Your average medical appointment doesn’t include a checkup on the doctor’s personal well-being, but a physician’s own health likely plays a significant role in the quality of care you receive.
When you think about what makes a good doctor, a number of factors likely come to mind: bedside manner, a doctor’s availability, where they did their training, and how well they are able to address your concerns and treat your illnesses.
You probably don’t think about physician burnout, a syndrome characterized by exhaustion, depersonalization, and reduced effectiveness, that has risen significantly over the past decade and has been experienced by almost half of all physicians sometime during their career.
On the surface, physicians do fulfilling work and are compensated well relative to the rest of the population. While this is true, looking at just these factors underemphasizes the long road one takes to become a physician. It also overlooks the day-to-day pressures associated with being a physician in the current health care landscape. In one survey, 88 percent of physicians reported feeling moderately to severely stressed. In another, about six of every 10 physicians stated that they wouldn’t recommend a career in medicine to their children.
If you ask physicians what factors contribute to burnout, you will hear reasons like excessive student debt burden, averaging $200,000 for many recent medical graduates. Long work hours and lack of work life balance is a problem especially for the 44 percent of physicians working over 60 hours per week. Other factors, like administrative pressure to see more patients in order to generate more revenue, increasing documentation requirements, and fears of litigation all contribute to the stressful and emotional nature of the job. One study showed that for every hour of clinical work, the average physician spent two hours on clerical work or on the electronic health record.
Perhaps most significantly, you will hear about the erosion of the physician’s traditional role in the health care team as insurance companies, administrators, and politicians have an increasing say in patient care. Many doctors feel that this interferes with the most rewarding part of the physician’s job, the doctor-patient interaction. While most physicians would still report the nature of their work as gratifying, an increasing percentage are reporting unhappiness with the job itself.
So, why should this concern you, the patient?
Patient care suffers. Studies have shown that burnout results in emotional detachment, decreased productivity, and decreased professional effort. This impacts the rapport physicians are able to establish with their patients, and affects how physicians order tests and prescribe medications. Eventually, it translates to increased health care costs, lower patient satisfaction scores, overall decreased quality of care, and increased medical errors.
Physician turnover increases. When physicians are unhappy at their jobs, they leave in pursuit of a better job, similar to any other working professional. However, in the case of physicians, they leave behind patients, who then have to start fresh with building a doctor-patient relationship with a new physician. Physician turnover is also expensive for medical systems, and indirectly, administrators pass those costs onto their consumers.
Exacerbation of the physician shortage. To combat burnout, physicians are increasingly considering changing practice models, cutting back hours, or leaving medicine altogether. Although many new practice models such as concierge medicine have their respective benefits, the number of patients seen in these practices is generally less than the practice of a physician who takes insurance. Coupled with the existing physician shortage that is rising as the U.S. population ages, the problem of access to care will be compounded by physicians cutting back their practices to address burnout.
Ultimately, physicians are humans, too. We all know that we function better when we are well-rested and happy. We are more efficient, better at problem solving, and more engaged. When we are tired, it’s hard to focus, and we become more apathetic. Unfortunately, when it comes to patient care, the consequences of this can be more serious.
Patients seem to agree that physicians are stretched too thin. A 2017 survey by the Physicians Foundation showed that 31 percent of patients felt that their physicians were overwhelmed and overworked, with another 53 percent thinking that their physicians were at capacity. Only 11 percent of patients who were asked felt that physicians had the time necessary to provide the highest standards of care. Physicians agreed with this assessment, with 14 percent of physicians feeling that they had enough time with patients.
For both the sake of the physician and the patient, change is necessary. What these changes should entail and how they can be made in the current health care environment is less straightforward. Simply telling physicians to take better care of themselves is unlikely to be effective, as many of the underlying reasons for burnout are related to external factors. A good starting point may be cultural change, and acknowledgment of the fact that in order for physicians to heal others, they need to be healthy themselves.