BY HANS DUVEFELT MD
Too many specific theories about physician burnout can cloud the real issue and allow healthcare leaders to circle around the “elephant in the room”.
The cause of physician burnout isn’t just the EMRs, Meaningful Use, CMS regulations, the chronic disease epidemic or any other single item.
Instead, it is simply this: Healthcare today has no clear definition of what a physician is. We are more or less suddenly finding ourselves on a playing field, tackled and hollered at, without knowing what sport we are playing and what the rules are.
Historically, physicians have been viewed as professionals and also, more lately, as skilled workers. But we are more and more viewed and treated as neither. Therein lies the problem.
The way professionals are treated is this: You present them with a problem and they use their knowledge to solve that problem Since they know more than the requester, they aren’t micromanaged. They usually also set their fees and determine the time needed to realistically finish he job.
Skilled workers are asked to apply knowledge and workflows to relatively strictly defined tasks and it is the employer’s responsibility to make sure they have what they need to finish the job. If the tasks are unrealistic, the manager is held responsible: If the assembly line is moving too fast and the majority of workers end up passing on unfinished product or start pulling it off the line to finish later at home, the manager is likely to take the consequences. No one is likely to say that all workers, individually, are responsible for such chaos.
But in today’s healthcare, we have a rapidly moving assembly line. The foremen blame the workers for not attaching all the parts or not keeping up with the workload. Upper management doesn’t always take full responsibility, instead shrugging and saying: “it isn’t our problem, they’re professionals, they should be able to figure this out”.
Put simply: If anybody wants to define and manage our work for us instead of letting us do it, they become responsible for the outcomes if we aren’t given the time or the tools we, as the ones who went to school, know we need.
The cure for physician burnout is simple: Listen to us when we say what we need in order to do our best. We didn’t spend all this time and energy so we could collect our salaries and goof off.
Most of us still have a professional mindset. We want to do a good job and we know how to do it. Let us.
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.
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In his or her life, a physician will have many many patients. I can barely imagine how many people will suffer economic damages, lose their heath or even life because they visit a bad physician. The root cause of physician burnout lies in the rating system for doctors. The system is supposed to focus on the efficiency a doctor treats a patient, rather than only the number of patients he or she treats. I learned about a company committed to antibody affinity maturation services (https://www.creative-biolabs.com/Nanobody-Affinity-Maturation.html). I think it’s done well in this aspect. Perhaps it’s important to assess the morality and sense of responsibility of the physicians by interviewing their patients.
Why don’t more docs open or join concierge practices? How many doctors work in markets with sufficient market opportunity to support such practices?
“The root cause of physician burnout is incredibly concrete – it is the business model by which we deliver care in the US.”
No.
The root cause of physician burnout is incredibly concrete – it is the business model by which we deliver care in the US. The Fee-For-Service ecosystem naturally pushes providers to maximize visit volume and schedule density to their breaking point. As a result, physicians have to see more and more patients every day in order to keep up with what management expects. Additionally, this leads to a more complex payment system and technology optimized for billing rather than physician workflows. A move to Value-Based Care can help alleviate many of these challenges: https://www.techprescribed.com/all-posts/emr-business-models-112018. The challenge – physicians will need to be evaluated on performance measures and will also need to focus more on care coordination. Many will not adapt well to this new system.
In my northern Maine practice, very few specialists are available. I handle way more than an urban primary care doctor. And much of what I wrote applies to anyone doing primary care. My point is we can’t set our schedules or determine the pace of our work, and the people who organize our work are not held responsible when we are overbooked More and more this is also the situation specialists work under as they become employed by large healthcare organizations.
It’s been a long time since I’ve needed a real PC doc. All my (minor) health problems have been done with PAs or NPs, from diagnosis to prescriptions. Clinics with real docs have hired the PAs and NPs as front line first responders, so to speak. I’m not sure what the real docs are doing behind the curtain. For really complicated stuff of course I go directly to a specialist.