As a primary care physician at one of the nation’s leading academic medical centers I’m still hanging on.
Over my 32 years, I’ve seen how my ability to interact with patients has been diminished by an ever-encroaching health care system. There’s a clock keeping track of how much time a patient’s chart is open. I have less than 15 minutes on average to assess my patient’s symptoms and discuss treatment options, and I see about 110 patients a week. All in all, I spend about 35 hours seeing patients and another 20 to 30 hours a week on documentation. It’s easy to lose sight of who you are and what you originally trained to become.
When the door closes on a patient visit, it’s a ménage a trois: me, my patient and the ever-intrusive computer. A patient recently asked me if I ever get away from the computer and I had to admit that I don’t. I can’t. Even on vacation when I’m supposed to be taking a break and recharging.
That’s the cost of being part of a health care system. When I was in private practice, my colleagues could cover my time off, and there was a financial incentive for them to do so. That’s not the way it works now because each of us is just trying to keep our own head above water.
I see the effects of physician burnout all the time and yet I’ve somehow escaped it. Maybe the reason is that my practice is a hybrid of primary care and endocrinology. As a primary care physician, I’ve learned how to make my patient visits efficient, how to see more patients and to schedule patients so that complicated cases aren’t stacked and how not to depend on labs to boost revenue. As an endocrinologist, I see referral patients, and I also develop and teach CMEs. That revalidates me. It also keeps me up to date in my specialty and in my work as an internist.
But my type of practice probably won’t even exist in 10 years. I think the evolution of health care will not be based on a patient-physician relationship. Instead, it will be a patient-system relationship. Patients won’t really have an individual connection with their physician; they will be managed by a team so they might see a nurse practitioner or a physician assistant instead because it’s more efficient. Efficiency is the engine of health care systems.
I could easily be burned out. But I’m not. I guess that’s because deep down I believe that life for myself and my patients really is dear. I haven’t lost sight of the fundamental aspect of internal medicine which is the individualized knowledge of patients. There is something sacrosanct about the relationship between me and my patients. Once they become anonymous to me, I’m no longer a good physician. That’s when I’ll ride off.
Mark W. Stolar is an internal medicine and endocrinology physician.
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