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Physicians Find Relief from Burnout in DPC

Physicians Find Relief from Burnout in DPC

Harp music plays through the phone as patients hold for the office of internist Garrison Bliss, MD. Bliss is one of the nation's first physicians to practice in a membership model where patients pay for their care on a monthly retainer basis, widely known as direct primary care.

Visitors to his practice website are greeted by a graphic bearing just his last name, with the "i" in Bliss formed by drips that had fallen gently into rings of nearly-still waters.

This type of "bliss" isn't too common in practices nowadays, with the physician burnout rate rising to unforeseen levels. Nearly 63 percent of practice-owning physicians reported somewhat or very negative morale in a 2016 survey by The Physicians Foundation. Overall, a majority, about 54 percent of all 17,236 physicians, reported negative morale.

Bliss, who studied philosophy and biology in college, and his staff saw their own stress levels going down when he first started using DPC in the late 1990s. Typically, DPC practices don't contract with insurers, but charge patients a flat monthly fee for most routine care.

"One of the first things we noticed when we started was how quiet the office was," Bliss recalls. "It went dead calm, and people weren't running up and down the halls. A lot of the stuff we used to spend time doing didn't need to happen anymore, such as prior authorizations."

Over the next couple of decades, Bliss built out the model, first in his own Seattle practice and then with venture capital partners, he spread it to other locations around the country. Today he cares for his own patient panel, about 400 people, most of them long-time patients.

"It's wonderfully comfortable. When I get called (after hours) it's often somebody I've known 30 years," he says, which alleviates the worry of dealing with new patients he has to screen as potential narcotics seekers.

With stress and burnout being a major concerns in practicing medicine, DPC is one option for physicians to change their day-to-day routine while reigniting their love for medicine.

And while the morale numbers are disturbing, they are actually better than in 2012, when more than 68 percent of all physicians reported negative morale, according to the same Physicians Foundation study.

Some DPC physicians do find that it replaces one stress with another, however. Internist Inaam Schneider, MD, based out of Raleigh, N.C., says the stress of running a private practice drove her out several years ago.

"I had up to 3,000 patients and seven employees and still found it difficult to make enough money to survive," she says. "I was extremely tired, maybe sleeping six hours a night."

Schneider also struggled to keep up with medical records and doing complete work-ups on patients in the allotted 15 minutes in her schedule. She says she had to see that many patients each day just to keep her office doors open. "You end up getting behind [on charting], tired and irritable," she says. "The physician is becoming just a referral specialist and there's no enjoyment in practicing."

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