THCB

Why Doctors Quit (And What to Do About It)

John Haughom MD white

I got an e-mail from out of the blue the other day.

The e-mail informed me that a colleague, a man I respected greatly, had tendered his resignation at the hospital.  That coming Friday would be his last day. There would be an informal gathering for staff at the hospital cafeteria and that would be that.

I was shocked. The physician in question was an institution at our hospital. As far as I knew he was happy, his patients loved him, he was respected by his peers.   I could think of no earthly reason for him to go.  This did not did not sound like the old friend I knew.

I did what any friend would do: I picked up the phone and called him.

“I just got the e-mail. What’s going on?” I asked “Is something up at home? Is everything ok with Sarah and the kids?”

“Nothing’s wrong. I’ve just been doing a lot of thinking. I’ve decided I want to spend time with the kids and explore some outside projects.

Outside projects? What sort of outside projects?

My friend was the not kind of guy who you thought of as spontaneously quitting his job. I pressed him. He finally broke down and confessed. He was miserable at work.

“It’s the bean counters. They’re everywhere. Every day I get an e-mail that says I’m underperforming on this metric or that metric. It’s making me crazy. My self-esteem can’t take it. Last week, I got an e-mail that told me I need to do a better job of answering patient e-mails. I didn’t even know they were allowed to e-mail us. How long has this been going on? I tell you, I love my patients, but I just can’t take it anymore.”

We talked for a solid forty-five minutes.

He told me about his troubles. He had been keeping longer and longer hours at work, spending an ever increasing number of hours on administrative tasks. His patient care was deteriorating as a result. He was putting on weight. He was testy. Relations with colleagues and support staff had eroded dramatically as a result.

As we talked, it became clear that the hospital’s electronic medical record was the culprit.  My friend had been driving himself crazy trying to keep up.  But try as he might, it just wasn’t working. His brain was simply not wired for the task. And his perfectionist nature — a valuable asset in the operating room – did not give him the room to work with the new system.  Try as he might, he simply could not make the adjustments needed to make the practice medicine the old way.

“You’re sure there isn’t anything I can do to make you change your mind?” I asked.

There wasn’t.  I was sorry to see him go, but I understood why the decision was the right one for him. The changes that he was asking himself to make were just too much for him. The sacrifice just wasn’t worth it.  He was doing the right thing.

Change can be a painful thing.  In the heat of the moment, it’s easy to forget that we’re going through a period of unprecedented change, unlike anything in the history of Medicine. Not everybody is going to make it.

The new science of medicine is going to require a new kind of physician. One that is at least as comfortable using technology and data as they are reviewing test results and examining patients. That change is going to take time. And it is going to take patience. Some people, like my friend, are not going to make the transition.

That’s not to say there won’t be bumps along the way.

For example, at this point, it’s clear to almost everybody that the complaints we’re hearing about the early generation of electronic medical records have at least some validity. Many systems are clunky, and that’s putting it nicely. “A medieval torture device with a mouse” was how one colleague described his system.

He wasn’t far from the mark.  And the companies involved have done a pretty awful job of responding to criticism (I say this as a physician speaking to my colleagues, not as a representative of my employer). It’s almost never a good idea to ignore your customer’s complaints or to blame problems on “ignorant users.”

I don’t blame people for being frustrated.

The good news is that the market is responding. New solutions are appearing every day. And a lot of very smart people are working on the problem.

I can confidently predict that within a few years the problems we are talking about today will be a thing of the past. The next generation of EHR systems will be lightweight, customizable and allow doctors to practice medicine without getting in the way.

The day is not far off when any resident will be able open up their laptop and crunch his or her patient data in the same way I can open up Excel spreadsheet on my home computer and look at my spending habits. They’ll be able to compare the effectiveness of the medications they prescribe themselves, look for suspicious patterns, compare their numbers against CMS benchmarks and do a hundred other things that sound like the stuff of science fiction today.

The Millennials are Coming!

By definition, the younger generation of physicians is far more open to technology, more comfortable with managing a large volume of information and used to quickly adapting to new technologies. After all, they’re trying out new apps and new programs every day. What’s new to my generation is old news to them. Millennials are more comfortable than the generations before them. From what I’ve seen, Generation-Y is even more adept.

That’s encouraging to me and should be for you too.  This makes them the perfect candidates to practice medicine in the new era where technology and data will be as important as instincts and classical training once were.

I’m absolutely convinced that coming generations of healthcare providers will not only be comfortable using these new technologies but will demand access to them. Data-driven medicine will become not only widely accepted but the new standard of care. The idea of practicing medicine without digital tools and without data will be unthinkable, like going back to the days before vaccines and antibiotics!

I can confidently predict that one day, we’ll look back and say “remember how we used to have to do this?” And laugh.

My friend who quit medicine?

I understand why he left and I wish him the best, but I have to admit that I wish he’d stuck around. The younger generation may get technology and may be more comfortable with rapid and disruptive system change, but there is much for them to learn about our craft.   My friend was — and remains — a good doctor. There is much that he had to share.

I think back to the kind and generous mentors who guided me through my medical school years and through my early years in practice. It is no exaggeration to say that I would not be the doctor I am today without their generous support and encouragement.

If you’re of my generation and feeling frustrated or confused by the changes that are playing out in our field today, I hope you’ll consider staying staying around just a bit longer.

These new guys? They may have their iPhones and their patient e-mails down, but that doesn’t mean they don’t have a world of learning to do. And this is where we can help.

It remains my personal operating principle that it is each and every physician’s duty to leave medicine better than on the day we found it.

And my friend? Well, let’s just say I have a sneaking suspicion he’ll be back.

John Haughom, MD is a senior advisor to Health Catalyst.

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armandAsad_Choudhry_M_D_DoctorFedUpBobbyGvegasNortin Hadler Recent comment authors
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Asad_Choudhry_M_D_
Member

Dude,

your retarded. you are what’s wrong with medicine. Its ok to think critically I know medicine beat that out of your mind during training.

DoctorFedUp
Member
DoctorFedUp

And by the way, I envy your friend for having the courage to get out. If he does come back, have his mental status evaluated.

DoctorFedUp
Member
DoctorFedUp

I AM a younger doctor who loves technology and EMRs are epic fails! They are absolutely terrible and I wish I had stuck to paper. Being a doctor now is a miserable endeavor. When I hear statistics like 400 doctors per year commit suicide, I am NOT surprised! This career has gone straight to hell. In the U.S., you are better off trying to be a YouTube star. You’ll be loved and well-compensated if successful. As a physician, you are drowning in school debt, drowning in overhead, drowning in regulations and everyone wants to take advantage of you! I am… Read more »

DikeDrummondMD
Member

In my work with hundreds of burned out physicians there are three basic reasons an employee physician quits. Here they are
http://www.thehappymd.com/blog/bid/328289/Why-Employed-Physicians-Quit

Dike
Dike Drummond MD
http://www.TheHappyMD.com

Steven Findlay
Member
Steven Findlay

Very good dialogue. My take: there will ALWAYS be tension between the doc-as-decider/professional/wise-and-well-trained-eminence with only his/her patients’ interest at heart AND the “system”—bureaucracy/regulation/budget/$$$/oversight/public health. This tension exists in other fields of human endeavor as well, of course. But we all know it’s pretty heavy duty in medicine/healthcare. There are many good reasons for that. To name one: it’s a life and death business every single day. EHRs are one of the latest bureaucratic/regulatory/tech approaches. As Dr. Haughom’s thoughtful blog notes, we are in the midst of a large-scale transition… from a crappy clinical record keeping system to a (hopefully better)… Read more »

Nortin Hadler
Member
Nortin Hadler

Mr Findlay and his organization have been making important contributions. But their attempts to empower consumers are missing the forest for the trees and the EHR mantra is defoliating the forest. Science is most powerful when it is refuting some hypothesis. Hence, an organization such as Mr Findlay’s is a match for overdiagnosis and overtreatment. But these are the soft underbelly of the clinical encounter. The reason for the patient-doctor relationship is to parse the values of both when contending with the clinical science that is yet to be refuted. This is a very human, idiosyncratic event that leaves the… Read more »

BobbyGvegas
Member

Coding in general is what I call “lossy compression.”

Peter
Member
Peter

Maybe Canada, or at least British Columbia is the place to work.

http://www.vancouversun.com/news/metro/doctors+eager+retire/11202429/story.html

Those stinking socialists.

@RogueRad
Member

“It remains my personal operating principle that it is each and every physician’s duty to leave medicine better than on the day we found it.”

Does this principle also apply to amputating the scope, reach and klutziness of EHRs? I thought not.

The fundamental dissonance I find in articles such as this is a failure to acknowledge that “better” is also “worse.”

The piece can be summarized as “Say you’re all right Jack. Say it, dammit.”

Res Morgan M.D.
Member
Res Morgan M.D.

Based on the info we’re given here, it seems like the doctor quit very specifically because of the mind-numbingly pointless chores the bean-counters required him to do. But this hits a little too close to home for the author, who choses to frame the story as yet another variant on “old fart physician is too stupid to learn how to use the EHR.”

Clueless.

Asad_Choudhry_M_D_
Member

you hit it on the nail. I was thinking the same as reading it. Is he trying to turn this into a feel good story. Medicine is getting less and less humanistic and more bout data mining blah blah checks and balances. The author is the worst kind of clueless.

etchory
Member
etchory

Yes, this scenario has become too common but I disagree with laying most, if not all of the blame on the EMR. Certainly it plays a role that varies in each individual’s circumstance. As I toy with the idea of walking away after 35 years if you count internship and residency the primary frustration is being an accomplice in the corrupt health care financial system in which we waste thousands of hours, dollars and skilled labor on the tower of babel of admission, observation, day surgery etc. No one has acknowledged one of the primary drivers of obscene health care… Read more »

@RogueRad
Member

So healthcare is not Toyota after all.

RRowleyMD
Member

This anecdote is fairly familiar. And the perception by the physician who “had enough” and is leaving the practice is that the problem is the administrative burden put on physicians and the onerous nature of the EHR tools he is being asked to use. But, is this really the underlying issue? I would argue that the root of the problem is deeper. How we deliver healthcare is undergoing a profound change, from a fee-for-service basis to a value-based one. None of us are experienced in knowing how “value” is to be measured – neither those who make e-tools, nor those… Read more »

Joe Flower
Member

So sad. It’s not as if we don’t know how to build interfaces that actually work for the customer. They are all around us. Just not (mostly) in healthcare. The core of the problem is that from the start, the vendors who created most of the EHRs, and the executives who bought most of them, never thought of the physician as the customer. They thought of the system, and the executives who run it, as the customer. They thought of the physician as part of the product value stream to be measured, tracked, and controlled. This is a fundamentally backward… Read more »

armand
Member
armand

I’m glad someone else feels there’s hope. As somebody new to the healthcare world, this is blatantly obvious. In most industries, nobody would even consider bringing to market a software that has over 100 clickable options on any given screen. I met a couple doctors who decided the problem was bad enough (many colleagues wanted to stop practicing, too) to pick up programming and do something about it because nobody else was going to. They started developing software that automates the manual and repetitive processes within their EMR – specifically EPIC. After 3 years, they’ve been saving those in their… Read more »

Retired MD
Member
Retired MD

Dr. Haughom, Don’t blame the doctor. Dr. Hadler is absolutely correct. This is a moral issue. No longer are physicians taking care of individuals with unique visions, needs and illnesses, but physicians are being forced to take care of patients as a population data point. I am retired, I am about your age, and I mastered the EMR in my office for the last 7 years of my practice. I did not use templates, since patients do not fit them. I also used CPOE at the hospital, and was a superuser who was on committees to help the hospital best… Read more »

Nortin Hadler
Member
Nortin Hadler

Dear Dr. Haughom I see where you’re coming from and where you’re going. Soon you will be scheduling patients (“units of care”) who will be processed to satisfy the requirements of record keeping and billing by people who work for your institution. They will be interviewed by means of questionnaires so that you won’t lose time having to focus on other than the presumptive reason they turned to you as a “provider.” In keeping with notions of efficiency and “meaningful usage”, you will ask the critical question while your scribe enters the reflexive answers into your EHR. Of course you… Read more »

EricNovack
Member

my sense is that it is not the EHR per se — but the EHR is the poster child for the increasingly over-regulated, bureaucratic nature of US health care delivery. We all – -especially our patients– have benefitted immensely from the advances in technology from pharma, to devices, to communication, to imaging… etc… Those are innovation driven — EHR is regulatory driven — and it has caused perhaps the most perverse misallocation of capital in US history. Many will say this is a partisan political statement– but its roots are wholly bipartisan. To advance from here, a massive deregulation ought… Read more »