Not too long ago, a physician left his job at a large health system. It was a loss for the medical community, because of how excellent a doctor he is. He travelled out of state for a few months, only to come back to his home state and restart clinical practice in a different city. It was great news, because many patients would benefit from this excellent physician coming back to do what he received years of training to do – treat patients who are in need of care.
When asked about what caused him to depart from his job some months ago, and what made him come back, the bright doctor replied that he was tired of the bureaucracy and stress surrounding medical practice. He only came back because taking care of people has always been his passion, and he just could not let the exhaustion overcome his desire to practice medicine. He took some time off, re-energized himself, and started seeing patients again. He kept his answer short, not going into the details of the “bureaucracy” and the reasons for “stress”. It was a clear case of physician burnout.
Not all physicians are able to come back to practice, after they suffer from “burnout”. Physician burnout is increasingly common. Many doctors leave, to pursue other careers.[i] Doctors these days are under a lot of pressure, because of the growing set of responsibilities they have – handling paperwork, learning new technology (such as electronic health records systems), overseeing clinical staff, working under time constraints, understanding insurance coverages, following federal and state rules and guidelines, dealing with lawsuits, and more. These are all in addition to the primary responsibility of a doctor – treating patients.
The relationship between a doctor and a patient is special – it is a relationship of trust. When a patient goes to a doctor, the patient may have to reveal many private aspects of his/her life, so that the doctor may carefully understand and assess the individual’s physical and mental health needs, and advise accordingly. The relationship requires listening carefully, paying attention to details, and prescribing the best course of action to achieve a desired outcome. Strengthening this relationship, particularly in the case of primary care doctors, may take time. And, when a doctor, in today’s day and age, is seeing hundreds and thousands of patients, it is increasingly challenging for the doctor to exercise patience and careful listening. Furthermore, constantly listening to people’s problems and health issues, and seeing fellow human beings going through pain and suffering can be very stressful and overwhelming at times. Add, on top of these, all the other responsibilities, which I mentioned in the previous paragraph, that a doctor has. It is easy to understand why doctors suffer from burnout, while striving to uphold the true meaning of the doctor-patient relationship.
Burnout is a serious problem facing doctors. Burnout is associated with exhaustion, cynicism, detachment from patients, etc. It is also claimed that burnout is more common among doctors than other professionals.[ii] Dr. Pauline Chen, in a 2011 article in the New York Times, highlights a research that surveyed more than 7,000 surgeons and found that nearly one in four were in the middle of litigation. She further writes that surgeons “involved in a recent lawsuit were more likely to suffer from depression and burnout, including feeling of emotional exhaustion and detachment, a low sense of accomplishment and even thoughts of suicide.”[iii] Dr. Ben George, an oncologist in Colorado, explains that he spends nearly 60 percent of his time (while with a patient) checking boxes on a computer to meet insurance and regulatory requirements.[iv] For these professionals who have been trained to treat patients and not perform such administrative tasks, these burdensome responsibilities may lead to burnout.
Physician burnout adversely impacts patients by reducing access to and quality of care. Citing national data, Dr. Donna Sullivan, a retired physician and past president of Northern Colorado Medical Society, explains that up to 30 percent of physicians are leaving the practice of medicine and about 55 percent of older physicians are choosing early retirement because of “emotional exhaustion, a feeling of ineffectiveness and compassion fatigue”.[v] The Agency of Healthcare Research and Quality of the United States Department of Health and Human Services also concludes that physicians who experience a burnout are more likely to leave practice. The agency further suggests that if burnt out doctors continue practice, patient safety and quality of care may be reduced greatly, as the practitioners can suffer from a variety of problems such as impaired attention and memory issues.[vi] Burnout can lead to poor decisions and medical errors.[vii] Physician burnout is detrimental for both the practitioner and the patient. A recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, suggesting the extreme importance of producing and retaining skilled doctors in the practice of medicine, to continue meeting patient needs.[viii] Burnout experienced by doctors will further exacerbate the shortage.
The issue of physician burnout has reached a point where leaders in the medical community have called it “a matter of utmost urgency”. According to a recent study, more than 50 percent of doctors in the United States reported experiencing at least one symptom of burnout. This data was used as evidence to claim that burnout is becoming “a national health crisis”.[ix]
The three most important factors in the discussion of healthcare are cost, access, and quality. If physician burnout continues, then we will likely see more and more doctors exiting the practice of medicine, which will reduce access. Burnout also affects quality, as burnt out doctors are not able to operate at their full potential when treating patients. Also, doctors are scarce resources – it takes many years of education and training to produce a doctor. And, as principles of economics would tell us, the more scarce the resource, the more expensive it would be. Therefore, if burnout leads to more doctors leaving practice, then we should not be surprised to see healthcare costs go up.
Physician burnout is a serious issue. The problem has grown over the years, due to the complex nature of clinical practice. As our country looks at increasing people’s access to high quality care, while reigning in cost of healthcare, it is extremely important that we address the issue of physician burnout.