Patients lose when physicians burn out

Despite loving my patients, I burned out. I chose my own quality of life over continuing to work with the chronically mentally ill population that I adored. This patient population is frequently shortchanged with their quality of care, and I have joined the ranks of people failing them.

This is my experience working in one mental health clinic in the United States. Every clinic runs differently, and there are fantastic systems out there. I am so grateful for the amazing clinicians and psychiatrists that continue to dedicate their lives to this population even when they are underpaid and overworked.

We go into medicine to treat patients, yet systems issues can destroy our resilience and prevent us from doing what we love. Instead of facilitating care, dysfunctional systems drive away physicians and make it harder for patients to get quality treatment.

The stress of funding mental health clinics

It’s not surprising many clinics aren’t well-run given the stress of funding them. Care for the chronically mentally ill population isn’t prioritized and is poorly reimbursed.

Parity laws, which mandate equal pay for mental health treatment as compared to other medical treatments, have been inconsistently followed by insurance companies. Significant differences in reimbursement remain even when the same procedure code is used by a psychiatrist vs. a physician in another specialty. The laws are not enforced, and insurance companies continue to get away with it. Many clinics rely on public funding to stay afloat. This funding continues to get cut.

With frequent budget cuts, leadership had an incredibly difficult job worrying about financial solvency. This trumped all else. Obviously, if your house is on fire, you aren’t going to start rearranging the furniture. However, when you realize fires are a new norm you need to be proactive; to minimize damage and also continue to make your house the best it can be.

Mental health clinic safety

Our clinic had safety issues that desperately needed to be addressed. For years I tried to address them by suggesting changes that were common sense and cost little to no money.

Leadership agreed to make these safety changes but never carried them out. I began to feel like they didn’t have our backs and were too overwhelmed by fundraising to care about “mundane” issues like patient and staff safety.

Inefficiency or incompetence?

I started to feel burned out. Defeated and powerless. The patients brought me so much joy, but the system was depleting it. I lost faith in the leadership and could no longer excuse inefficiencies as a byproduct of clinic work but more indicative of incompetence. Our safety was being put in jeopardy and leadership turned a blind eye.

Here’s an example

The kitchen was centrally located and had open doors on either end that led to the clinic hallways. The kitchen doors had no security system even though key fobs were already in use separating the waiting room from other areas.

Every time a birthday was celebrated a large pointed carving knife was used to slice the cake. This knife would be washed and put in the drying rack next to the open door; visible to all who walked by. This seemed like an obvious safety concern.

My suggestion was to put a key fob on the kitchen doors to limit patient access. The costs would be minimal. After a year of expressing my concerns about safety, leadership finally agreed to put the fob on the doors. However, after another year of waiting, they never followed through.

A recipe for physician burnout

During the same years that I was unsuccessfully attempting to improve clinic safety, appointment time was reduced from 20 to 15 minutes, and we switched to electronic medical records. Patients in individual therapy were shifted into groups. No one had the time to listen to and care for our patients anymore.

Patients and staff ended up feeling unheard and marginalized together; both of us sharing a lack of positivity and lack of hope that we could improve our environment to create a brighter future.

What was lost when I chose to leave

When I left the clinic, it was because I could no longer tolerate a system that wouldn’t improve. For me, it meant leaving my patients who I worked for nine years to engage. Trusting therapeutic relationships don’t come easily in this population, and I treasured that they allowed me to share in their lives.

When I left, my patients lost a physician who cared about them and their quality of life. They lost a human connection when they may have no one else. I knew they loved chocolate milk, meatballs, and smoking. They also loved to play basketball, wrote raps and poetry, and didn’t eat if they were too distracted to go to the soup kitchen. I knew what their early relapse signals were and how to engage them enough to tweak medication in hopes of warding off hospitalization.

I’m replaceable

I know I am not the only one that can do this work. I also recognize this is an area of physician shortage. Our most psychiatrically challenging and medically complex patient population is slowly being treated predominantly by locums tenens psychiatrists (who don’t have the time to build relationships) and mid-level practitioners (often newly graduated who now need to treat highly complex patients on multiple medications with multiple medical conditions).

Despite all this, I think I may have lost more than my patients. I lost part of my career purpose and the passion I had to find a way to engage and treat this population.

For now, I am grateful if I catch a glimpse of one of my beloved patients walking down the street or cross paths with them in town. I know you are alive. I hope you are well cared for. I’m sorry I left you.

We all lose when physicians burn out.

Melissa Welby is a psychiatrist and can be reached at her self-titled site, Melissa Welby, MD.

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