Stop piling on physicians: The last straw in burnout


We are all familiar with the saying: “the last straw.” It refers to the fable of the camel who could carry heavy loads.

In the story, the camel is a beast of burden. Its owner, in an effort to transport as much straw as possible, keeps piling more and more on the camel’s back. Camels are strong and can handle a lot. But at some point, even the strongest camel will buckle if enough weight is piled on.

How much is too much?

As more and more gets piled on, there is a point at which the camel reaches its limit. This is the point at which any more weight, even the weight of one last straw, becomes too much for the camel to handle, and it collapses. And when that happens, the camel’s value is gone. That’s the last straw.

I’m passionate about preventing physician burnout. What does a fable about a camel have to do with burnout? Stick with me, the parallels are striking.

The root cause of physician burnout

The root cause of physician burnout is putting highly motivated and caring professionals in a work environment in which they are unable to succeed. A work environment full of barriers and frustrations that prevent physicians from providing quality care to their patients. Frustrated physicians burnout as they go to heroic lengths to maintain quality and service to their patients. They:

  • Try to make varied patient clinical presentations fit within the constraints of the EHR
  • Learn workarounds to maneuver through unfriendly EHR user interfaces
  • Hunch over keyboards performing data entry that could be done by others or by cognitive support
  • Click boxes to prove to CMS their meaningful use of the EHR
  • Hassle with payers over prior authorization issues
  • Pick the right diagnostic code from the 10-fold increase in choices following ICD-10
  • Answer questions coming in through the EHR’s patient portal
  • Check state opioid databases prior to prescribing narcotic pain meds
  • Ensure they are conforming with multiple quality measures to ensure maximal reimbursement in 2019 through MACRA
  • Explain to patients that the testing and treatment that Google recommended for their symptoms is not in their best interests
  • Get translators or language lines into the exam room for increasingly diverse patient populations
  • Learn virtual visits and figure out how to get paid for them
  • Spend thousands of dollars and hundreds of hours on maintenance of certification, performing tasks and taking tests to prove they are current and competent

The last straw for physicians

The items above are new, or more demanding, due to changes in external demands in the last 10 years. Many seem reasonable or did as they were introduced. Each was added incrementally, and each on its own would not be that big of a deal. Physicians can cope with each one, one at a time.

But consider the cumulative effect. Each represents another straw on the camel’s back. And the camel is now overloaded. They can’t hold up under the burden. The camels are breaking.

Just look at the impact. Physicians have high rates of depression, substance abuse, family dysfunction, and suicide. We lose 400 physicians a year to suicide. That’s the equivalent of two medical school graduating classes each year.

Are leaders reducing the burden?

Leaders are beginning to take notice. A group of 11 CEOs of major health systems recently posted a blog in Health Affairs declaring physician burnout a public health emergency. The AMA has dedicated significant resources and appointed a VP to focus on provider well-being and practice resiliency. The National Academy of Medicine is launching its initiative.

It’s great to see this long overdue attention to physician burnout and the increased focus on wellness. My question is, “Are we responding the right way?” My answer is, “Not really.” There is a lot of emphasis on wellness programs. Wellness and resiliency programs help to make the camel stronger. That’s good. Your hospital or group should have one. But they don’t address the root cause.

We’ve got to stop piling straws on the camel’s back.

Paul DeChant is a health consultant who blogs at Preventing Physician Burnout through Lean Done Right.

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