Greetings, subscribers and readers of Florida MD!
From an early age I was taught that physicians were honorable and well-respected professionals in our country.In fact, I became a nurse to help physicians in the fight against disease and ultimately care for people. For over 18 years working alongside physicians, I have witnessed firsthand the weight they have to carry. As a nurse passionate about changing health care and helping physicians manage its ever-changing world, it has been incredibly frustrating to see the decreased morale, the increased cynicism relating to the business of medicine and, even worse, the steady decline of medical students wanting to enter primary care. Physicians,who through my lens are the epitome of medicine and the backbone of patient care in this country, are struggling.
Given the state of health care in 2018, physicians have a tough job. From navigating administrative bureaucracies, to staying current on shifting payment models, physicians face significant challenges. And that’s on top of operating a medical practice with large patient loads. As a practice consultant, I work with physicians to help manage these changes that are frustrating at best and stressful and daunting at worst.
In this ever-changing field of uncertainties, physicians have reported experiencing poor professional morale, burnout and depression. In the 2016 Survey of America’s Physicians: Practice Patterns and Perspectives, the two factors that physicians found the least satisfying about medical practice were “regulatory/paperwork burdens,” followed by the “erosion of clinical autonomy”. Physicians spend 21% of their time engaged in nonclinical paperwork.1 These burdens are being exacerbated by new payment models and quality measures, leading physicians to feel at capacity or overextended. (see table A)
Physicians bear the bulk of responsibly implementing new delivery models and maintaining care, but the majority feel that they have little input or even influence over health care regulations and other mandates. This lack of control of how health care is structured or where it is heading is leading to professional frustration and poor morale which is no surprise considering almost half of physicians surveyed reported feelings of burnout.1
In order to combat these issues, many surveyed stated that within the next one to three years, they will cut back on hours, retire, switch to a concierge practice or work locum tenens. Interestingly, the desire to be employed by a hospital system or large multi-physician owned corporation has not increased. (see table B)
Burnout is not a disease, but a syndrome characterized by exhaustion, cynicism and a decreased sense of efficacy.2 Physician burnout is job-related and situation-specific. Although physicians may have different susceptibility, burnout is largely driven by factors in the work environment, such as too many or unrealistic job demands coupled with insufficient resources, lack of control and inadequate support.3 For those of us currently working in health care, it’s no surprise that burnout affects half of the physician population at a time when physicians are working more and earning less.
So, what do we do? Burnout is a complex issue, and I suggest first treating our physicians as humans and not robots. Medical schools have introduced wellness programs and education to help upcoming physicians manage their work-life balance. Hospitals and other large institutions can focus on improving processes, especially those that tend toward bureaucracy, increase physician stress and decrease morale.
Physicians are taught ‘Patient First,” which is important. But are physicians putting themselves first outside of work? While there are frustrating things physicians may not be able to control within their field, they can focus their efforts on what they can control－like taking time off for vacations and focusing on family and their social lives. Getting away physically, but especially mentally, to relax and have fun is key.
For those of us who are not physicians, yet work side-by-side with them and see the signs: Speak up! Let your physician know you understand that it’s tough, and offer to take some items (that are within your scope) off their plate. Also suggest that they take time off to play golf, have a spa day or to go on that vacation they always say they’re going to take but never do. As a consultant, I encourage physicians to take vacations, go to dinners, and reconnect with old friends or hobbies if work has become 24/7. Quality of life is important－it’s what we tell our patients every day, and now it’s time for us to apply it to our lives.
I am passionate about finding solutions to physician burnout. If you are too, feel free to submit your thoughts or questions by email with the subject line #PracticeTactics to firstname.lastname@example.org or visit Wehelpdrs.com.
By Khalilah Filmore
1. The Physicians Foundation (TPF). 2016 Survey of America’s Physicians: Practices and Perspectives. 2016
2. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129-146.
3. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016; 15(2):103-111.