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……


Problem solved.

Mic drop.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  12 comments for “Fixing Physician Burnout

  1. Cynthia Savage
    August 11, 2016 at 3:11 pm

    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.

    • Doug Farrago
      August 11, 2016 at 3:24 pm

      You should look into DPC

  2. L. J. Sloss, M.D.
    August 11, 2016 at 11:22 am

    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.”)

  3. JA
    August 11, 2016 at 10:30 am

    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

    • Doug Farrago
      August 11, 2016 at 12:57 pm

      You have no idea what you are talking about.

    • Pat
      August 11, 2016 at 5:15 pm

      JA, what is your line of work?

  4. John Kelly, MD
    August 10, 2016 at 3:57 pm

    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.

  5. H
    August 10, 2016 at 11:52 am

    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!

    • H Kenneth Fisher MD
      August 11, 2016 at 7:04 pm

      Bravo ! You’ve identified the head of the nail, and hit it!

  6. Perry
    August 10, 2016 at 9:09 am

    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.

    • Perry
      August 10, 2016 at 9:11 am

      Oh yeah, trash MOC and recertification.

  7. Pat
    August 10, 2016 at 8:03 am

    Yeah, this AAFP editorial made for such good satire, I thought it could have been in the Placebo Journal.

Comments are closed.