Friday, July 10, 2009

The Biggest Threat to Health Care Reform: Physician Burnout

It was supposed to be delayed gratification.

After all, that's the American way: work hard, put your nose to the grindstone, get good grades, be obsessively perfectionistic, then you'll be rewarded if you just stay with it long enough. It's the myth that perpetuated through medical school, residency and fellowship. Our poor residents, purposefully shielded from the workload they're about to inherit, march on.

But then they graduate to find to find the population aging, chronic and infectious diseases are more challenging, and the number of complex health advances and therapies are exploding. Just then, we decide to launch a full scale attack on physicians and their patients with increased documentation requirements, call hours, larger geographic coverage of their specialties, reduced ancillary workforce, and shorter patient vists.

Physicians get it - burn out and dissatisfaction are higher now than ever before. This is probably the greatest real threat to the doctor-patient relationship and health care reform discussions don't even put it this on the table.

At the same time that we expect our doctors to be devoted, available, enthusiastic, meticulous and at the top of their game with perfect "quality" and "perfect performance," while simultaneously cutting their pay, increasing documentation reqirements and oversight, limiting independence, questioning their professional judgement, and extending their working hours. We must become more efficient!




ShrinkingDoc said...

I think you figured it out, Dr. Wes. We're not all Supermen and Superwomen. Some people can do it forever, but I think a lot of us can only do it so long without going crazy.

For me, it was primary care. I'm sure it's the same for specialists. IcedLatte at Medical Marginalia had a post on how there truly IS NOT enough time for a primary care doc to take care of their panel of patients if you consider everything they really should be doing for them.

Thankfully, due to the shortage of people who CAN do it all, there's more than enough demand for urgent care to fill in the gaps. Then I go home and sleep at night.

Do I think urgent care is the ideal solution for dealing with a lot of the things I see? NO way. But I do a damn good job for people while I have them and try to get them hooked back into the system in the right way to get them the longer-term care that they need. The trouble is, it's getting harder to get them what they need as the system gets screwier.

Trouble is it's such a mess, I can't even begin to imagine how it can be solved, especially when it seems like it's going to be politicians solving it. They never seem to do ANYTHING for the right reasons.

Hmmmm. Guess I'm kind of pessimistic, huh?

james gaulte said...

A profound insight said very, very well. AND some also expect that we work tirelessly for social justice.

Anonymous said...

For all of you, thank you. There are so many of us who appreciate what you do, specialists and general practioners alike, each and every day.

Dr B said...

Great Posting. I only hope that as we watch the "crash" of medicine as we know it, that on the other side, there will emerge a market for those who will take the time to map the RV septum and prevent apical an example of what goes on behind the scenes for no recognition or reward. I have no faith that government will understand the difference....
They all just want to be re elected.........
however, a very LARGE thank you to the appreciative post here. We do this because of you!!

Anonymous said...

As HugeMD pointed out: "...Thankfully, due to the shortage of people who CAN do it all, there's more than enough demand for urgent care to fill in the gaps. Then I go home and sleep at night....."

And the urgent care does it for twice your office fee.