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In Practice

Is physician burnout really a problem?

Dan Page for The Boston Globe

The doctor will see you now — but he or she won’t be happy about it.

At least that’s what the popular news site, The Daily Beast, contends. An item published last month grimly titled “How Being a Doctor Became the Most Miserable Profession” cited high suicide rates among physicians and increasing numbers of doctors retiring early and leaving medicine for the corporate world as evidence of widespread misery among my colleagues. Loss of respect and autonomy, decreased insurance reimbursements, and larger administrative burdens — some imposed by new medical documentation requirements under the Affordable Care Act — are said to contribute to our alleged burnout.

Also last month, an editorial appeared in The Wall Street Journal titled “A Doctor’s Declaration of Independence.” An orthopedic surgeon called for physicians to say, essentially: “We’re mad as hell and we’re not going to take it anymore!” Dr. Daniel F. Craviotto Jr. claimed: “I don’t know about other physicians but I am tired — tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces.”

Craviotto recommended radical action by doctors, such as refusing to accept insurance, including Medicare, until our grievances are addressed.

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I have mixed feelings about these articles, and many similar recent ones touting how awful my job has supposedly become.

On the one hand, I feel validated. There’s no question that practicing medicine isn’t as much fun as it was even five years ago. New regulations and restrictions issued by government agencies, insurance companies, and professional organizations mean I now spend time I’d rather spend with patients checking boxes, populating templates, and dialing 800 numbers.

Also, because of decreasing reimbursements, physicians are now under pressure to see patients more quickly than ever before. A primary care doctor now spends an average of 12 minutes with each patient. That’s not much time in which to see someone with a long list of complex medical problems and medications and numerous questions and complaints — not to mention a life story, tricky family dynamics, and photos of grandchildren to share.

More busywork combined with shorter visits make me feel perpetually rushed, which makes both me and my patients unhappy. Studies show that a rushed physician is more likely to make mistakes. A more pernicious effect is that when a doctor is in a hurry he or she is less likely to fully engage a patient.

For example, not long ago, I met a new patient who had a fairly simple medical history but who’d suffered much pain and loss. I found myself resisting the temptation to save time by not probing those emotions too deeply, even though I knew that doing so would forge a bond between us, a bond that would help me be a better doctor to this patient — the kind of bond that is, to me, the most satisfying part of medicine.

Still, I think that while the Daily Beast and others accurately convey, to some extent, the concerns of many physicians, they do so in an overly dramatic and misleading way.

Take the assertion that high suicide rates among doctors reflect decreasing job satisfaction. It’s true that 300 to 400 American doctors kill themselves every year. But high suicide rates among physicians have been noted for decades and have been attributed to uncontrolled depression, not job dissatisfaction. Doctors often feel embarrassed about seeking psychiatric care from their colleagues or fear that the stigma of a psychiatric diagnosis will jeopardize their livelihoods. This fear is well-founded. It’s only recently that most state medical licensing boards have stopped requiring physicians to report whether they’ve ever received mental health care — information that has been passed along to insurance companies and hospitals.

Physicians retire early, elect to work part-time, and opt out of practice for many reasons besides “misery,” including a need to care for family, a desire to explore other interests, and to seek higher salaries to pay off the six-figure debt that medical trainees, on average, incur.

The tedium associated with current medical practice is irksome, but not entirely new. My dad, who was a solo practitioner in the 1950s through 1980s, did more paperwork than I’ll ever do. He spent hours at home every night dictating notes and letters into a clunky IBM dictaphone. And I’m just old enough to remember the early days of hospital computing systems when gathering a patient’s data involved calling or even walking from lab to lab.

I’m not denying that my colleagues and I are frustrated by changes in medicine, but that frustration is more nuanced and more counterbalanced by joy than most media coverage reflects.

In a recent conversation with several colleagues about professional burnout I was struck by the fact that different people felt burned out by different things: for some it was filling out forms, for others it was being scrutinized by bureaucrats. For me, it’s being the target of anger and suspicion that seem so prevalent in society today. I appreciate patients informing and advocating for themselves. I don’t appreciate patients arguing with me about anatomy and physiology — or my motives.

Many of my colleagues said that burnout isn’t an all-or-nothing state, that they felt burned out on certain days but that often, after a vacation or even one meaningful patient encounter, they’re rejuvenated.

Interestingly, a friend of mine who’s a public school teacher told me The Daily Beast piece captured the current mood of her profession. I’ve spoken to people in many fields who feel more pressured and less appreciated in recent years.

I wonder if physicians are really no more burned out than anyone else. Maybe we get written about because people find it fascinating — or even a little gratifying? — that highly trained people who do rewarding work with good job security and relatively generous pay can be as unhappy as everyone else.

Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. She can be reached at inpracticemd@gmail.com.
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