Physician Burnout Symptomatic of Healthcare's Current State

August 23, 2012

The backbone of our healthcare system - the physician - is in trouble, as physicians struggle to cope with forces of market and government-induced reform.

The Mayo Clinic recently conducted a survey to quantify how many physicians show signs of burnout; of approximately 7,300 respondents, almost half did.

Their conclusion – the practice of medicine should be more of a team approach. Mayo has thrived on a consensus approach to care, but Mayo is not representative of the rest of the U.S. where 60 percent of physicians practice in groups of six or less.

We read about this in an e-mailed USA Today article sent by a colleague. He thought it was important, and he is correct - it is. Not for the obvious conclusion, but for the validation that the backbone of our healthcare system is in trouble, as physicians struggle to cope with forces of market and government-induced reform.

Whether or not this sounds like you, read on. Our observations will be either informative or cathartic.

The pressure on physicians comes from many directions. Too many or too few patients; insufficient and dwindling reimbursements; uncertainty; frustration; a struggling economy; second-guessing by insurers, regulators, and trial lawyers; practice, hospital, and peer politics; overreaching and overreacting regulation; financial woes; speculation; failed purpose syndrome; misinformation; too much information; inadequate time to properly care for patients; a looming flood of Medicaid patients; 78 million baby boomers becoming Medicare eligible at the rate of 10,000 patients a day; and the list goes on.

The degree of change is individual, the combination is regional, and the problem is national.

Today’s system trains and equips physicians to practice medicine exquisitely and to deploy the best technologies, but it fails miserably to prepare them for the business side of practicing medicine, leaving many vulnerable and increasingly easy prey, and fully liable, for changes mandated by others.

We have watched this build over nearly two generations, much of it from our respective perches in the C-suites and as physician leaders and defenders, and today on the front lines as advisors and weekly commentators.

Many practices have become insular with almost a siege mentality, while others have become suspicious of outsiders, resigned, or are whistling past the battle lines as if nothing has changed, or will.

Then, there are those who have dropped out, gone to other careers, retired, or taken jobs with hospitals or clinics. In the words of Skip Holtz, the University of South Florida’s head football coach, “The grass is always greener on the other side until you have to mow it.”

This is not a “woe is me” moment; it is a clear and present danger to the healthcare delivery system and much of it is self-inflicted, particularly the growing problems with alcohol and substance abuse.

As individuals and small groups, physicians, like anyone or anything, are relatively powerless against large systems on a mission, even well intentioned ones.

The attitude of the large systems is often that eggs have to be broken to make an omelet. This is all well and good until you’re one of the eggs, sitting nestled in your little cubby in the carton, all alone and easy pickings.

It’s when the eggs team up with the chickens that things get interesting.

To spare us all from continuing with this analogy, strength is in numbers, and voices are heard only when one speaks up.

Burnout occurs when someone else is in control. It is often reversed when one has or is represented with an equal seat at the table. Every specialty is organized; every state has a medical association. Being involved and getting that seat at the table is more than therapeutic for those on the road to burnout; it is the missing link to a functional and sustainable healthcare system.

Richard Reece, M.D. is the author of "The Health Reform Maze."

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