This article is the second in a three-part series on physician burnout. The first installment focused on the financial costs of physician burnout. This second article focuses on the human or personal side of physician burnout.
In early 2019, Dr. Miller was preparing to quit his hospital-owned practice near Cincinnati to launch his own concierge practice (we’ve changed his name to protect his privacy). Dr. Miller loved his patients, he didn’t want to do this, but he was trapped in a patient care model that was failing him. He found it impossible to provide the care he wanted to his patients while maintaining a life outside of medicine. The updating of patient’s charts in the EHR was totally dominating his evenings and weekends. He was single and hadn’t been on a date in months.
As his frustration and dissatisfaction peaked, he decided to make the difficult change to a concierge model. The disruption for him, his patients, and his soon-to-be-former employer would be very costly, but he just couldn’t take it anymore.
Sadly, stories like Dr. Miller’s are repeated all across the country. Long-term unresolved job stress has led doctors to feel exhausted, overwhelmed, cynical, and detached. A recent Mayo Clinic Proceedings article concluded that doctors are 50% more likely to battle emotional exhaustion than the average American worker. Primary care physicians are particularly susceptible – they’re 40% more likely to experience burnout than specialists.
As a result, many physicians are looking for an exit. They are seeking administrative jobs to reduce patient time or have accepted a half-day or even a full day of “admin catchup time” to avoid the negative impact on their families, to the detriment of their paycheck. Other doctors are simply retiring earlier than planned to escape the grind. Still others are transitioning to different practice models altogether. Many fantasize about quitting medicine and starting a new career. Collectively, these escapes reduce patient access without solving the underlying problems that precipitate burnout.
For physicians that are unable to escape, many feel the walls closing in month after month. They become disenchanted with their profession, even hating medicine. They detach from their families and friends. Medscape’s National Physician Burnout & Suicide Report of 2019 found nearly 4% of US doctors (35,000!) are clinically depressed. Tragically, some have even turned to suicide to end the misery. One doctor commits suicide in the U.S. every day – the highest suicide rate of any profession. And the number of doctor suicides – 28 to 40 per 100,000 – is more than twice that of the general population. It’s no surprise that solving physician burnout ranks in the top 5 on most hospital CEO’s list of priorities.
Burnout starts with long hours: the average physician works 52.6 hours per week, or 30% more than the average US worker. It’s even worse for the 40% of doctors that work more than 60 hours each week. However, having persevered through medical school, long hours are not the sole cause of burnout. The nature of the work is just as much of an issue. With more and more time dedicated to data entry in EHR charts, many doctors have gradually lost their personal connection with their patients – they’ve lost the “Joy of Practicing Medicine”.
The tremendous pressure to close charts causes many physicians to feel they are simply a cog in the healthcare machine with no higher purpose than capturing revenue. They long for the day when they felt like a valuable knowledge resource, like a practitioner of medicine with an essential vocation. What they thought they were signing up for is NOT what they are experiencing.
Physicians’ families have a front row seat to the destructive power of burnout. Spouses, kids, parents, and friends all see the internal battle between a desire to deliver quality care for their patients and their need for a personal life.
After a full day of patient visits (often feeling pressured and running behind by the end of the day), many physicians come home, feed the kids, help with homework, rush the kids to bed, and then jump back on the computer for 2-3 hours of additional chart work. Spouses are forced to pick up the slack, often causing more stress and friction at home.
Burnout manifests itself in increased isolation, greater irritability, more time away from home, less communication, less time together, a drop in physical intimacy, and emotional separation. Frayed relationships at home only add more pressure on the physician. A real-world solution is desperately needed.
Given the breadth and depth of the problem, a variety of solutions have been tested to combat physician burnout, often having little or no effect. Sadly, many so-called solutions fail to tackle the underlying issues and instead apply “Band-aids” like meditation, breathing exercises, and relaxation techniques.
A recent InCrowd Survey asked physicians what they wanted their hospital administrators to do to help them combat physician burnout. Their #1 response (at nearly 66%) was to add more staff to help ease the administrative/documentation burden. Any serious attempt at solving the burnout problem needs to take this information seriously.
One common approach is hiring a scribe for each physician to interface with the EHR, a bit like a “human app” added to the computer. While this is a step in the right direction, the scribe model comes with a significant limitation: because the doctor is still in the exam room throughout the entirety of every patient visit, scribes don’t provide a boost in productivity sufficient to pay for their additional cost. As a result, hospital executives choosing this solution simply add more cost to primary care offices which are usually already operating deeply in the red.
A better and more financially sustainable solution is to implement the Team Care Medicine (TCM) Model. The TCM Model is gaining traction nationwide and has been proven to significantly boost physician productivity and reduce/eliminate physician overtime (often referred to as “pajama time”). For example, a six-doctor primary care practice in the Midwest launched the TCM Model and within six months had reduced average “pajama time” by nearly 80% (see below).
Even as they reduced after-hours work, these providers were able to see more patients each day. As illustrated below, their average visit volume increased by 35%.
Best of all, these physicians are experiencing a restored “Joy of Practicing Medicine”. They’re reestablishing connections with their patients and with their families. Remarking on happy physicians, happy patients, and happy administrators, one doctor called it a “Win, win, win!”
After launching the TCM Model, Dr. Miller abandoned his plan to switch to concierge medicine. With his charts current before the end of each workday, he’s started exercising again and is enjoying a long-term romantic relationship. This was unthinkable just 6 months earlier!
The TCM Model has been implemented in hundreds of doctor’s practices across the country. Here are just a few of their comments about its benefits.
“The executives and administrators see the upside of increased productivity, the quality of care is better and I’m having fun. I enjoy practicing medicine again.”
Patrick Anderson, MD
“[Now] I go home with nothing to do but play with my children and I have no reason to come in on Saturday.”
Travis Howell, MD
“I realized this was the model we needed to adopt. Not only for our patients, but also for our own well-being.”
William Byars, MD
“As for my personal side, the TCM Model allows me to have a life outside of medicine, which I didn’t have before.”
Dick Albert, MD
“I love it…I am having ‘fun’ again!”
Jerry Dempsey, MD
In the TCM Model, the role of the physician is upgraded from overloaded work horse to team captain. The clinical support staff (usually MAs) are equipped to operate up to the limit of their license, performing 7 new skills that relieve the physician of unnecessary administrative burden. With a larger team of higher functioning clinical support staff, the physician is able to focus on the patient (not the EHR), to focus on diagnosis and care decisions (the reasons they went to med school), while the MA experiences more meaningful work and the practice enjoys higher revenues. For more information, go to www.teamcaremedicine.com.