Fixing Physician Burnout
I wanted to just use three words: Direct Primary Care and then do a mic drop but I couldn’t help laughing at the AAFP’s Family Practice Management editor’s view on the subject. Here are his thoughts:
What are some of the causes of burnout? Payment, documentation, and regulatory requirements; inefficient technology and workflows; excessive and often inappropriate administrative paperwork; and lack of control.
What are some potential solutions?
- Payment mechanisms that reward physicians for doing things more efficiently, including payments for e-messaging, phone calls, and telemedicine.
- Standardizing quality metrics, formularies, and prior authorization rules.
- Government payment initiatives that don’t constantly threaten physicians’ financial security.
- Government regulations that give physicians more, not less, say in the health systems in which they work.
- To date, physician-led accountable care organizations have been more successful than hospital-based ones.
- Incentives that promote better electronic health record usability.
- Better teamwork, delegation, and workflows.
- Tort reform.
- Simplification of documentation requirements.
If you were a reader of this blog over the past 14 years then you would know that the AAFP was a major part of the causes listed! They were complicit in NOT defending us against this bureaucratic nightmare. And his solutions? Efficiency, metrics, ACOs, EHR usability incentives, teamwork, etc. Sounds like more of the same. Good luck in fixing that burnout thing. Or you can recommend……
DIRECT PRIMARY CARE.
Problem solved.
Mic drop.
The fix is easy but it is unpalatable to most docs. My grandfather practiced as a pediatrician for 50 years. He never took insurance but his office visit was never more than a few dollars a visit. Patients do not believe doctors need to earn 5-6 times more than a teacher or a nurse. I plan to practice medicine only until my kids graduate college. After that, if I work, it will be a cash only practice and I’m prepared to see my income drop considerably. Because docs are increasingly seen as overpaid. The market we want, one of freedom of practice and no barriers betwixt doc and patient, will be one in which we drive Chevys and not Mercedes.
You should look into DPC
Here is a response I wrote on a related topic in STAT:
Q: What recommendations do you have for medical schools and hospitals to prevent depression and suicide?
I think the linchpin issue is to recognize and respect the value of the individual and to support originality, independence and personal responsibility over the homogenization, intolerance for differences of opinion, and “interchangeable widget” treatment of medical trainees and their fate as faceless data clerks at the service of a billing-system-centric EMR. Economic parameters need to be adjusted to remove the enormous advantages and leverage of large medical systems versus patient centered individual and small practice settings that are preferred by physicians and patients alike. Administrative overhead, both in terms of overpopulated management hierarchies and disproportionate salaries, needs to be radically trimmed and the entire health care system reoriented to the care of the patient and service and responsibility to the community at large. Academic medical centers must see to it that clinical departments are run by distinguished and active clinicians and not by grant-funded researchers who have little to contribute to the care of patients and contempt for the sweaty drudges who do that kind of work. In addition to the ready availability of support services including mentoring and counseling, the medical workspace at every level needs to be cleansed of the atmosphere of fear, coercion and depersonalization (including the term “provider.”)
Oh sure Lets all chase patients for payment Sounds like fun Duh Yeah then lets watch their behavior about entitlement DPC may work for a few It is no panacea The editorial was excellent
You have no idea what you are talking about.
JA, what is your line of work?
When the stated end result is that medical care is going to cost less, you can bet that physicians’ pay will be cut, or the equivalent, there will be reporting duties to yet another entity which small, direct primary care physicians cannot squeeze out of their day and will be stiffed out of payment. No, we must have industrial care, with 7 patients an hour or you’re fired by some junior M.B.A.
The reason doctors burn out is because the tasks we are asked to either complete or box click etc in EMR are without meaning. When work is meaningful, burn out is reduced. The most meaningful things we do with patients, listening to their stories/ narratives and ascertaining what is most important to them in treatment, do not have a billable code…although it is the reason most of us entered into medicine in the first place …burn out at an all time high!
Bravo ! You’ve identified the head of the nail, and hit it!
First, get government the hell out of the practice of medicine.
Second, EHRs are not the be all end all solution to any of our problems, only cause more if anything.
Third, forget ACOs period. Conflict of interest from physician to patient.
Fourth, don’t simplify documentation requirements, abolish them. Other than what is necessary for the physician patient encounter.
Tort reform can stay.
Oh yeah, trash MOC and recertification.
Yeah, this AAFP editorial made for such good satire, I thought it could have been in the Placebo Journal.