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Physician Burnout and Round-the-Clock Primary Care


Certainly physicians want to be responsive to their patients. But they shouldn't provide 24/7 "on-demand" services like Amazon.

Most of you are familiar with Dr. Richard Ferber's groundbreaking and often controversial method for sleep training babies 3 months to 5 months of age. Here at Performance Pediatrics we are fans of Dr. Ferber and conversations about "Ferberizing" one's baby is a standard part of our well-baby exams. In fact, Dr. Ferber's book, of which we have several copies, is the most popular title in our patient lending library.

Dr. Ferber's method for sleep training a baby benefits not only the baby itself, but almost more importantly, the parent. Using his method, parents teach babies to self-sooth themselves to sleep, and as a result, sleep more soundly and regularly. More critically, however, when a baby sleeps through the night, so does the parent.

Like sleep-deprived parents of infants who reject Dr. Ferber's method, we see our fellow physicians experiencing burnout at record numbers. You work too many hours with little professional satisfaction and limited financial benefit. We have used this blog many times to call for a single-payer healthcare system to remove the endless and useless paperwork created by the money-sucking American health insurance industry. That is not, however, what we're focusing on today. For while we share with you the burden that is health insurance, we don't relate to the other main contributor to your physician burnout: the inability to achieve work/life balance.

We work 40 hours a week, Monday to Friday, 9 a.m. to 5 p.m. We close our practice for every federal holiday and we take three weeks to four weeks of vacation each year. We've been successfully practicing this way for 10 years, and while it's not without its challenges, we make as much, if not more, money as similar physician practices in our community. How do we do it? Well, basically, we "Ferberized" our patients' parents into believing they can manage some of their children's healthcare at home.

From the day our office opened in 2006 we thought of it as our job to triage our patients effectively and teach their parents to manage some care at home. This has resulted in fewer unnecessary sick visits, fewer phone calls, improved and less expensive care, and, here's the key, improved physician satisfaction. We are available when our patients need us, but we are not always available when our patients wantus.

According to the Institute of Medicine, America's overuse of healthcare services costs nearly $300 billion a year. And while extended and weekend hours provide "convenience care" to a demanding public, extended hours have been shown to encourage patients to run to the doctor for every minor symptom they experience. Our current healthcare system trains patients to "feel better fast" by running to the nearest ER with an advertised short wait time, urgent care clinic, or buy the newest over-the-counter snake oil remedy. Contrary to popular advertising, a typical cold lasts 7 days to 10 days. It's time we take a page from Dr. Ferber and teach our patients to self-sooth.

Rumor has it that our quality contracts and new ACO contracts will encourage our practice to stay open longer and provide weekend hours; to be available "whenever" our patients want us. We believe extended hours will increase unnecessary care which will increase costs and lead to more physician burnout.

So ask yourselves: Does primary care really need to be totally accessible 365 days a year, with very early and very late hours? Won't we all sleep better and lower our burnout rate if we help our patients lower their unrealistic expectations of being "picked up" every time they cry out?

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