CHARLES KENNEY and JACK COCHRAN, MD

In recent weeks and months a number of articles have delved into the issue with a sense of seriousness and purpose that the doctor crisis deserves. Progress on reducing unnecessary pressures on physicians is painfully slow, but the broadest possible recognition of the problem is an important step toward dealing with it effectively.

We hold a basic belief about the future of health care: Solving the doctor crisis is a prerequisite to transforming our delivery system to improve access, equity, quality, and affordability. How can we possibly achieve the overall excellence and affordability in health care if large numbers of doctors are alienated and burned out?

Let’s be very clear: This is not about coddling doctors.

It is about preserving the ideals of the physician as healer and enhancing the professional experience – essential elements to optimizing care for patients and families. It is about acknowledging an honorable profession whose members deserve an environment in which they can serve patients to the best of their ability; an environment in which physicians can aspire to continuous improvement as engaged learners who embrace their role as active members of the Learning Coalition.

Traced Back to Medical School

The problem begins as early as medical school. Richard Gunderman, MD, recently authored an article in the Atlantic arguing that medical students:

are suffering from high rates of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. College students choose careers in medicine because they care, because people matter to them, and because they want to make a difference. What is happening to the nearly 80,000 U.S. medical students to produce such high rates of burnout?

Dr. Gunderman argues that we “need to understand not only the changes taking place in medicine’s external landscape but the internal transformations taking place in minds and hearts. … In what ways are we bringing out the best elements in their character — courage, compassion, and wisdom — as opposed to merely exacerbating their worst impulses — envy, fear, and destructive competitiveness?”

Another physician, Sandeep Jauhar, writing in The Wall Street Journal, suggests that medicine is experiencing “a sort of midlife crisis. … American doctors are suffering from a collective malaise.”

What has caused this malaise – this sense of disturbing unease? Dr. Jauhar cites a number of reasons but gets to the heart of the matter when he writes that

our profession’s woes include a labyrinthine payer bureaucracy. U.S. doctors spend almost an hour on average each day, and $83,000 a year… dealing with the paperwork of insurance companies. Their office staffs spend more than seven hours a day. And don’t forget the fear of lawsuits; runaway malpractice-liability premiums; and finally the loss of professional autonomy that has led many physicians to view themselves as pawns in a battle between insurers and the government.

Dr. Juahar suggests some remedies including replacing the fee-for-service payment system with value-based care (see our recent post on payment reform). The comments on Dr. Juahar’s article (nearly 1,000!) reveal the level of anger and bitterness among some physicians. The toxicity of many of the comments is jarring.

A fascinating article called “Physician Burnout: It’s time to Take Care of Our Own,”*** reports on an experimental program designed to help physicians suffering from burnout. Samantha Meltzer-Brody, MD, a psychiatrist at the University of North Carolina, writes that

burnout impacts nearly half of all seasoned physicians in practice and up to 75% of resident physicians in training … more and more physicians report anxiety, stress, and emotional exhaustion. … These good doctors are in crisis in increasingly high numbers — an epidemic that requires immediate attention.

The form of that attention at the UNC School of Medicine comes as a program called Taking Care of Our Own, which “offers educational programs about burnout and mental health for resident physicians, and strategies for avoiding and/or addressing it. … We offer multiple different forms of mental health treatment that include evidence-based therapies for burnout, depression, and anxiety, and have developed a comprehensive referral base of providers who have experience caring for this patient population.”

Treating Doctors’ Mental Health

The program is in its early stages, but early on Dr. Meltzer-Brody reports that there has been a “deluge” of physicians seeking help.

The overall goal of the program, she writes, “is to provide timely, cost effective, and efficient care to identify and treat physician mental health issues ensuring improved performance and professionalism. Ultimately, this is good for the doctors, great for the patients, and critical for the health care system. We strongly believe that this type of program needs to be offered at all institutions involved in training the next generation of physicians.”

The program shows promise but what about steps to head off burnout – including steps to enhance the lives of physicians and substantially increase their level of professional satisfaction?

Are you aware of wellness programs that are working well inside or outside of the medical field? What other solutions do you recommend? Let us know.