So many people are suggesting that if only doctors practice self-care we could deflect burn out before it overtakes us. Yes, physicians are probably the worst professionals for taking care of ourselves. We work long hours, answer calls at all hours of the night, take little vacation, work in stressful situations, and often face hostility in the workplace. But this is not the reason we are burning out at high rates; we have thrived under these same conditions since medical school. Honestly, I don’t think I had more than 3 hours of sleep a night during medical school. And in residency, I once went 3 straight nights of call, ER rotation, family medicine clinic, repeat with 0 hours of sleep. Yes, it was stressful and exhausting but that’s all that it was: stressful and exhausting. Telling me to sleep better is not going to cure my, and I suspect most other physicians’, burn out, because we have spent most of our years of study and subsequent careers existing on limited, interrupted sleep.
Many people suggest yoga and meditation to overcome the flames of burn out. While it may work for some, I am not particularly well-balanced enough to do yoga (once took 2 people down trying to balance on one leg in some awkward pose) and my mind never stops long enough to meditate. Sure, getting some form of exercise can improve our mental outlook. But, it is not going to help my patient who has been fighting her insurance company for three years now to get a hip replacement to ease her progressive pain so she can go back to work. It’s not going to ease my frustration of having to switch my patient from Advair to Flovent because the insurance company won’t pay otherwise: they are not even the same class of medication! Nor is it going to help me not bring home work with me because I now have to click off a multitude of check boxes in the EHR or the government will say I’m not doing my work and financially penalize me. Yes, doctors should exercise because it is healthy but that isn’t going to fix the problems causing our burn out.
Others suggest eating healthy as a means to alleviate this growing problem. Again, reducing carbs is not going to help my patient get the MRI they need. Reducing fat is not going to pay for my patient’s surgery after the insurance company refused to pay the bill after deeming it “not medically necessary”, after the surgery was already done. What do I tell my patient when they come to me crying that they don’t know how they are going to afford to pay the astronomically absurd bill? Go vegan? Doctors should eat healthy because everyone should. But, it is not going to fix physician burn out.
Is practicing “self-care” going to ease my burn out? Not unless it can fix any of those things that are creating it. I am not burning out from lack of exercise, eating non-nutritious food, or working long hours in a stressful environment. I am burning out because I took an oath to give my patients the best care, to do no harm. Yet, all too often obstacles are placed in the road that prevents me from doing that. Please stop telling me to eat more veggies and meditate to avoid burn out! What I need is for someone to tell me how to convince the insurance company to let my patients have a few more weeks of physical therapy or to cover that CT scan for my patient with abdominal pain. If you can do that, you’ve just solved the burn out crisis for most physicians.
Copyright secured by Digiprove © 2018 Linda Girgis, MD, FAAFP
I’m absolutely AMAZED to read the comments of other physicians who read this article, agree with the problem- then suggest complete government control of healthcare as the solution!? Are you daft?!
The biggest culprit of denying patient services or medications- i.e. Impeding patient care, and causing us burnout- is GOVERNMENT INSURANCE. That is the biggest problem with most socialized healthcare systems. The delivery of timely and appropriate healthcare is terrible. Not to mention the bureaucracy, the red tape, and the reduced wages that inevitably follow! How can the solution be more of what is causing the problem?
Can we please do a better job at diagnosing and treating this issue?
The problem with American healthcare is both cost, and 3rd party systems making healthcare choices based on money. instead of us and our patients making the decisions, it is a financially incentivized organization making the call, not based on the patient’s wellbeing, not on sound medical judgement- but on a bottom line. This applies to governments trying to reduce cost just as much as it does to private insurance trying to make money.
The solution will require some way to take back control of medical decision making away from these 3rd party leaches, while targeting the real drivers of high medical costs- Medical equipment manufacturers, pharmaceuticals, and hosptial system waste.
I burned out twice in my 33 year career, at 40 and at 58. All for the reasons discussed above. I noticed they are have an 86% success in treating PTSD with MDMA. They just went to Phase 3 trials. I wonder if that would help for burnout? Any psychiatrists out there?
Hello Gordon,
I’m a Neurologist too & I understand cutting work load as one get older! As I said, I think the BURNOUT concept is the wrong terminology! Over work burnout is very well known! No brainer buddy!!
What we are talking about is how MIDICINE has been taken over by BIG CORPORATE AMERICA!
HOSPITALS, INSURANCE/MANAGED CARE & BIG PHARMA!! WALL STREET, SUPERMAN!
Can you hear yourself talking, you’r In your 70’s & you still don’t feel financially secure to retire??
That’s what I’m talking about, unfortunately, physicians lack of business acumen! Physicians are pushed to a corner, keep working, take whatever is thrown your way , keep your mouth closed, bite your tongue & be pissed all the time!! Every body hates EMR, yet it thrown in our way regardless of what we think! The list goes on & on!
Buddy, your ACADEMIC background is why you don’t understand the BUSINESS of MEDICINE! Just to ease your mind I got an EMBA!!
I’m glad you’re happy with the status quo! No thanks to the ACADEMICIANS, it’s their lack of business attributes that led the younger trainees without any knowledge as to what’s involved in the REAL WORLD?
I wish you well buddy! Hope you get to become financially secure enough to retire by the time you hit the next decade of professional career!!
Remember, it’s NOT a BURNOUT, it’s a PLOT!
Have a good life!
Sam Kabbani, MD, CMD, FAADEP…..
No, Sam, I am financially secure enough to retire. And I was age age 65. I’m still in it because I like neurology enough that I don’t want to totally give it up. I don’t let hospitals tell me what to do. I tell them what I am willing to do if they want a neurologist. They are desperate enough to agree. Obviously, I can’t be completely unreasonable. For example, I take no call. I will only work day shift. Some of them don’t like that, but they can hire tele neurology at night. Their other option would be to hire tele neurology 24/7, as they can’t find local neurologists willing to cover them. Their ER docs and hospitalists don’t find that acceptable.
Buddy, I’m you? I don’t take call & I don’t let the Hospital tell me what to do either! I work 20 hours a week, out patient ONLY, by choice!
There’s shortage of neurologists! In the current PRACTICAL NEUROLOGY journal, you should read my response to an article
“Neurologists Needed”!
Gordon, I think you’re still missing the point!
Today’s practicing MEDICINE problem is NOT BURNOUT, it’s a PLOT premeditated, planned & excuted by HEALTH CARE EXECUTIVES!
Why do you think the shortage of NEUROLOGISTS & lack of appeal of NEUROLOGY??
UNCLE SAM..
Neurology never had large appeal. The main problem now is financial. Most students have large debts and cognitive specialites don’t bring in enough money to pay them off quickly. So they flock to dermatology, radiology and other procedure oriented specialties. There are also shortages in fields like endocrinology.
Most health care executives aren’t smart enough to put together any kind of effective plot. And what plotting they do is against their rival health systems, whom they hate. They would love for there to be a surplus of neurologists, so they wouldn’t have to pay us so much.
Hahaha! You really think they’re paying you/us a lot ha ha??
Of course if you compare that to Academic pay, ok, may be you’re getting little more! But don’t kid yourself, you’re not being reimbursed enough, even though you may think you are?
Executives are behind all the PA’s, denials, Audits, Adjustments, Refunds Generic versus Brand name drugs & the list goes on & on! Don’t forget EMR, which is hated universally by most Docs.!!
I Agree, PHYSICIANS are smarter, but NOT in BUSINESS!!
Uncle Sam..
I don’t know Sam. I think $1750 for a 10 hour shift is reasonable. That’s what hospitals are paying for neurologists now. I agree being the sole proprietor of a private practice would not be the way to go in this environment. In fact some of the large group practices around here have dissolved as the neurologists make a lot more as employees. I’m not saying the business people aren’t going to try to maximize their profits at the expense of patients and docs. Of course they are. The only way to stop that would be to take it out of the market by having the government run it all or at least regulate prices and wages. But then the government would try to keep costs down, so you would be in the same fight. You could go cash only, but that only works in markets with a lot rich people. I don’t see any way out of this.
Excellent. We’re not going to yoga, mindfulness, exercise, team work. etc. ourselves out of this mess. If the problem is so widespread, then it is structural — that means inherent in the business model of American medical care. Profit oriented and squeezing every last ounce of productivity out of the health care work force while a few at the top of the food chain make billions and shift the blame for burn out on everyone else. A reasonable first step would be to establish an authentic Medicare For All (not some coopted watered down version) and that would give us a platform to begin fixing many other problems.
20 years ago, when I left academics for private practice, I realized that I had to be careful or I would burn out long before I was ready financially to retire. I am now almost 75 years old, and I still haven’t burned out. I still like medicine. I still work 1 day per week in clinic and do neurohospitalist locums no more than 5 days per month.
I first chose a town to practice in where there was zero competition. I was the only neurologist and I was welcomed and greatly appreciated. I chose a town where the medical community was composed of docs who valued their leisure time and very few worked more than 4 days per week in clinic. I chose a hospital that did not expect me to come in at all hours to see patients. I set my clinic hours as 9AM to 4PM with a 90 minute lunch hour. I took Wednesday entirely off. I chose an area of the country (Oregon) with great recreational opportunities. At age 65, I cut down to 3 days per week. At age 67, I had the hospital take over my practice, they hired a young neurologist, and I went down to 2 days per week, and the hospital pays me a set fee for each clinic patient or consult I do, regardless of what they collect. I started doing locums occasionally (in the local area). At 70 went to 1 day per week. So far, this is sustainable. Yes, I still have the frustration of clinic patients not getting the authorizations needed. I still have to write notes much larger than I normally would or the billing people both in hospital and clinic get upset. But all in all, it is still better than retiring and no longer contributing in the face of severe shortages of neurologists.
Long term, I think it is that fact that I managed my practice time with an eye to not getting overworked and burned out. I may have not made as much money as I could have if I worked harder, but then again, maybe I would have burned out and had to retire and not made any money at all after that.
Hope this helps some of you.
Physicians ,so called, BURNOUT is FRUSTRATION rather than burnout! It’s 2 folds,
ADMINISTRATIVE & ECONOMIC!
Stumbling blocks along every step of the way!
Not being reimbursed for work we done & delivered!
It was a predetermined & premeditated decision, since the so called “ HEALTH CARE REFORM “!
The idea of weakening PHYSICIANS grip on the Health Care DOLLAR! The GOAL of course was to cut down the cost of HEALTH CARE!
Of we all know what happened, Health Care Cost went up Exponentially & still going up!
Hospitals, insurance companies & BIG PHARMA, got all the POWER, CONTROL &a whole lot mor MONEY 💰
Physicians as usual were busy taking sides & snap shots at each other, for their own silly benefits!
Different specialties, different interests & different ALLIANCES! At the end PHYSICIANS & there PATIENTS where the BIG LOOSER!
PHYSICIANS have BIG EGOS & little BUSINESS ACUMEN!
So , go ahead call it a BURNOUT?
I call it a PLOT!
Sam Kabbani, MD, CMD, FAADEP.
Indeed, it seems to be a very real plot.
I just retired (2 weeks ago) before;
My moc was due in three specialties
My repeat certs in bls, acls, fluoro, sedation, and privileging
They got rid of my non clinical time and forced me to open new clinics
Before they implemented “new” ideas that I had tried multiple times and failed over the last 20 years even though I told the new leadership so
They changed the 2 EMRs again forcing me to learn another system
Before they reorganized the departments again
Before they assigned me new committee meetings
I retired along with my other experienced peers
That is not burnout—even though some would apply the term, that is rational decision making
I hope you enjoy your retirement. I’m too far away to consider that route.
You win the Internet. A decision I shortly face as well. My line-of-work is being turned into a “specialty”. Instead of grandfathering those of us who practice it in – we all have to take another Board exam. I will be in my early 60’s. It’s ludicrous.
The physicians who are most affected by burnout are the ones who want to practice real medicine. The physician who does a careful history and physical, who listens to and educates a patient, who practices cost effective medicine and actually pursues an accurate diagnosis. The current system’s abuse is greatest for these physicians. And they are typically the ones who have been in practice long before EMR/EHR was forced upon us.
The current system does not value or reward a physician who pursues a specific diagnosis in what I call the Osler tradition of medicine. In the current system, the diagnosis is irrelevant because everything is a diagnosis. Administrators and bean counters look at numbers and want increasing numbers of patients run through their clinics. Procedures, procedures, and more procedures are what feed the bottom line. The RVU defines your worth. Government has all but taken over. It is no surprise to me that physicians are increasingly having problems with burnout. And no amount of exercise, yoga, meditation, or a specific type of diet is going to change that. The current trend is to add thousands of woefully undertrained mid-level providers who will eventually become “independent practitioners” in most states. I don’t see improvement in the near future.
Dr Linda, I wholeheartedly agree with what you wrote ! And I can see where Dr Plotzker is coming from. Burnout is a fuzzy condition. One day may feel worse than another. I try to practice self-care, but work-life schedules don’t allow me to “schedule” selfcare in, unless I drop something else. Self-care happens if there is an opening in my day, before I crash in bed from exhaustion.
As a solo pediatrician, with 1 NP to help me with the patient load, I see my abilities to maintain what I have built for over 21 years slowly being eroded. Now, I can no longer allow my NP to see patients if I am not in office ( here goes any time off !!!) lest I take a 15% paycut !
When will it end? NEVER !
I agree with Dr Doyle, It is time to jump ship and save ourselves, cause we sure can’t save the ship ! It is sinking fast, and no political administration is going to save it…..Alas !
It will be people like Dr Linda, and us who will prompt for changes, or create them by changing the model of practice. I am seriously thinking of only accepting cash/credit cards in my clinic. Yes, I will have fewer patients, and I will be able to take vacation once again ! ( I haven’t had a real time off in 5 years !)
What do you think? Could I make it work? Or will I go bankrupt for lack of clients?
There is so much to consider….
I feel your pain. There have been many doctors who made going cash only work. I personally would have a hard time doing it because I would lose patients that have been with me more than a decade. I care about my patients. That’s what all there regulations don’t get.
Thank you! I am a neurologist and I just folded my practice. I can’t take the red tape-insurance-EMR Purgatory that has become modern medicine. We are treading chronic illness water. Nothing we do makes a difference anymore because the things that do make a difference have so many barriers to overcome, it often isn’t possible to get there. But mostly nothing makes a difference anymore and who cares anyway cause nobody is paying for those things that don’t make a difference. And nobody is paying for those things that do make a difference. Basically no one is paying.
As a doctor in private practice, I feel what you are saying. So sorry you had to fold your practice and I think many of us are not far behind. But, you made a difference to many patients. No one else may see it but you did. And that is the essence of being a good doctor. Yes, it is hard to get our patients the care they need. You tried your best and that is all any of us can do.
Many will want to say burnout is mainly for those who have been at it a while EMRs, new scheduling practices, overtaking of administration are all to blame. Yet I’m only 5 years in. And I feel it. I thrived in residency enjoyed long night shifts, caring for cardiac patients in the PICU, etc. But 5 years out now and I already see changes in expectations. And it is not on patient loads I tend to finish tier 3 or 4 every year with RVUs so I’m not padding my schedule at all. I like being busy. As long as busy makes sense.
As soon as medicine became more focused on administration and what the patients want and not on what physicians feel is the best way to do things, we all became salesmen and not what we trained to be. Yes sick patients can stress us, but constant prior auto requirements, focus on patient satisfaction over doing your job right (or physician satisfaction), etc has changed the medicine landscape. And no amount of eating healthy or meditation is going to change that.
The definition of stress (ie. burn out) is taking responsibility for something you have no authority over! Either give me back authority over medical decision-making…Or I won’t take responsibility for what happens to my patients. You can’t have it both ways!
Linda,
I feel your pain (and frustration.)
It may also be necessary that we define what we understand with burnout.
Hospital authorities, Med schools, and Health insurance companies, and (dispassionate) medical literature are quick to say, or imply, “burnout” under MDs are signs and symptoms of individuals who are weak, incompetent, and past their prime. Many of us differ on that. Burnout can also be the result of abuse in health care.
I argue we must practice excellent “self-care” for more than preventing burnout. (Sensible eating, remaining seriously fit, better sleep health, spiritual & emotional renewal several times a week.)
The list is long: (1.) For ourselves. It keeps us sane, not only professionally, but personally. In enables us to bounce back. It enables us to “fill with resources.” It’s impossible to keep pouring from a jug, keep giving, without filling up, without renewal. It helps us keep our sense of humour. (No. it’s not easy—it is crucial.) (2.) For our loved ones. (3) For our patients. (4) To make and proof a point to the (subtle/and not so subtle) abuse of medical schools, colleges, hospitals, and Health insurers. It is crucial to not let the aggressor gain power over our sense of self-worth and believing we are weaklings, remaining victims. Self-care in this scenario is crucial.
Perhaps its time, if the different role players in healthcare are serious, to solve the pressing problem (and the cost) of escalating burnout under physicians to address the systematic and institutionalized abuse of power, making the MD the scapegoat, paying the price.
It’s about changing the culture in government.
Changing the culture in Health Insurance.
Changing the culture in Med schools & hospitals.
It can be done.
Is the political and moral will there?
Not if the different role players continue to see medicine as a mere business and making your million.
Scant ethics. Little, if any compassion. Anemic morals.
And we claim we are in the healing profession.
First do no harm.
We can change that.
It’s a choice we make every day.
In the meantime, I will look after myself (and yes, speak up!)
Yes, this!! I agree that if we work to pull our stress down below our threshold for falling apart or decompensating (whether that means needing to take a mental health day, losing our temper when generally we wouldn’t, or feeling physical effects of anxiety) by practicing routine self care (and it differs for each of us…it doesn’t have to be yoga, good doctor!), we will be in a position of having a buffer to work with to keep us on the sane and reasonable side of things. When we are squarely on the side of sane and reasonable, we will reason, negotiate and problem solve better, set better examples for those who support us professionally and those who are “growing up” in medicine, and have more good to offer all with whom we have the privilege of associating.
I am coming from 14 years of working in a very stressful Emergency Department environment and now a year of practicing a new specialty under daunting circumstances that are completely out of my control. To pretend that our burnout comes from any one thing (fighting with insurance companies for approval and similar struggles, for example) is fooling ourselves. To look on this life of no rest, chronic exhaustion and never ending stress and abuse as “normal,” “expected,” and “what we’re used to,” is where the mindset needs to change. Just because we can function under those circumstances doesn’t mean we should continue to try to. As we seek to practice self care, we seek to find our BEST selves to share with our patients whom we serve. And maybe, just maybe, under those circumstances there will be some good of us left to take home to our families and our quiet times once the day’s professional obligations are through.
Having retired four months ago, planned five years in advance as the prospect of burnout became very real, the first thing I did was set a treadmill schedule and a daily breakfast. I felt better. And I probably retired at the chosen time without burnout.
Respectfully, I might question whether the impedimenths to initiation of patient plans really underlies this. My first job our of residency was with the VA, eight relatively content years there with mostly respect for my professional colleagues if not the many functionaries that get to the down elevator first at 430PM weekdays. Impediments abound. Restricted formularies, equipment still on order for two years, surgical consultants that never see an undraped patient or a pre-op referral themselves. It is a land of process, yet an experience that many residents and medical students like myself found endearing and a pretty collegial self-contained atmosphere despite its dark side. That’s not really what burns people out. My work, whatever I wished were better, always struck me as meaningful and a challenge to my skill and a challenge to my tenacity.
Burnout as I understand it, and the definition remains fuzzy, has been a more recent phenomenon, affecting people in late career more than early or midcareer. It involves loss of what you previously had, be it autonomy, control of scheduling, your own practice, ability to admit your own office patients to the hospital as their attending physician, being part of medicine’s pageant from drug rep logo pens to committee assignments. We were trusted to use other people’s resources, whether hospitalization, prescriptions, consultations. Now the trust has atrophied. We deplete the insurer’s resources rather than manage them and therefore need barriers in the minds of those who fund the care. We no longer ponder the nature of the physical signs that we observe, just click the box that notes they are there. Or too often don’t even bother to do that, or make the Type 1 error instead, clicking the box that says no dysuria, when we never asked and they really do have that dysuria that we could have helped. That’s the origins of burnout and why it is more intrusive among physicians who once had more favorable working conditions which gives them that irretrievable loss.
A-fookin’-men.
I left medicine, and I was a decent doc. Most of us are. But when the chief physician suggested I take anxiolytics (“everybody else in the department is on them”), I realized the inmates had taken over the asylum.
https://doyle-scienceteach.blogspot.com/2016/08/why-i-left-medicine-to-teach.html
Dr Doyle, what are you doing instead of practicing medicine? I am also looking for a way out of this Asylum….
I teach in a public high school now.
Very Cool ! Do you counsel the youngsters to stay away from a career in medicine, like I do with my own children?
I tell them to follow their dreams.