Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

This is why physicians are burning out

Thomas Paine, MD
Physician
March 21, 2015
Share
Tweet
Share

shutterstock_141195013

American physicians have had it.  We are retiring early, cutting back, changing careers, and moping in to work in astounding numbers.  The typical pep talks, whether given aloud by medical directors and administrators or consisting of internal dialog occurring in the physician’s mind, are not working anymore.  “You have it better than most people.”  “You are still making good money.”  “Your patients still need you.”  “It will get better.” “You invested a lot of time, money, blood, sweat, and tears into this.”   “This is the path you chose, and it isn’t as bad as you think.”

As physicians, we hear phrases like this frequently, even if we are only saying them to ourselves.  Trouble is, these pep talks aren’t working.  Physicians don’t become more satisfied and less burned out after a meeting or a few encouraging words.

Amazingly, time spent at work is not the main predictor of burnout.  The work environment is a much stronger predictor.  Work environments that are high demand, low control, and low support are most likely to cause burnout.  The trend in American medicine over last two decades has certainly brought more demand, less control, and less support for the U.S. physician.  Could this be why we are burning out at an alarming rate?

Physicians handed over their administrative and financial duties to businessmen from the late 1980s through the 2000s.  The centuries-old model of the physician “hanging a shingle” and evaluating/treating patients paying out-of-pocket (and providing charity care) is officially dead in America.  Physicians are altruistic scientists by nature, not businessmen.  This paradigm shift seemed like a great idea at first, but where has it brought us?  Health care is now an industry run by businesspeople, instead of a healing art orchestrated by scientists.  The bottom line is the most important factor — revenue vs. expenditures.  CEOs and administrators in non-profit health care systems make multi-million dollar salaries.  The doctors most certainly do not, but should any worker in a non-profit organization make 5 to 10 million dollars per year?

Physicians have slowly but surely lost control.  As the control slipped away, physicians lost all say regarding demands placed upon them.  Doctors also gave away the right to decide how much support we need, as well as the skill level of the people supporting us.  In summary, physicians have given away control, while allowing support to dwindle, yet have accepted increased demands.  Is it any wonder that we have burned out?

I talk to many of my physician colleagues about our current path as American doctors.  We frequently discuss the minor, but unending changes mandated by “the brass.”  These slow changes forced upon us are akin to beach erosion.  A single wave doesn’t do much to change the shape of a particular beach, but millions of them spread over a period of years can render an entire coastline unrecognizable.  If we could take physicians who practiced twenty years ago and drop them into clinical jobs today, they would be appalled at their inability to make decisions regarding how they practice.   Administration now decides when we work, whether our clinics are open on weekends and for evening sessions, how many minutes we have to see each patient, how many patients we must see per day, how much money we make, whether or not we can order a test we feel is indicated, which computer system we use (no matter how onerous), how much they can cut support staff, and which patients we will see.  As doctors, isn’t this kind of our gig?

Our altruistic policy of always doing what is best for the patient, coupled with our unwillingness to deal with the administrative and financial side of health care has landed us all in our current situation.  Health care is now a business, and we find ourselves in the comically futile position of begging businessmen to do what is best for us and our patients.  First and foremost, the businessmen care about the balance sheet.  Why should we expect them to honor our requests?  We have allowed ourselves to be backed into a corner, not realizing that we still hold the ace of spades.  In a business sense, we have the unique knowledge base and skill set that generate the revenue in the first place.  People will pay for our advice and our technical skill.

The modern day pioneers of medicine are the ones leaving the traditional health care model of insurance companies, mega health care systems, 10-minute appointments, worthless metrics, and hoop-jumping in order to get paid.  I have the utmost respect for these doctors, for they have taken a leap of faith.  I am sure that the leap is the correct one, as they have reclaimed control of that most sacred aspect of medicine: the doctor-patient relationship.  I hope and pray that their collective vision inspires a grassroots movement to practice “outside the system.”  Once big insurance companies and mega-health system administrators lose enough revenue, doctors will win enough bargaining chips to regain the ability to practice medicine as we see fit.

Thomas Paine is an emergency physician.

Image credit: Shutterstock.com

Prev

The vexing problem of dying for the medical profession

March 21, 2015 Kevin 10
…
Next

A thank you to a mother and son in the ER

March 22, 2015 Kevin 1
…

Tagged as: Emergency Medicine, Hospital-Based Medicine, Primary Care

Post navigation

< Previous Post
The vexing problem of dying for the medical profession
Next Post >
A thank you to a mother and son in the ER

ADVERTISEMENT

More by Thomas Paine, MD

  • Telemedicine encounters inherently sacrifice quality

    Thomas Paine, MD
  • How to destroy a great ER: A step by step guide

    Thomas Paine, MD
  • This is critical advice for doctors today: “You’ve gotta like your patients”

    Thomas Paine, MD

More in Physician

  • How restrictive opioid policies worsen the crisis

    Kayvan Haddadan, MD
  • The dying man who gave me flowers changed how I see care

    Augusta Uwah, MD
  • How market forces fracture millennial physicians’ careers

    Shannon Meron, MD
  • Unity in primary care: Why I believe physicians and NPs/PAs must work together toward the same goal

    Jerina Gani, MD, MPH
  • Guilty until proven innocent? My experience with a state medical board.

    Jeffrey Hatef, Jr., MD
  • How to balance clinical duties with building a startup

    Arlen Meyers, MD, MBA
  • Most Popular

  • Past Week

    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • How denial of hypertension endangers lives and what doctors can do

      Dr. Aminat O. Akintola | Conditions
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • When recurrent UTIs might actually be bladder cancer

      Fara Bellows, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why doctors should rethink investing compared to the average U.S. investor [PODCAST]

      The Podcast by KevinMD | Podcast
    • How chronic stress harms the heart in minority communities

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • The dying man who gave me flowers changed how I see care

      Augusta Uwah, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 31 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • How denial of hypertension endangers lives and what doctors can do

      Dr. Aminat O. Akintola | Conditions
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • When recurrent UTIs might actually be bladder cancer

      Fara Bellows, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why doctors should rethink investing compared to the average U.S. investor [PODCAST]

      The Podcast by KevinMD | Podcast
    • How chronic stress harms the heart in minority communities

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • The dying man who gave me flowers changed how I see care

      Augusta Uwah, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

This is why physicians are burning out
31 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...