When the doctor needs a doctor: Burnout a big problem in the industry

It’s 7 p.m. You’ve just finished a long tough day at the office and your cell phone rings with a call from the hospital. One of your patients has been admitted. By the time you leave the hospital, it’s 9 p.m. and you’re starving. You grab dinner at a drive-through window and head home. When you arrive, you grab the bag of food and your very heavy briefcase. The weight reminds you of the 15 charts you need to finish from the day’s appointments.So much for sleep. You crack open your laptop and get to work, counting down, file by file.

It’s a nightly ritual for many medical professionals across the country. While the average American full-time employee is working 47 hours per week, a study by the American Medical Association found that 25 percent of physicians are working between 61 and 80 hours per week.

Physician burnout, defined by Medscape as “as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment,” is far from new. In fact, a 2018 study found that 42 percent of doctors reported being burned out.

How is this happening? The hours are just a part of the equation. Medical red tape plays the largest role. Many providers are spending more than 27 percent of their days updating the medical records systems that were designed to make patient care and billing more efficient. There are just not enough hours in the work day to get it done. A 2017 study published in the Annals of Family Medicine found that the average doctor has an 11.4-hour workday and nearly an hour and a half of that time is at home.

“The frustration gets worse when physicians work in an environment that treats them and their patients like a commodity,” explains Dr. Amir Bacchus, chief medical officer at P3 Health Partners. “When corporate medicine sees health care providers as just another pawn on the board, they take away many of the elements that brought them to the profession in the first place, including spending time with their patients and leading patient care.”

What does this mean for patients? A study by a Stanford researcher Tait Shanafelt found that “physicians with symptoms of burnout are twice as likely to leave an organization as those without such symptoms.” When providers leave, it becomes even harder to get appointments at most medical practices. Patients are then handed off to new providers, often disrupting the continuity of their care.

In some cases, patient care becomes depersonalized because the physician doesn’t have the time to understand all the factors that contribute to their patients’ health, such as financial restraints, family support and seemingly unrelated symptoms. With this strain, Harvard Health’s Dr. Peter Grinspoon said “doctors can suffer from impaired memory and attention, and poor decision-making. They can be distracted, and their communication with both patients and peers deteriorates. They feel less empathetic and engaged in the outcomes of their day-to-day decisions. Their bedside manner worsens. They can make mistakes, sometimes devastating.”

Medical professionals are usually compensated through insurance companies through a fee-for-service model (i.e., they only are paid for patient visits and services). Because the insurers have reduced their per-visit pay to physicians, providers must squeeze in 25-30 patients per day to stay in the black. In an eight-hour day, approximately half is taken by administrative and documentation tasks, leaving about 13-16 minutes to spend with each patient.

This pressure not only leads to exhaustion, but also a detachment from why the provider chose the medical profession — caring for people. Dr. Ron Lamberts, an internist who also blogs at Physician’s Weekly, said, “Because I am paid by volume, I am constantly pressured to spend less time with my patients. This makes me feel like I’m not doing a good job on anyone…I constantly have to choose between doing good and getting paid, and that’s really lousy.”

Finding solutions to physician burnout are imperative to improving the quality of healthcare in Southern Nevada. However, it will take more than a checklist.

P3 Health Partners CEO, Dr. Sherif Abdou, believes combatting burnout requires a revolution in the medical profession. “Metrics need to shift from volume to value — for both the provider and the patient.” Rather than weighing the physician down, providers and their patients should be surrounded and supported by a care team. That team can follow up with patients and ensure proper documentation is made to build and help the patients regain and maintain wellness.

The American Academy of Family Physicians released a report earlier this year reinforcing the value of the care team model, especially when combined with strong communication and collaboration skills. In addition, a Harvard Business Review study found that doctors improved both burnout and patient satisfaction when their team included mid-level medical professionals, such as certified nurse practitioners and certified physician assistants who can manage nearly all patient needs.

Shifting from volume to value, enlisting a qualified and collaborative care team and rewarding providers for quality care can make a difference for both physicians experiencing burnout and their patients who need access to medical professionals. As simple as it may sound, making these changes requires a far-reaching commitment.

“Physician burnout did not appear overnight and resolving it in Southern Nevada takes collaboration and commitment from the medical and business communities,” said Abdou. “We need a clinically integrated system of care that focuses on wellness instead of profiting from sickness.”

Dr. Ana Karamanides is a practitioner with P3 Medical Group.

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