Physician a burnout has great current interest.  Many authors are worrying about burnout and therefore writing about this problem.

What are the common root causes of burnout?  Primarily burnout comes from loss of control and overwhelming undesirable activities.

Burnout occurs when the job becomes overwhelming.

Burnout likely is increasing because many physicians feel that they do not control their lives.  Too often the current finances of medicine “force” physicians to spend inadequate time with patients.

Administrators often encourage this behavior.  Too many administrators have examined overhead and income, and their analysis argues that physicians should spend less time with each patient.  But good physicians know that their professional responsibility requires more time with each patient.  This conflict, in my opinion, leads to burnout.

I write often that our payment system is flawed.  While I have not been this explicit before, I would argue that our payment system, especially for outpatient internists and family physicians, is a leading cause of burnout!

Physicians are high achievers.  We want to do our best possible job.  When external forces prevent us from doing the job properly, then we have psychological distress.

Talk with a physician who leaves the “grind” and turns to retainer medicine.  These physicians are much happier with their patient interactions.

Some physicians will develop burnout in any situation.  Most of these physicians have chosen a specialty that does not fit their personality.  Obviously if the specialty does not fit the physician burnout is inevitable.

But we can and should decrease burnout through a better understanding of who physicians are.  Therefore I accuse both CMS and the major insurers of a major unintended consequence.  We have too many physicians leaving or avoiding outpatient practice because they have developed burnout, or they understand that the job as currently constructed would cause burnout.

Until we improve the working conditions for family physicians and outpatient internists we will continue to promulgate this problem.

If my diagnosis is correct, then the treatment is clear.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.