went to medical school in the first place: our patients. And this Gen X family medicine faculty member has swung completely over to the side of the millennial generation’s quest to redefine the medical workplace and re-embrace that essence and passion of medicine and replenish the wellness tanks. If unsuccessful, with medical students continuing to largely ignore primary care specialties, and many others leaving it, our future existence will be in doubt.
Sherwin Gallardo is a family physician and can be reached on Twitter @KPDocSG.
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