Physician burnout and the shortage of physicians are pressing issues within the health care industry, often unnoticed by the general public until their own health is at stake. The erosion of the title “doctor” and the increasing encroachment on physician authority have contributed significantly to this problem. Physicians have allowed the interference of the federal government, burdensome regulations, and insurance company restrictions to impede their ability to provide quality care. Physician burnout is primarily rooted in the loss of independence and the diminishing role of physicians in decision-making processes. In this article, we explore how these factors have led to burnout and propose potential solutions to alleviate this crisis.
The loss of physician independence
Physician burnout is not solely a result of excessive workload or poor work-life balance. Contrary to popular belief, it is a straightforward issue with a single underlying cause: the loss of physician independence in making decisions about patient care. In the past, physicians were dedicated to the well-being of their patients. They went above and beyond to ensure their patients received the care they needed, often finding ways to accommodate those who couldn’t afford medications or accessing charitable programs to provide free care.
However, the landscape has changed dramatically. Physicians are now burdened with onerous regulations, such as mandatory reporting, that have never shown evidence of improving patient care. The introduction of prior authorization requirements and contractual terms from insurance companies and Medicare has further interfered with physicians’ ability to provide efficient care.
Diminishing autonomy and patient-centered care
Physician burnout is exacerbated by the loss of autonomy. Physicians are now forced to collect Medicare copays or face criminal charges. They must account for every drug sample they receive and can no longer provide it as free medication to those in need. They must navigate complex networks of “in-network” doctors for patient referrals and can no longer just refer patients to the specialists or consultants they know and trust. The once-direct process of prescribing medication, tests, or treatments has been replaced by the need for approval from non-physician insurance representatives following rigid protocols that do not account for a patient’s individual needs. This constant questioning, second-guessing, and denial of a physician’s skill, knowledge, and experience have eroded their confidence and added to their frustration.
The impact of external factors
Physicians attempted to comply with government and insurance company demands, hoping to improve patient care. However, the enactment of the Affordable Care Act (ACA) further compounded the problem. Physicians were forced to adopt electronic medical records (EMRs) before the software was ready and allocate valuable resources to report meaningless statistics to the government. Suddenly, physicians found themselves responsible for monitoring unrelated aspects of a patient’s health, which had no direct relevance to their specialty. Physicians were turned into data entry employees.
Moreover, the coding system’s emphasis on documenting a certain level of complexity resulted in physicians adapting to the system and being able to document excessive but irrelevant information to meet coding requirements. This discrepancy in expectations created further frustration between physicians and the systems when Medicare and insurance companies realized that doctors could now provide more comprehensive notes to support their higher coding. Then the system responded by lowering fees for the work being done. In the case of Medicare, they completely eliminated the coding for a consultation that had a higher fee than the lower-paying new patient codes.
Addressing physician burnout
To effectively address physician burnout, it is imperative to restore physician independence and respect for their expertise. The following actions can help mitigate the crisis:
Cease forced reporting: Eliminate burdensome reporting requirements that do not contribute to improved patient care outcomes.
Eliminate prior authorizations: Remove the unnecessary prior authorizations that do not result in cost savings but impede timely patient care.
Respect physician decision-making: Allow physicians to have the final say in determining appropriate testing, treatments, and referrals based on their expertise and patient needs.
Reinforce the role of physicians: Recognize the significance of the medical degree and restrict the use of the title “doctor” in medical settings to licensed physicians, ensuring patients understand the distinction.
Make it illegal for anyone but a licensed physician to own a medical practice and outlaw the corporate/hospital ownership of medical practices. No non-physician should employ a doctor and be able to dictate how they work or take care of patients.
Physician burnout has reached critical levels due to the loss of physician independence and the erosion of respect for their expertise. Restoring autonomy and empowering physicians to provide the medical care they have been educated and trained to provide to their patients without non-physician interference. If that is done, physicians will do as they have always done, they will make medicine their life’s work and provide the care to the people that is needed.
Brian Hudes is a gastroenterologist.