LINDA GIRGIS, MD | PHYSICIAN | OCTOBER 9, 2018
Recently, my inbox has been overfilled with offers for programs, yoga, meditation, and a whole host of mindfulness training opportunities to combat physician burnout. I think by now everyone knows that doctors are fighting high burnout rates. But, those sending these “special offers” don’t get the root of the problem. We’re not burned out because we work long hours in a stressful job with limited time off. Rather, we are burned out because we are trying to function as doctors in a broken, dysfunctional system.
What are the root causes of physician burnout?
Loss of control. Every day, many times a day, I am forced to take on an insurance company to get a diagnostic test or medication covered that a patient needs. This sometimes takes hours of my staff time and many times ends in a denial despite the time investment.
Not being able to help our patients. I know many people don’t think doctors care. Honestly, most doctors do. I have one patient who was told she needs a joint replacement three years ago. We are still fighting the denials while the patient gets worse and worse. She wants to get better and go back to work but she is just getting more disabled because she is not getting the treatment she needs. And the only reason she is not getting the care that would make her better is that her insurance company refuses to cover it. Yes, I know it is much harder for this patient than it is for me but imagine watching that scenario play out hundreds of times.
Over-regulation. We used to keep patient records in order to keep track of their medical histories. But, once the government started passing mandates on how the record should be maintained, the records have now become a data capturing tool that are more useful for insurance companies than doctors. You know how people keep complaining the doctor just looks at their computer and not the patient anymore? Well, we don’t want to do that, but the burden of the metrics reporting has grown into a wild beast that is difficult to tame. Let us have our medical records back and we won’t need to sit on the computer so much.
Over-administration. Although I’m in private practice, I hear the horror stories that are rained down on employed physicians by the non-physician (mostly) executives. There is the pressure to see more patients, be more productive, earn high customer satisfaction scores, and keep costs down.
Run away costs. Patients often can’t afford the medications I prescribe. Sure, I can prescribe a cheaper alternative, but it is not always the best one for whatever is wrong with the patient. Patients often don’t want to go to specialists because of the high copays and deductibles. Also, services such as physical therapy (PT) are often too over-priced for many. While our politicians clamor for an end to the opioid crisis, it remains the far more affordable treatment than alternatives such as PT.
Long hours/stressful work. Yes, I said earlier that this is not the cause for burnout. Rather, it contributes to the ever-increasing burnout of many doctors. We all knew we would be working long hours, under stress when we first entered medical school. But, when you combine it to the other factors facing us, it becomes harder to handle that stress and those hours.
While meditation, yoga and mindfulness training may work for some (I’m all for easy solutions to complex problems), burnout will never go away until the root causes are addressed. And who really is going to do that? Corporations are profiting off the dysfunction and politicians are making their careers off the agendas supporting them.
Linda Girgis is a family physician who blogs at Dr. Linda.