[Editor's Note: This is a guest post from Dike Drummond, MD. Dike is a family physician and creator of the Burnout Prevention MATRIX Report with over 117 ways to lower physician stress. He provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD. We have no financial relationship, but there is an obvious synergy in the work we do.]
Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.
When there is bad air in the mine, the canary's sensitive lungs will cause it to drop over dead before the miners notice any shortness of breath. When the bird stops singing … the miners head for the surface … fast. It is a life saving maneuver.
Here in 2015 as we start to implement the provisions of Obamacare and projections of physician shortages as high as 91,500 by 2020 come from respected sources, I believe we have a similar “coal mine” situation in healthcare.
Unfortunately, physicians appear to be the canary in the mine.
Even before the pseudo-shortages of the Affordable Care Act, physicians were not in good shape. Symptomatic burnout is present in an average of one in three doctors on any given office day. A 2012 survey by the Physician's Foundation reported that 60% of doctors would retire today if they “had the means”.
High patient volumes, the hassles of Electronic Medical Records (EMR), political uncertainty and changing reimbursement rates are all cited in surveys and online forums as new and increasing sources of stress for doctors. Online patient complaints always center on “the doctor seemed rushed, didn't listen, or didn't seem to care”, which are classic signs of overwork and burnout.
The biggest new burnout threat may be Pay for Performance (P4P).
Healthcare organizations will soon be paid bonuses for reaching certain care quality indicators and patient satisfaction thresholds. Patient satisfaction is incredibly important and should be tracked and rewarded. At the same time, if care organizations simply use these reimbursement changes to dump more stress on the doctors they will actually block the doctor's ability to be present and care for their patients more effectively. Where is the tipping point … where the canary falls off the perch?
How did we get here in the first place?
Dike Drummond, MD
Healthcare is a classic giving profession. Doctors and nurses learn early that patients come first. Our job is to serve them as best we can, no matter how tired or drained we may be feeling. Their needs come before ours. Simply acknowledging our own needs is a challenge. Finding time and tools to get them met is a struggle for most physicians.
Many healthcare organizations systemize this self care blind spot.
It is rare for the physicians and staff to appear in the Mission Statement of a care organization. The patients and care quality will always be front and center in the mission. Any mention of the providers and staff is very rare.
Take a quick look at your organization's Mission Statement. Does it mention provider or staff health, wellness and satisfaction? If so, is your organization actually doing something about it?
This creates a double bind where the providers are challenged to get their needs met and their organizations fail to acknowledge we have any in the first place.
The last American sweatshop
As a result, many healthcare workplaces feel like a classic sweatshop environment. There are too many patients to be seen, multiple systems come between the doctor and patient (EMR for instance,) there are quotas to be made, and no regard whatsoever is paid to the health, wellness or stress levels of the physicians and staff.
The workplace resembles a mine. We are waiting for the physician/canary to drop.
In my work with doctors with career threatening burnout, it is common to hear of hospital departments and group practices where the entire staff is just barely making it through their work week.
Thank goodness for work hardening
Dike's book, click on the image to buy at Amazon!
The only reason these toxic workplaces don't implode is the stamina and work ethic of the doctors and staff in the system. On one level, residency is a work hardening program for physicians. We can take a tremendous licking and keep on seeing patients. Our organizations know this and just pile it on. The leaders count on the doctors to carry any load they pile on while taking no responsibility for the stress involved. It is just like putting a canary in a shaft where you know the air is bad and hoping it survives.
Everyone loses
Tragically, unless your group actually monitors for physician health and satisfaction, the toll burnout exacts on the doctors and their patients remains invisible.
Research shows burnout has a pervasive negative effect on every aspect of a physician's practice and life. Physician burnout has been linked to
– Lower quality of care and lower patient satisfaction rates
– Higher rates of medical errors and malpractice risk
– Higher physician and staff turnover
– Higher levels of divorce, alcohol and drug use and suicide for the physician – our Canary.
So how much longer can we simply pile more and more stress on the doctors? When will this canary be stretched beyond its limit and simply topple off its perch and crash to the bottom of the cage? Does anyone care or is this something doctors just have to take care of on their own?
There is a different path available to healthcare organizations.
This path results in a win:win:win situation.
- More patient satisfaction and higher quality care
- Happier, healthier doctors
- Higher profitability as the P4P trend continues
The key is to stop taking the canary down the mineshaft in the first place. Focus the same amount of effort on creating a healthy environment for your physicians and staff as you do on patient satisfaction for one simple reason.
Your doctors cannot produce consistently high patient satisfaction scores if they are not consistently healthy and happy at work.
Happy doctors naturally have happier patients. Put the canary in a sunny window and change the papers in the bottom of her cage. This is a fundamental shift with positive consequences for everyone in healthcare.
The most successful organizations in the near future will be those that acknowledge the universal presence of physician stress and burnout.
- They will monitor for burnout and support the health of their providers and staff in multiple innovative ways.
- They will put physician health and wellness in their mission statement as a priority equal to that of patient satisfaction.
There are hundreds of proven ways for both physicians and organizations to make real and lasting changes in the physician experience as soon as this fundamental shift is recognized.
I also predict this type of organization will be rare
Leadership must stop simply loading on more work responsibilities and cracking the whip. Organizations must be committed to caring about the doctors and staff and constantly focused on creating a healthier and more efficient workplace.
With this new priority of physician wellness, these same organizations will be able to activate the power of a physician staff that is balanced and healthy, with their physical, emotional and spiritual needs met. This is the natural foundation for consistent quality care and patient satisfaction.
Just imagine a work environment …
… where you enjoy your work team and the practice environment, the systems work to let you care for patients smoothly and effectively and you know that your leadership “has your back” and really cares about the quality of your experience as a member of the group. What would that be like? What quality of care would doctors and staff in that organization offer to their patients naturally and automatically.
Our healthcare workplaces don't have to feel like a coal mine. We don't have to sit around and wait for the canary to drop.
What do you think? Do you work in a healthy workplace in an organization that cares for their physicians and staff? Do you appear in your organizations mission statement?
What is the biggest stressor in your practice that your group could change if they wanted to? Are you burnout? Have you been before? What did you do to change? Comment below!
Incredible that 60% of physicians would retire today “if they had the means”.
Dr. Dahle is doing a fantastic job of arming us with the knowledge we need to acquire those means. We’d better keep this site quiet to avoid the mass exodus!
Kidding of course, the real solutions to physician burnout are some combination of systemic change and personal improvement in the way we live our personal and professional lives. I’d like to see a reduction in the bureaucracy, metrics, and various hoops we jump through in order to continue doing our jobs. The individual physician can work on stress reduction, but it’s tough to yoga your way out of complete burnout.
We had a discussion about burnout yesterday in our compliance meeting. Someone brought the article that says that burnout is basically abuse. What else do you call a job where you don’t get 30 minutes for lunch, can’t go to the bathroom, are expected to make difficult decisions with limited information on which people’s lives rely etc? “Burnout” makes it sound like it’s the physicians problem whereas “abuse” makes it clear the problem with the system.
The counterpoint, of course, is that “burnout is a first world problem.” Lots of people hate their jobs and there is a support group for that. It meets on Friday evening at the bar. Many, maybe most, other jobs that pay similar incomes also require years to get to that income, require working more than 40 hours a week, and involve difficult, unpleasant tasks. Having had the opportunity to make a physician-like income doing something besides medicine, I can assure you it takes a lot of time and hard work and a not-insignificant amount of risk of failure.
I have mixed feelings on the subject, but I also come from a position where burnout is almost impossible for me. I’m currently working 120 hours a month and will soon be cutting back to under 100. That’s like 25 hours a week. If you’re getting burned out at 25 hours a week, that’s an issue. I mean, I’ve got enough time to have a completely different job on the side. And that job has allowed me to leave medicine if I want. I’m basically only practicing now because I want to. I also own my job. Nobody else is skimming off my income. I am the boss. I get to choose my co-workers (at least partners, pre-partner physicians, and APCs.) So me whining about burnout would come off as pretty ungrateful for a fantastic job, a fantastic income, and a fantastic life. Given how little I work and how well I’m paid, I don’t think having to deal with some dumb metrics and a few drug seekers is a big ask. Our latest thing is administration wants us to stop admitting patients to the hospital at 12:30 am. By getting them admitted before midnight, they get to charge for an extra day. It’s a pure money grab. That’s fine, whatever, they’re running a business just like we are, but the hoops we’re talking about jumping through in order to avoid this sort of thing are getting a little bit ridiculous- like the emergency physician writing holding orders on a patient he knows is going to be admitted even before labs or x-rays come back.
Look for me Friday evening at the “support group”. 😉
I’ll be the first to admit I’ve got the best job I’ve ever had. I’m a glass half-full kind of guy, and quite happy with life overall. Like you, I choose to keep working at age 40 even though I could walk away and be just fine without the income.
You and I are working by choice, but we are in the minority. I think it’s important to highlight the burnout situation and you’ve got a platform that reaches a lot of physicians. We may be doing alright from a burnout standpoint, but about half of physicians are not.
Thank you Dr. Drummond for sharing your insight for all of us WCI readers, and thanks again Dr. Dahle for creating this repository of financial knowledge, which I think is a key component the physician can control to decrease burnout.
Exactly. The financial issue is a key component, but what Drummond opened my eyes to is that there are a lot of other components. So even if you can’t do much to improve your financial situation quickly, there are some things you can do right away to improve things.
I had a horrible case of burnout after an abusive residency. Just to be honest, I would in a heartbeat retire if I had the ‘means’. However, I did a wonderful fellowship where I was treated like a human and learned all kinds of interesting things. I now work in private practice and dont go to the hospital save maybe once a year. I work about 3.5-4 days a week, no nights or weekends. Lots of time with the kiddos. I could certainly make more money working more, and hope to work up to a full 4 days a week soon. Im paid just great for this amount of work for sure.
I dont feel burned out anymore, and the time has allowed me to spend more with family, learn about finance, and start thinking about entrepreneurial things I’d like to do and want to get going on. Its been a refreshing experience, but amazingly took over a year to wash out that negative from before.
You forgot to mention the constant threat of losing everything while doing all the above.
Every year I work more or longer hours. I think the CEOs and top management are stressed to make money, and that is the only way they can justify their millions, so everyone keeps squeezing everyone. There are less RNs to help MDs. I can see ourself moving towards employment model cause of the amount of work. Once employed you lose control but there is a 20% increase in staff …hopefully…
At least nursing can unionize. Physicians need to unionize if they are to survive the administrator enslavement who keep giving themeslevses million dollar bonuses each year at cost of cutting resources and staffs.
Depending on the system, the issue is above the administrators and with the shareholders. Our hospital runs very lean with regards to nurses. If things slow down, nurses are “flexed” home. Where does that savings go? To the private equity fund that owns the hospital system. Capitalism has its issues, no doubt.
I’m curious about your assertion:
“Patient satisfaction is incredibly important and should be tracked and rewarded.”
What is your evidence for this? I’ve read that higher patient satisfaction is associated with increased mortality.
http://archinte.jamanetwork.com/article.aspx?articleid=1108766
http://www.kevinmd.com/blog/2012/02/patient-satisfaction-kill.html
We also had a discussion about patient satisfaction yesterday at our meeting. While I do care about patient satisfaction (you can have a great deal of satisfaction without practicing bad medicine) I don’t care at all about patient satisfaction measurements since they’re not even usually statistically significant.
Exactly, they track the wrong stuff. All about questions and if theyre pertinent to actual whats important. Like asking prisoners how happy they are about the situation in jail. Its basically a guaranteed bad response since you’re telling people what they dont want to hear, any sociologist or behavioralist would tell you how unlikely that is to yield useful information.
I thought it was a good article. However, I always cringe when I see other doctors promoting the propaganda of the bureaucrats. For example, the govt. throws around the word “quality” all the time when they discuss the changes that they have made to medicine. Their real agenda is to decrease costs. Since that wouldn’t go over well with their constituents, they market that agenda under the guise of improving “quality.”
However, what do they know about quality anyway? It’s not like anyone is looking to the IHS or VA systems as the model for quality (not disparaging docs in those systems, just the systems themselves).
Case in point – patient satisfaction surveys. They mandate them and promote them as a quality measure. However, it turns out that higher satisfaction is associated with increased mortality. Is it no surprise that if you give people antibiotics when they don’t need them, or narcotics when they don’t need them, or admit them when they don’t need to be admitted that you might be doing them harm? You’ll likely get better satisfaction scores, but I fail to see how that measures “quality” and I fail to see how that makes patient satisfaction “incredibly important.”
You can throw “meaningful use” onto that bonfire with quality and patient satisfaction.
Good point.
As an epidemiologist (here b/c I’m married to an ER doc) I have to say that just because something is statistically significant doesn’t mean it’s meaningful.
Agreed. But the chances of it being clinically significant when it isn’t statistically significant seem unlikely.
https://twitter.com/aslavitt/status/686718314517663744
CMS shows signs of responding to our death moans.
I can’t help but think with this rate of burn out who are the physicians left working? Dumb ones? Everyone is wanting an out
1. Dike Drummond – is he even practicing? or just helping docs (thats his revenue)
2. Dennis Bethel – is he even practicing? or just helping docs invest (thats his revenue)
3. WCI – this blog. Although i’ll give him credit since he still practices
I mean everyday i see docs leaving/burning out. I am soon as well. Toxic environment, terrible admins, increased pressure to produce, EPIC (a private compnay raking in millions having a monopoly – how come microsoft got in trouble in 90s and not this Fing company? ) Enough is enough. I see how the world works; we are relegated to being drones while admins/ancillary service providers rake in $$
Dont tell me – youre a doc ,don’t care about money. Give me a break. I agree with poster above. Unionize.
To be honest, I respect WCI with this blog helping docs, but we were supposed to be financially compensated well so that we can help patients. Now we have to “worry” about securing our futures.
Will not be recommending my kids to medicine. Will instead tell them to be a real estate investor/flipper or blogger or some service provider helping the “rich” physicians for a fee.
Dike is not practicing. Dennis is. I’m still full-time until July, then 3/4 time after that. Frankly, I was planning on doing that after a few years even without WCI.
I agree it is disappointing to have to “worry about money” as a physician after all our academic instructors told us we wouldn’t have to worry about it. Due to the “squeeze” I write about in my book (increasing medical school costs/debt with increasing regulation/decreasing payments) there is much less room for error in physician finances.
That said, solid financial management should still allow any physician to have a very nice financial life even with a significant debt burden and a low physician salary. You’ve got to get pretty far to the extremes before it hits the misery stage. Like a pediatrician with a relatively low salary, say $150K, and a relatively high debt burden, say $450K.
If you hate medicine enough, you should be able to punch out within 5-10 years from when you decide to do so and enjoy a middle class lifestyle for the rest of your life without ever working again. Now, if you define “middle class” as private school, paying for your children’s college, a new car every 3 years, and European vacations, then you’re probably not going to be able to do it. But if you live like the average American household a la Mr. Money Mustache, then it’s doable. The problem with some docs is they want to avoid the hassles of practicing medicine but want the medicine income. There are some ways to do that, but it’s going to be a tough go for most docs.
To offer a counterpoint, I’m not dumb, burned out, looking for an out, and I love EPIC (super easy to copy notes, order meds/labs electronically, read other providers LEGIBLE notes!) And I guess I won’t say that I don’t care about money, because I need to eat, but I’m making about 25-50% less than I could if I didn’t work outpatient/in an academic institution/part time. So I’d say the money doesn’t drive me. And I LOVE LOVE LOVE my job! Our office has really great support staff that I am very thankful for.
Random thought-I wonder if burn out will be less or come for different reasons for younger physicians who have “grown up” with an EMR. That seems to stress out a lot of the older docs I’ve worked with but doesn’t bother me at all because it’s all I’ve ever known. I also like it because we certainly document more than in the old school notes I’ve looked at, but that helps me sleep better at night because I know if I ever get sued, I’ll have documentation that can actually be read and demonstrates my medical decision making.
I agree the EMR improves “legibility,” but I have doubts about “INTELLigibility.” Most of the notes I have seen are generated to pass coding requirements for billing, NOT to pass on important relevant information. The EMR notes are often redundant or so dense with extraneous information that finding the salient medical facts is indeed like being in a mine– but more like mining for precious gems than mining for coal.
Yes, I agree that can be an issue. We used powerchart before epic, and the powerchart notes were just useless! But in epic I can create my own templates which are very pretty and readable (the only thing I auto import is the med list and allergies) because that is a major pet peeve of mine. I guess that tech writing class I took in college really made an impression on me. I hate reading ugly documents!
Great article but what does an employed MD do if the cases keep getting piled on more and more without additional staffing help or pay? Find another job? Not so easy in a saturated consolidating market where the new job may be worse! And to complain about these issues to anyone who wants to listen makes you look like a whimp, whiner and trouble maker. How do you feel sorry for someone making as much as many specialty MDs? There is skimming of our professional billing and ever increasing quotas. Better behave like a good worker and hit the rvu goals or else your contract may not get renewed. The possibility of starting my own practice in the saturated metro is nil. Great description in the article of a huge problem but few solutions exist. A side gig would be nice but Jim beat me to it (:
I disagree that few solutions exist. I would encourage you to buy and read Dike’s book. It is written exactly for someone who feels like you do/is in your situation.
I am not going to change the organization. I can go part time, take the risk of a new job or try to get more fulfillment from activities outide of medicine which I have been doing. Additionally, as more and more MDs become employed liked me, I am hoping for some positive changes to happen on a national level as far as working conditions go (but not holding my breath).
The organization does not have to change for your level of burnout to decrease. The sense of hopelessness you feel has solutions far less drastic (and unlikely) than those you are currently envisioning. I suspect you would score very high on a burnout survey. This book is for you and anyone else who feels their burnout cannot decrease without huge changes in their organization or in medicine. I suspect you will find some pearls in there worth far more than their cost in money and time to get them.
Think if the above scenarios are true you will see issues of a shortage bounce back in your favor. These things swing one way and then the other.
Dike and WCI,
Great article, an extremely important topic and one that I am passionate about. Burnout is systemic in my observation, and it will likely only get worse with the current systems we have in place right now. I firmly believe that every physician, no matter how bright eyed and bushy tailed after residency basically plan for their early retirement, Plan to be out at 40, 45, 50 whatever, and if it works out for you and you love what you are doing…great, keep doing it. The worst thing is to be burned out and imprisoned in a cell of your own doing…probably preaching to the choir here.
I will make a plug here. If you are burned out and on the edge, give Dike a call to let him talk you down. His book is excellent and has great actionable advice even if you are not burned out.
Part-time work is a great solution. Radical transformation of your practice (Pamela Wible burn it to the ground and rebuild it from scratch style) is a great solution. Staying burned out and soldering on is a poor solution.
PS: Small ask. Please get rid of the video adds on this site. I hate them, and almost everyone I know hates them. They are distracting and slow things down. I have visceral anger every time I visit a site with them. Gives the site a commercial slimy feel. Your material is too good for this. Your site of course, I’m just giving you a data point 🙂
What video ad are you talking about? I don’t know of a video ad anywhere on the site.
I see one for Sporty Dog.tv on this page right now–alongside the article.
Could be one of those tracker ads from another site that follows you around the internet. I think fb does that kind of thing.
Hmmm….I have no idea what that is. It’s certainly not something installed on my site. Probably on your computer.
Strange, not there after reloading the page. I will message you if I see it again as it slowed down load time and was very distracting.
I hope you don’t have a virus or something and are simply mistaken that it was on my site.
I found this comment on the web. I think his comments are wise:
Dr. Isaac Zamora| Dermatology
After more than 30 years in private practice, I have learned a few things about burnout. Don’t take your work home with you- leave it in the office. Take vacations whenever the need arises; if you don’t, you may not be physically capable when “retirement” comes. Fill out all the government forms, prior authorizations, referral letters, documentation, etc. with a grain of salt. Don’t stress over them. They are not that important in the grand scheme of life. Take a nice, long lunch break and read non-medical journals. Smile and laugh with your patients. Give them time to voice their concerns. Remember why you are doing this in the first place. Don’t stress about the schedule being too busy (or too slow). Never rush. Don’t keep your cell phone on you when working. Stop worrying- you have a great career and you are vital to the community. Don’t retire too soon; you will be struggling with finding important tasks to keep you busy.
And remember what’s important: family, love, health, clarity, humor. Meaningful use is not important.
I agree that these are wise comments. This article gave a lot of food for thought. From my perspective, I burned out during residency and had to leave. After I got my head on straight and my health back on track I tried to get back into residency multiple times and failed. I had to ‘create’ my own residency volunteering in a free clinic, which eventually morphed into paying work and finally my current job in a FQHC doing the work I’ve wanted to do all along. Unfortunately my financial pressures are very high with years deferred student loans (thankfully at a low interest rate and on PSLF). Absolutely no emergency fund and low retirement savings while I’m in my early forties. I’ve only been in my current job for 6 months, and I feel the pressure mounting. I feel like the schedulers at the main clinic over an hour a way have total control over my life. I made a conscious choice when I accepted this job to work only 32 hours a week (I actually work 40+, but they don’t pay for administrative time). I also don’t take my work home and so far I’m managing. I know I don’t have a very high burnout threshold and I try to be very careful in how I handle this, but until I know my patients better and can handle 22+ patients a day….. I think I need to read this book. I love practicing medicine, but I don’t like feeling like I have no control.
I like Dr. Zamora’s attitude and recommendations. If we could do those things, the workday would certainly be more pleasant and burnout would not be making headlines.
The problem is, few physicians are empowered to choose to take a nice, long lunch break or give patients plenty of time. There are 15 more to see after lunch and you’re already 45 minutes behind. If you own your own practice and dictate the schedule, you might be able to do those things. If you’re trying to meet quotas and metrics and the other demands of a modern day practice, it’s not that simple.
I do agree with the assessment on what’s important in life: family, love, health, clarity, humor. I respectfully disagree with the recommendation not to Retire Early. That’s what the RE in FIRE stands for.
I don’t think doctors are so powerless as you imply. I have worked in a private practice, an academic medical center, and now am employed by a healthcare network. I have had a lot of say over how my schedule is run. If I chose to see fewer patients per hour I can do so. I think the financial pressures that doctors are under (high debt, high spending, poor savings etc.) adds to the pressure they feel. They think the world would come to an end if they lost even 10% of income. Making wise choices in the past (pretty much what WCI recommends) has given me the freedom to chose to be less busy and to enjoy it more.
The not retire early topic is a different and bigger topic. My thinking has changed over the years. Currently I am FI. I still want to work for as long as I’m able to though. I feel I provide a valuable service to others and medicine is a calling. A lot of people think that is corny. So be it. I love what I do and I have a long list of patients who value what I do and want to see me even sooner. It isn’t about the money for me so much (although that is nice too) as the service, challenge, stimulation, meaning, identity, etc.
WealthyDoc,
If you don’t mind me asking, considering you are FI, but still working, what is your goal or plan for the extra money you are making?
I invest a lot. Some traditional stocks/bonds and some in private companies in a LLC investment company. I give more to charity. I support my parents, my brother , my kids, and add more to 529. Who knows how much their grad school could cost?
I wonder how much boredom plays a role in the whole burnout thing.
Like, you know your conversation with a patient 5 sentences/exchanges down. ( Like the consent for an LP;…. “am I going to get paralyzed? ” No, it’s very safe”.. “but I read it on Google you can get paralyzed…” )
You feel totally in a groundhog day daze with close to 80% encounters.
I think boredom certainly is a contributor, but Im unsure if theres a profession out there where you will always find it intellectually stimulating in practice and at the same time feel a level of mastery, theres an important balance. I mean in theory ours is very much so, but in practice not so much. This is probably the biggest plus for academics that they can spend time and discuss all kinds of things amongst a wide variety of disciplines.
Having to constantly say the same things over and over about stuff that certainly should not need to be said does get old. I wonder what the corollaries are in other professions (vaccines, other irrational issues).
Dermatology getting burned out? Maybe from boredom. Hard to believe specialties who barely step inside hospitals are experiencing the same crisp. Same goes for ophtho. Is private world the protecting factor here for career longevity?
I think ownership helps you feel a little more empowered. Many burnt out docs feel a sense of powerlessness and lack of control over their job. I think owning the jobs helps with that.
Exactly, burnout isn’t always just that you work a lot of hours. It is also that you feel a loss of control. I’m old enough to remember when doctors were in charge. However, our autonomy has just continued to slip away.
For example, the tele-radiology service missed a neurosurgical urgent / emergent case. Our radiologist over read it and we got alerted. We have no neurosurgeons at my hospital. Nurse manager asked me what to do. Said she had called him and he could no longer move the extremity (he had some weakness when he had come in but could definitely move it per the ER record).
I told her that she should tell him that he needs surgery and we have no neurosurgeon on call and that he should go straight to the hospital with a neurosurgeon. She disagreed and said we couldn’t do that. She felt that we would some how be violating EMTALA.
I told her that I thought she had misinterpreted that mandate, but even if she was right, I was more interested in doing what was right for the patient. After all, there would be a huge delay in his care had he come to my ER and we had to transfer him.
Being the nurse manager, she over-ruled me and brought him back to our hospital. After registration, evaluation, and acceptance of transfer, he had a 3 – 4 hour delay in seeing the doctor that he truly needed.
Those kinds of things burn me out. I signed up to help others. Not play games or try to comply with one-size fits all mandates that don’t make sense in certain scenarios.
I think this is significant problem in dentistry that will become increasingly apparent in the coming years. Our clinic just hired a new grad; student debt is $395K and starting salary is $120K. Some bonuses can be earned based on two metrics; total number of patients seen and patient satisfaction (terribly ironic).
Our clinic sees mostly medicaid patients which comes with tremendous red tape, delays, and non-dental people making decisions on which dental treatments are approved/denied. Our patients have mental health challenges, severe anxiety, drug dependency, no-show appointments, are not compliant with home care instructions, routinely fail to take accountability for their health, and do not hesitate to tell us how much they hate us directly to our face on a regular basis. Yet the new “population health” models want to grade a dentist on the oral health outcomes of our patient base. All of this is a recipe for widespread and sudden burnout in the dental profession, particularly for those newer dentists who cannot afford to buy a $750K – $1M private practice and thus end up working in public health or the ever growing “corporate” dental world.
I am sick and tired of physicians complaining about burn out. Like we have the worst jobs. There are literally 100’s of jobs / professions that are more pressure filled, where workers get abused, disrespected, injured, assaulted and even die. Try raising family on 50 – 60 K / yr.
We are the luckiest bunch, we work in safe environment and get paid very well. If you cant handle the pressure then cut back on your work load. Better yet, try different professions and see how you like it.
Its everyones right to be upset and get burned out. Depending on your job in medicine it can be very pressure filled, and there arent a lot of professions where you have the possibility of losing a livelihood it took you much of your young adult life over what may not be a true error or even your choice (say emr/formulary, or insurance disallowed your first choice). Add education, training, expertise, and no, not really, and not when you consider other options a doctor might have. Safe environment depends on your definition of safe.
We get paid well, thats true. I’ve worked different jobs and I’ve been very poor. While I do not want to be very poor ever again, theres little comparison to what working a different profession is like. I mean when you lose all your money on Pets.com did that analyst who gave it a strong buy rating have his malpractice go up, lose his bonus, job or license? No, no one even knows his name and he probably made more than most primary care physicians. There are very real pressures and nuances in this job that come with the territory and to downplay it with some moral high ground is short sighted and self righteous.
Its not really an environment that has traditionally tolerated this kind of frank discussion, evidence your post, sometimes just venting (not ruminating) is a healthy cathartic exercise for people and helps to know others feel the same and hear how theyve dealt with it. You are not aware of everyones full plate so its beyond presumptuous to say that if youre a doctor and burnt out its your personal problem.
I think it is helpful for docs to try doing work that is a little different. The variety is good for burnout and the perspective is also valuable. There aren’t a lot of easy jobs out there where you can make 4 figures a day.
Attitudes like this are part of the problem, in my opinion. Maybe you have a happy life and job situation and assume everyone else should as well. Is your solution for people to stop talking about it and just suck it up? Medicine has an incredibly high burn-out rate and THE HIGHEST rate of suicide among any profession. To say we are lucky because we make a lot of money and don’t have physical danger is not addressing the major problem. You say there are hundreds of jobs that have higher stress – how do you explain the suicide and burnout rates?
Have empathy for your colleagues that are suffering and stop with the burn-out shaming that seems so fashionable these days.
Is that the highest rate of attempted suicide or the highest rate of completed suicide? I bet it would be a very different list.
Good question. Every study I have read looked at the rate of successful suicides, which at the end of the day is what really matters. Physicians are always first on the list. Dentists are usually number 2 or 3. Being a physician seems to be especially toxic to women, as they have a much lower rate than men in the general population, but are at parity with male physicians.
Suicide attempts and suicides are very different animals. Many people that unsuccessfully commit suicide don’t really want to die. They create scenarios that will be unsuccessful (make sure someone will find them after the overdose, etc).
You’re preaching to the choir. I meet at least one person with an unsuccessful suicide attempt every single day. Either they didn’t really want to die or they’re an idiot. It’s not like it’s that hard to figure out what will and what won’t kill you. I suspect physicians are a little more knowledgeable than the average Joe about what will and won’t kill you. Frankly, I suspect a number of successful suicides are really accidental- the person didn’t really want to die but stumbled onto a lethal method thinking they’d wake up again in an ED like usual.
I’ll give my perspective since I think it’s a little unique to the conversation. My wife is 2 years out of peds residency, I’m finishing up a pathology fellowship. She took a job at an urgent care associated with a large corporate pediatric hospital that’s always concerned with the bottom line. Low paying and understaffed. The patient volume she was expected to see when she signed are drastically different due to staffing. For a physician, it’s low paying but she can at least get her loans forgiven in 5 years. She’s already asking if she can quit.
My new private job is well compensated, physician owned, lots of vacation, 4.5 workday week, 4 weekend calls a year. I’ve rotated with the group as a resident so I have a good feel for the workday. You get your stack of slides in the morning and afternoon and are free to work on them at your own pace. The slides don’t get mad if you keep them waiting. You have your bread and butter cases and then your crazy, rare cases that make the job fun. It’s the kind of job where you’d laugh at the concept of burnout.
I’ve asked my wife about her changing jobs, but they’re all working long hours with declining reimbursements. The idea of burnout is specialty and practice dependent. I wish medical schools would address this better, but many state medical schools seem pretty politicalized. I know mine was constantly pushing the primary care agenda, even giving lectures that in hindsight feel more like state run propaganda.
I have known plenty of stressed and burned out pathologists. The slides may not “get mad if you keep them waiting,” but I can assure there are human beings that are often anxiously waiting for a pathology report. De-humanizing what you do is one way to prevent burnout not immediately available to most doctors, and perhaps SHOULDN’T BE. If the patient or the patient’s doctor is not leaning on you to work faster, there may in your future be an administrative human being who might “get mad if you keep them waiting.”
Another way you may discover the humanity attached to those slides is something from which you, as a fellow, are still shielded. Slides don’t sue pathologists, but I can assure you that slides somehow can get human lawyers to sue, and human sheriffs to come to your office and serve you papers. And paid human experts to bad mouth you…and all sorts of human jurors to pass judgement on you whether they know anything about what you do or not.
Wow, were the personal attacks necessary?
Where is there a personal attack?
The implication of future liability cases seems to be a good start. Regardless, most cases aren’t as life changing as you make them out to be. I doubt patients are waiting by the phone for their colon biopsy results or hernia sac report. For example, if I get a bunch of routine cases that come out late in the morning, I can take a lunch break to recharge. Those in clinic don’t have that luxury without running the risk of having the patient angry with them.
Great topic with significant financial repercussions. I think that one key to avoiding burnout is to find “meaningful work”. There are many definitions of “meaningful work”, but one of the best that I can remember (paraphrasing and I do not remember the source) includes the following three components:
1. Intellectually stimulating.
2. The worker has significant control or say in the operations.
3. The worker is rewarded for his effort.
Some physicians have work conditions that are strong in these attributes, and others not so much. Some feel more like assembly line workers, held to a high standard, with little control and minimal reward for going the extra mile.
Personally, I have found that reducing some non-clinical roles have improved my own burnout factor. As someone who just can’t say no, I have wound upon a lot of committees and with numerous leadership roles, sometimes requiring exhausting quantities of mental energy, time away from my family, and other responsibilities, often for causes that I have little interest. I have stepped away from some of these and continue to do so.
For one role, I have told the organization that while I believe in the mission, I am no longer interested in doing volunteer consulting work. Every other stakeholder in the room is paid to be there and as a the physician champion, I was there for free. No more!
I think this is a great point, but that it can differ by person
I have a significant administrative role in my organization which includes serving on a lot of committees, going to a lot of meetings, etc.
I get compensated for this overall but not each thing I do and still see patients about 50% of my time
I like having different things to do and I think it helps me keep from getting burnt out on seeing patients. I really look forward to and enjoy my clinic days, but also appreciate my non-clinical time as well. I am “good” at the administrative part so am able to feel like I am accomplishing things and also that I have some ability to guide where the organization is heading
I think the key is for each person to find the mix that works for them
“Have the organization include physician wellness in the mission statement.” Ha. Great joke.
Very glad there are people like Dike addressing issues like this though. Burnout is a very real thing in medicine today (as shown by the 60% number). My question is, for those in the 40%, what percentage of those already have or are close having the means to retire? My suspicion is it is most of them. It’s a lot easier to relax and say you love your job when you’re sitting on a nice nest egg. I enjoy what I do but I sure would like to do it about 25-50% less time and spend more time with my family/friends/travel etc. hopefully someday I get there but in the mean time, yeah, I’m in the “i could retire tomorrow if I had the means” crowd.
How Patients Can Help Prevent Physician Burnout-maybe for the monthly email. Should be open access.
http://blogs.wsj.com/experts/2016/02/19/how-patients-can-help-prevent-physician-burnout/
Via email:
When insurance companies get away with paying pennies on the dollar, how can we possibly get out of the mine/off the hamster wheel? They are squeezing the life out of health care providers all the while amassing enormous profits. I feel lucky to be a dentist because some of us have been able to set our own fees. Only 15% of the dental population has remained “out of network”. We have had to fight this longer than physicians since dentistry is very time intensive. Doing dentistry on a hamster wheel usually doesn’t fare well for patients in quality or comfort, not to mention a dentist’s job satisfaction. It’s simple, taking more time costs more. If the insurance companies set the fees we have to have a intolerable environment to create a profitable business. When insurance companies get away with paying pennies on the dollar, how can we possibly get out of the mine/off the hamster wheel? They are squeezing the life out of health care providers all the while amassing enormous profits. I feel lucky to be a dentist because some of us have been able to set our own fees. Only 15% of the dental population has remained “out of network”. We have had to fight this longer than physicians since dentistry is very time intensive. Doing dentistry on a hamster wheel usually doesn’t fare well for patients in quality or comfort, not to mention a dentist’s job satisfaction. It’s simple, taking more time costs more. If the insurance companies set the fees we have to have a intolerable environment to create a profitable business.
I am late to the party. I read through everyone’s comments and replies. Some of the posters’ comments give me sadness.
I finished my Fellowship in 2004. I have done variety of jobs, pretty much everything in my field except working in a prison. And yes, I have had two successful fee for service practices too.
I have not burned out. I am not stressed. In fact, I am having the best happiest years of my life – at work and at home.
To me, absence of burnout or stress by itself doesn’t mean happiness. Happiness is a conscious choice and has to be learned, practiced and carefully nurtured.
I want to keep on doctorin’ till I die.
Sorry, I forgot to pitch in for Dike Drummond.
He is a genuine professional and very personable. I have talked to him and he is very honest and forthcoming. I can vouch for his competence and skillfulness in conducting sessions that would help anyone. I was not his client but I shared with him how I have cultivated my happiness, and he helped me look forward further more.
I have Dike’s book too obviously. It is not a book you can read once, and then say that you know everything in it. This is a book to be studied and lived. It would take someone anywhere from 12 weeks to 2 years to implement what is in it.
Just like WCI stands on the shoulders of giants like Bernstein, Bogle etc., Dike has similar sources and resources for his work. Just like you can take many quick shortcuts by reading WCI’s book into personal finance, you can take many shortcuts by using Dike’s book too. A must have book in any Physician’s life!
I’m reading Stop Physician Burnout. It is EXCELLENT. Easy to read and practical. I highly recommend it to any practicing doc.
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