Doctor Burnout

This doesn't involve spinning rear tires leaving the high school parking lot!

Report Underscores Impact Of Burnout On Physicians In US 

Health Exec(1/30, Baxter) reports:

“Burnout is having a devastating impact on clinicians, with more than half of U.S. doctors saying they know a colleague who has left clinical care,” and “nearly one-third have said they have considered leaving their clinical care profession as well.” These data, from the “US Physician Feelings on Burnout 2022 Report published by InCrowd, underscores the rising impact of burnout on healthcare staff,” finding that “in late 2022, 30% of U.S. physicians said they feel burned out, compared to 23% the year before.” Also, “mental health is another worrisome area among U.S. clinicians, as 32% said their mental health has suffered over the last 18 months.”

This post caused me to reflect on my own training, my 49 years in practice, and the current state health care in our great country.

The media tries to control the language, always the first step in controlling the populace. Russian Communism controlled their people with brutality and with PRAVDA.  (Quick go look it up.. “Pravda” is a word in Russian that means “TRUTH” – yeh, right. Thus, the Russian Media, newspaper, Radio Moscow all spread “Pravda.”) They defined the “truth” so therefore anything else was untrue. American, Canadian, and Australian communists have changed that word to “misinformation.” Same thing.

So, there is lots of hand wringing about the ongoing “doctor burnout.”  When talking with my peers (same age roughly, trained in the era of hard work, and mostly retired), we reminisce about our experiences both in training and in practice. Actually we have so many stories from our residency at Lackland AFB - general surgery, five years (1972-1977)… and just as many with the time with Dr DeBakey - two more years in Houston.. 1981-1983. So many stories we always threaten to “write a book!” Needless to say we refer to doctors training today as — little female kitty cats.. (You know what I mean).

We the “old farts” tended to go into academia or private practice. The big multi -megabucks health care industries didn’t exist that much in the 1970s. But today - the “mega” hospital corporations employ >70% of the US physician work force. Those mega-hospitals are run by 2-yr wonder MBAs plus or minus an MD degree. The MD credentials often get left at the door when the MD/MBA “doctor” becomes an administrator. As administrators, they can quickly draw or interpret an Ishikawa chart, always have an old TQM (Total Quality Management) diploma on the office wall and know how to “run” meetings.  As a hospital commander in the USAFR even I had to take the TQM-like training: how Japanese car manufacturers took over most of the US’s market!  General McPeak was our commander. We “rebels” had to rename TQM.. called it “To Quote McPeak” - but I am getting off the tract here.

Back to the health mega corporations… They “employ” >70% of the doctors in America today.  These employed doctors appreciate several benefits not enjoyed by physicians in private practice: predictable workday, weekends off unless “on call,” prescribed vacation days per the management, board fees, meeting allowances, secretarial support, uniforms, and other overhead costs are covered. The salaries of the employed doctors are negotiated and might or might not involve a bonus if work output is high enough to impress the leadership.

Private practice on the other hand means the doctor owns the practice finances his own overhead:  rent, utilities, salaries for nurses and secretaries and technicians, medications used, uniforms, internet, equipment, stethoscopes, computers, billing, and collection - basically everything. In return for hospital privileges, private practice doctors may not get a penny from the hospital for being “on call” but must agree to be available for emergencies.  If a hospital has two neurosurgeons each gets to take “call” 50% of the time!  Beside the physical demands, the financial risk (billing, collection) is borne by the private practitioner: he must come if called and take all comers regardless of insurance status.

So, one might think that private practitioners are more prone to BURNOUT than employed physicians, and it does happen.  But BURNOUT is more prevalent among the latter, young physicians who prefer employment.  I think this observation represents a lack of resilience in the young doctors of today due to “wimpy” training that includes hyper-supervision and a lack being “responsible” during their last years of residency.  In a recent survey, 60% of graduates from General Surgery training programs felt “uncomfortable” being “alone” in the operating room (without faculty supervision).

Though young physicians are computer literate and computer competent, the EMR (electronic medical record) plays a role in burnout.  Even the best of EMRs remain cumbersome, time consuming, takes the doc away from the bedside.  The nonsensical data input flow frustrates and slows down the clinical flow– “the computer doesn’t think like a doctor”.  To address this failing, more and more doctors are using “scribes”—- young 20 something year old students who stand next to the doctor and enter data as he examines and talks to patients. (Please realize when I say “he” it could very well be a “she”) I am not going to make this a pronoun test… Point is the EMR is indeed recognized as part of the problem. In the last month or so New England Journal of Medicine (NEJM) had an article about how the “sepsis alert” function in the EPIC program was wrong 67% of the time. Yes, you see that alarm come up so often and you investigate and it is a nothing.. after a while one gets “alert fatigue” and quits looking. That is just one item. I ran across it preparing for my upcoming surgical lecture on removal of infected and dysfunctional pacemaker leads over the last decade… We had such high hopes that “Artificial intelligence” would help us identify these patients. I guess not. Computer fatigue is recognized.

“MENTAL HEALTH” issues may also play a role in physician BURNOUT.  COVID19 and governmental and corporate response to it are largely responsible.  Recently, over 160,000 nurses have left their healing profession. Tragic and wasteful I would say. What has happened?  Well, some health care workers said, “I will work and care for these sick folks at my own risk, but I will not take the “shot.” [Hint - it is NOT a vaccine – (lie number 1), and it doesn’t work) -lie number 2). and the list goes on.]

So the big shot government, big shot academic institutions. and big shot hospital systems declare “thou shalt take the vaccine!” or be fired or be kicked off the staff/faculty/etc… AND. if you speak out against it you are spreading “misinformation” and thus we will not only deprive you of “privileges”, thus income, but we can and will (California) remove your license to practice medicine (or your being hired as a hospital nurse). Readers remind me - isn’t there some “restraint of trade” laws that maybe were broken? Federal Trade Commission?

If you are reading this, you know about the truth spreaders: FLCCC, Dr. Malone, also fellow Dallas cardiologist Dr. Peter McCullough, non-doctors like Steve Kirsch, and others -  the list is long. We were right and I love Elon Musk’s preferred pronouns: TOLD/YOU/SO —

So healthcare workers were basically fired and then labeled as a mental case if they opened their mouth and spoke out against the insanity. The accusers were the hospital executive 2-yr wonder MBAs, the government doctors in high political positions (who haven’t touched a stethoscope or read an EKG in 30 yrs!), academic institutional and professional association leaders who may draw a professors salary - (but honestly don’t know how to sign onto their EMR - even if they are still practicing.) They would say “patient care? that is for the young associate professors and residents to do: “I don’t have time for rounds on ‘my’ patients cause I have to go to Boston or Basel or Hawaii for the upcoming American Board of __________ fill in the blank.  Or, “I’ve got to go to Washington DC to finalize our XX million dollar health care grant, or go to Aruba with the CEO of “Pharma” company to set up a grant from them to our department”  They are the big shots!

President Obama’s desire to make all health care systems equal is well underway, and BURNOUT is contributing.  American medicine is being dragged toward the level of the Cuban barefoot doctor medical system.