In today’s health care system, we as physicians find ourselves frustrated by inefficient EHRs, heavy patient workloads and complex regulatory burdens. Our cumbersome health care system has led to high rates of dissatisfaction among our fellow physicians, and more dire, high rates of suicide.
The physician suicide epidemic has many grasping for solutions. Even more so, the debate has arisen, are we suffering from “moral injury” or “burnout?” The debate revolves around two seemingly different classifications of how physicians feel in their job. But what is the difference between moral injury and physician burnout, and more importantly, how can we address this issue holistically?
The concept of moral injury arose in relation to military situations, in which soldiers in time of war were required to participate in situations that violated their own moral and ethical codes. According to experts, moral injury in the context of health care is an inability to provide high-quality care and healing. All of us enter the health care field optimistic and committed to providing quality care to our patients. However, the reality we meet is not always so simple. We become torn between the conflicting responsibilities of meeting patients’ needs and a system that doesn’t always allow us to do so. Often, when these responsibilities are in conflict, the health care system takes priority, leaving the physicians suffering moral injury and patients receiving lower quality care.
Through a different lens, burnout is defined as emotional exhaustion, depersonalization and reduced feelings of work-related personal accomplishment. As many have argued, using the term “burnout” implies individual responsibility, that somehow physicians are unable to resolve factors that cause us stress. At its heart, burnout is physicians blaming themselves instead of blaming a broken health care system that is nearly impossible to navigate.
Perhaps, burnout is the unwanted consequence of moral injury: as physicians consistently find themselves unable to provide quality care for a variety of reasons, they suffer emotional exhaustion, depersonalization and diminishing rates of personal accomplishment.
Semantics aside, the common denominator is the alarming rates at which physicians are reporting dissatisfaction with our jobs. Instead of attempting to adapt to a system that is inherently flawed and will certainly lead to dissatisfaction, we as physicians must come to the table and share firsthand insights about how we can fix this broken system.
To do so, physicians must have a louder voice in efforts to improve EHR systems that continue to eat up our limited time and negatively impact our relationships with patients. New payment models and care delivery systems need to account for “drivers of health,” which encompass each patient’s unique social, economic and educational backgrounds. This will enable physicians to treat the full spectrum of a patient’s needs, which will ultimately improve outcomes and drive down costs. Lastly, we must empower all physicians with leadership skills to ensure the physician’s voice is included in decisions shaping the health care system.
As the foundation of health care, physicians directly and immediately experience the consequences of a flawed health care system, and in turn, so do our patients. A broken system impacts how we operate day-to-day and hinders our ability to provide the high-quality care we want at an affordable price for our patients. The dissatisfaction we feel in our jobs affects both the health care system, as physician shortages increase, and our personal lives, as we become increasingly unenthused about our careers. How can we be expected to take care of our patients when the health care system is not taking care of us?
To combat the growing dissatisfaction, our opinions need to be factored into the policy and structure of the health care system. Policymakers, insurers, administrators, and employers should not be leading these conversations, we as physicians should. Without someone at the table who has an in-depth and practical understanding of the intricacies of our health care system, how can we expect to fix anything? In the interim, we continue to place useless bandages on our system in the form of unnavigable IT systems and complicated reimbursement policies, rather than addressing the systematic issues.
It is time for us to step up as physician leaders and take charge in shaping the policy that affects us and our patients. It’s also time for policymakers to take heed. Physicians have the knowledge needed to inform realistic solutions. We just need a seat at the table.
Gary Price is a plastic surgeon and, president, Physicians Foundation.
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