There is growing recognition that the broken American health care system is taking a toll, not just on patients and their families, but on health care professionals as well. Nearly half of all physicians in various surveys now report that they are burned out. Inevitably, the experts are lining up to further study the issue and to teach doctors better coping skills.
In terms of the need for further study, I am but a simple country doctor, but I think the issues are pretty clear. If you punch someone in the face, they're going to get a black eye. And if you try to practice good medicine in our terrible health care system, you're going to get very frustrated, often to the point of burnout.
Burnout is a simple case of physicians' lofty expectations meeting up with the disappointing reality of the American health care system.
In medical school we are given the impression that medicine is a sacred pursuit. It is traditional at many medical schools to begin a student's experience with a white coat ceremony, where we are given our pure-as-snow new uniforms and invoke an oath to do no harm and to give every patient the best care possible. It is a powerful, emotional experience. We talk about medicine as a calling rather than a profession. We then receive intense, prolonged years of training, at great expense, but leave medical school armed to help people, who are often in dire straits, with a well-honed history and physical exam, and an amazing array of modern tests and treatments.
But then, once in practice, reality quickly takes hold. We are driven to maximize revenue in the setting of a payment system so complicated that it often takes Herculean effort just to get paid. At the same time we are badgered to minimize spending on patient care, but have no control over, or even knowledge of, the costs of care. There are barriers to the best patient care at every turn—patients unable to afford the care they need, inscrutable insurance coverage, tests and treatments priced far beyond almost anyone’s ability to pay for them, and now, lengthy insurance prior authorization processes for even basic tests and treatments. As if all that wasn’t enough, we are also forced by government mandate to use unusable EMR computer systems to report unattainable quality metrics. We are incessantly belittled that our care lacks value in a system designed to destroy value. And despite everything, if anything should happen to go wrong, we can still be sued.
Under these circumstances, burnout is inevitable. We are truly damned if we do, and damned if we don’t. We carry on our shoulders the responsibility for patients’ lives—to do no harm in a harmful health care system.
What can physicians suffering from the effects of burnout do to mitigate the situation? Experts suggest things like getting more sleep, learning to meditate, exercising regularly, learning to say no, learning to value the small things in life, recognizing that things could be worse, and learning better time management skills, just to name a few.
These are wonderful suggestions that will be incredibly effective as long as while we are doing them, we also fix the broken health care system that is the source of the burnout in the first place!
If we really want to reduce burnout among physicians, we will:
Simplify the American medical coding, billing, and payment system.
Remove the myriad barriers to patient care, enabling doctors to make decisions based on what they (and their patients) feel is in the patient’s best interests.
Finally enact legislation that brings affordable, comprehensive care to all.
Eliminate prior authorizations for all but truly exceptional tests and treatments.
Eliminate payment bundling strategies that encourage us to skimp on necessary care.
Create some semblance of functional health care markets.
Require transparent pricing so that decisions can be made based on cost when feasible.
Limit the size and/or monopolistic power and practices of the largest health care entities, including insurance companies, pharmaceutical companies, and health systems.
Create a functional, usable EMR that delivers on the great promise of health IT, and then give it, at low or no cost, to all who want it.
Eliminate value-based payment programs like MACRA until we have a functional health care system and health IT tools that make value attainable.
Avoid payment penalties that would discourage doctors from taking care of the sickest, poorest patients.
Avoid payment strategies, like bundling, that encourage physicians to skimp on necessary care.
Once and for all, create a reasonable malpractice system that protects patients, but also encourages improvements in care.
There should be no surprise that American physicians are burned out. And therapy and self-help strategies aren’t the answer. The answer is fixing the broken American health care system.