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Join Dike Drummond, a family practice physician, burnout survivor, and executive coach. In this episode, we’ll delve into the future of health care in the United States, discussing workforce demographics, the impact of burnout, the role of AI, and the potential collapse of existing health care entities. Get ready for insightful perspectives and actionable insights as we explore the critical questions facing the health care industry in 2023 and beyond.

Dike Drummond is a Mayo-trained family practice physician, burnout survivor, executive coach, consultant, and founder of TheHappyMD.com.

He discusses the KevinMD article, “The future of U.S. health care: 2030 and beyond.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Dike Drummond. He’s a family physician, burnout survivor, executive coach and founder of TheHappyMD.com. Today’s KevinMD article is titled “The future of U.S. health care: 2030 and beyond.” Dike, welcome to the show.

Dike Drummond: Well, thanks for having me. This is an exciting topic.

Kevin Pho: Dike, you are one of the foremost experts when it comes to clinician burnout, and I see you everywhere with your workshops, your keynotes and your talks, and you’ve helped thousands and thousands of clinicians. Tell us a little about your story and journey.

Dike Drummond: Well, I did medical school at Mayo. Mayo’s got a tiny little medical school on the Rochester campus. I did my family practice residency in the UC Davis system in California, then 10 years of full-service family practice in Mount Vernon, Washington, which is north of Seattle. I delivered 250 babies as an old-school, full-service small-town doc. I burned out of my practice in the year 2000, when I was 40 years old, and then I got certified as a coach, and I’ve been coaching doctors and entrepreneurs for about 23 years now. I started the website The Happy MD back in 2010, and it was meant to be an oxymoron: The Happy MD. There are no happy MDs, so you’d have to click and see what it’s about, right?

Since then, I’ve focused every ounce of my professional life on helping doctors and organizations recognize and prevent burnout. At this point I’ve trained about 40,000 doctors for about 175 organizations on four different continents. We train wellness champions to go in and build this strategy inside the organization, and we’ve learned a whole bunch of stuff and honed it down so it’s easy to learn, easy to implement and works every time. A lot of times, the conversations in my communities these days go like this: How is this all going to work out? What in the world is health care going to look like in 2030? It’s a fascinating question, especially if you are not going to retire between now and 2030.

Kevin Pho: Yeah, and some of the demographic statistics are just amazing. So you’ve been involved in the clinician burnout space for decades now. You’re one of the first physicians I can think of who was involved in this space, and now you see so many clinicians going into coaching, and we have so many episodes on this podcast and articles on my site talking about burnout. Tell me about the evolution, some of the trends that you’ve seen over the last 10 or 20-plus years you’ve been involved in this intersection.

Dike Drummond: Well, let’s go back to before the EMR, and before 73 percent of doctors became employees. Back in the day, when I practiced in the 1990s, the doctors owned the practice, and there wasn’t any EMR. Even then, historical research shows that the average burnout rate on a particular day was about one in three. So doctors do burn out, just like everybody does. It’s just that when a doctor burns out, it affects their performance in a way that hurts a lot of different people: their teams, their patients, their own families and all of that.

The EMR came along and doubled the workload of the practice. It turned all of us into data entry clerks, because it wasn’t designed by anybody who knew anything about seeing patients. Then we got to a point where, in 2017, over 50 percent of doctors were employees, and these days it’s about 73 or 74 percent. So all the autonomy we used to have back when we owned our practices has been taken away. You’re swinging in the breeze, controlled by the business model and the revenue model of your employer, and you’re being asked to use the evil that is the EMR to document everything. And now here’s the big thing: Right now you’re short-staffed.

Emergency rooms around the United States these days are sort of like a mini scene of the evacuation from Afghanistan, simply because the hospital behind the ER doesn’t have enough nurses to open all the beds. So all the ERs in town are on divert, and there are 23 people being roomed in the back hallways. It’s really a bit of a FUBAR experience to be in the ER in some places around here.

In the meantime, everybody and their uncle has jumped on the prevent-burnout, physician well-being bandwagon. We’ve got the usual major institutional suspects, like the AMA, the National Academy of Medicine and the Surgeon General, and the usual cadre of academics publishing study after study, not necessarily giving the average doctor anything usable, because an academic’s job is to do research, not necessarily to catalyze transformation. That’s what a coach does.

There are also a couple of coach trainers out there who will teach you how to be a coach and who focus specifically on doctors who want to get out of practicing medicine, positioning it as an exit ramp from the need to see patients. One of the statistics I published in this blog post is an interesting one, because these coach trainers specifically target female doctors: Statistics show that within seven years of graduating from their residency program, 40 percent of female physicians will either go part-time or step away from medicine. So it’s an obvious market: Give the disaffected a tool and promise that they’ll be able to make a living doing it. That’s not very common. It’s never been common for coaches. If you look at the coaching industry, it’s always been easier to make money training people to be coaches than it is to be a coach who makes a living serving the folks you want to help. The challenge has always been a marketing and client attraction challenge.

Right now we have six coaches who work with me, all of whom are doctors and are certified by the ICF as executive coaches. It used to be that I was the only person out there positioned as a physician and a coach for burned-out doctors, and now everybody’s stepped in. But guess what? The trajectory of the burnout rate has not been bent. We haven’t moved the needle. Coaching doctors who are struggling through their workweek is an interesting phenomenon, because we know there’s a huge need. There are about 950,000 doctors in America, and the latest study, done in 2021, shows a 63 percent burnout rate.

Kevin Pho: How many doctors is that? 600,000 or so?

Dike Drummond: Yeah. Well, that’s the size of the need. But how many of those doctors are going to take steps in their own interest to hire a coach, restructure their workday, build a more ideal practice and make a difference? How many organizations are going to do something to improve the physician experience within the walls of their treatment centers? That’s the real thing that is upsetting to me, and it’s the nature of American business. If I’m a CEO, CMO or chief wellness officer and I go on LinkedIn, what am I going to talk about? I’m going to talk about how great we are and everything we’re doing. But you know what? I don’t want to talk to those people. I want to go out into their organization, out to the front line, far away from the mother ship, and ask the doctors who are seeing patients today, “Does your organization have your back?” And I am not hearing a lot of that.

Kevin Pho: Your KevinMD article is titled “The future of U.S. health care: 2030 and beyond.” You mentioned that there are some alarming trends, and if we don’t change this trajectory, by 2030 we may be in a situation even more dire than the one we’re in now. Tell us more about that.

Dike Drummond: No, the dire nature of the situation between now and 2030 is guaranteed, simply because of the demographics. We have a big bulge of boomer doctors moving into their retirement years, and many of them are made, and what I mean is that they’re financially free. They don’t have to work any longer. The thing we have in our favor is that it’s really hard for doctors to retire. If they retired when they became financially free, rather than being gripped by their practice and not knowing what else to do, they would have been gone a long time ago. But 45 percent of American physicians are over the age of 55. Forty-five percent. We’ve got a projected shortage of 130,000 doctors by 2030, and if you look at nurses, it’s more like 300,000 or 400,000 projected by 2030.

If you look at what’s happening, there’s a big replacement going on. We’ve got a bunch of boomer doctors whose residency education was not work-hour restricted, and if you compare them to the way a recent residency graduate who had a work-hour-restricted residency works, they work in different ways. If you talk to CMOs, and I talk to CMOs all the time, about one of the stressful things they have to deal with, what they’ll tell you is that it takes two recent graduates to replace one of my boomers. So even if we think, “Well, let’s increase the medical school places, or let’s increase the residency slots and take in a bunch of FMGs to address this shortfall,” the recent graduates simply work differently. And those same CMOs will say, and this is actually true, that if you look at the actual number of patient care contact hours for a recent residency graduate compared to a boomer from an unrestricted residency program, the recent graduates have about one-third fewer contact hours. So when they go out onto the wards, they aren’t even fully baked. The organization that employs the new graduate has to put in a prolonged mentoring and supervisory program, 12, 18 or 24 months, just to get them up to speed.

So not only have we got a shortage of bodies, but we also have a transformation to a completely different kind of doctor, at a point where the whole industry is trying to drive the consumer to video visits, virtual visits and everything else, with Walmart delivering your drugs by drone to your front porch, and AI, who knows what that’s going to do. It just makes things unclear, except that there’s a big hole, a great big hole, and I’m not sure how to fill it.

But for our listeners right now, what does that mean for you? It’s going to be an amazing job market. You’re going to have so many opportunities, and people in our communities who have had bad positions have had to change their jobs. The other thing out there is a whole bunch of innovations in how you might practice medicine that are disconnected from having to sit in an office and see patients one at a time, going door to door between three exam rooms and billing in an EMR. So there’s an amazing flourishing of different job descriptions, and there’s an amazing need out there, an amazing need. One of the keys in the future is that docs need to get so much better at interviewing for a job. Starting right now, I don’t care what you think about your current practice, I would encourage every single doctor in America to do an interview at least every quarter, just to see what’s out there, and just to notice how much more the people you’re interviewing with respect you and want you than your current boss does.

Kevin Pho: Now, for those hundreds of thousands of physicians who are burned out and listening to you on this podcast, at what point should they try to change their current position and see if it becomes a more tenable situation, versus leaving and looking for something new? It’s always that decision point: Stay and hope things get better, see if you can effect change from the inside, versus leaving altogether. Tell us a little bit more about managing that decision point.

Dike Drummond: Well, let me just give you the red flags. If somebody’s asking you to do something that’s unsafe or dangerous, or if somebody is putting you in a situation like that and is obviously not interested in helping you out and getting you the people you need, and right now that’s mostly a short-staffing circumstance, you just need to get out of there. Just walk away. Your reputation doesn’t have to crash, and you don’t have to be personally liable for something that happened because you were overwhelmed, just because your boss won’t give you the appropriate tools and staffing to get the job done. So if it’s unsafe, get out of there. If you’ve got a psychopath boss, an abusive boss, get out of there. Just jump. There are plenty of ways you can cover yourself in the short term, and locum tenens is a better choice than staying in a situation like that.

What we teach is that all doctors need something they were never taught to build, and that’s an ideal job description. Your ideal job description is something that takes several weeks to wake up, but it’s the answer to the question: If I could design a practice that’s perfect for me, what would it look like? What kind of patients would I be seeing, doing what kind of stuff, for what kind of hours and what kind of pay, on what kind of team, in what kind of organization, where in the world? Take some time, just write it down on a sheet of paper and put a date next to it.

Then what you do is simply imagine a two-circle Venn diagram, and this Venn diagram is a diagram of feelings. Two circles: One is this practice, and one is your ideal practice. I’ll just say it, and you can imagine it yourself and answer this right now. You know what your current job feels like. You can imagine what your ideal job would feel like. How much overlap does it feel like there is between these two circles right now? I’ll give you some normal values. If it’s 40, 30 or 20 percent and on a downward trajectory, and the trajectory is important, if it’s going down, that’s probably painful, and you’re going to want to do something. If you’re at 60 percent overlap and up, especially if it’s going up, that is really good, actually. And just take your perfectionist thinking and shove it in a basket for a second. Nobody gets 100. Nobody gets 100. Peak is 80, 85, maybe 90. But you get to decide how satisfied you are with your career, and especially now, with this doctor shortage coming, if you don’t like your current overlap in that Venn diagram, you can jump and find a better overlap. But only if you interview properly, and doctors make horrible mistakes in job searches. That’s a whole different topic.

Kevin Pho: We’re talking to Dike Drummond. He is a family practice physician, executive coach and founder of TheHappyMD.com. Today’s KevinMD article is titled “The future of U.S. health care: 2030 and beyond.” Dike, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Dike Drummond: Go ahead and make your ideal job description. What is the overlap between how this job feels and your ideal job description? If you’re not feeling the love, if you’re not feeling respected, even if it’s not dangerous, it’s just not ideal, I encourage you to polish up your resume and go do some interviews. You’ll be amazed at the opportunities out there, and you’ll be amazed at the dichotomy between how you’re treated by your home organization, if you’re not feeling the love, and how you’re treated by organizations that are trying to recruit you. That’s going to be a skill that’s needed more and more as we go forward, but the future is going to be really good for job opportunities for physicians who are willing to be flexible.

By the way, you don’t have to change physical locations to change your job. We have a lot of people in my communities who got new jobs and are working their shifts from home, doing telehealth states and states away. So don’t think, “I can’t change, because I live right down the street from Mom,” or “I’ve got two kids in high school.” No, no, no. Interview anyhow, because you can find these hybrid jobs. Be flexible, go interview, and I encourage you to act like a sports free agent. You’re carrying a very valuable skill set on your back that is going to be more and more scarce as the years go by. If you’re willing to be flexible and hold your employers to account, I think individual doctors are going to work out just fine here. The boomer docs are not long for seeing patients in the first place; that whole generation is going to go away. So the rules are going to change, and nobody knows how AI is going to work, but you can defend your practice and have, I believe, a good career going forward. But you’ve got to remain flexible and be willing to jump ship if you aren’t getting what you want here.

Kevin Pho: Dike, thank you so much for sharing your perspective, time, and insight, and thanks again for coming on the show.

Dike Drummond: My pleasure.