The alarming rise in physicians resigning from their roles is a testament to the severity of the crisis. Where physicians were once the pillars of health care, delivering vital services to their communities, they now find themselves struggling with diminishing job satisfaction, declining productivity, and inadequate self-care routines. The result is a mass exodus from the profession, leading to a shortage of health care professionals and jeopardizing patient care.

The advent of electronic health records brought the promise of streamlining processes, enhancing patient care, and improving overall efficiency. However, this has not been the case. Instead, EHRs have become a major contributor to physician burnout. They have forced physicians to trade patient interaction for screen time, transforming them into data entry clerks. The EHR system, originally designed to replace paper records, has morphed into a behemoth of unnecessary information, detracting from patient care and increasing administrative burdens on physicians.

Before the current EHR system, when I would need a consultant for a hospitalized patient, I would enter the order, and the unit clerk would call in this consultation to the physician’s office. Now, I have to spend time contacting that physician to let that doctor know there is a consult for them.

Prior to the current EHR, when I would have an emergency appendectomy at 3 a.m. to perform, I would call the hospital nursing supervisor and inform this person I was on my way to perform the surgery and to please call the on-call team. Now, the first question I am asked is if I entered the information into the EHR system, and if I have not, the on-call team will not be called in.

The repercussions of poor reimbursement rates

Having undergone a robotic inguinal hernia repair, I was privy to the reimbursement rate my colleague had received. It was a mere $360 for such a complex surgery and the extensive amount of time my colleague had spent performing the procedure and entering all the information into the EHR system. This fee also includes all the visits to the surgeon’s office for the next 90 days related to this procedure.

With the cost of running a private practice escalating, the decreasing reimbursement rates for physicians have added fuel to the fire. Large health care systems receive significantly higher reimbursement rates, even for identical procedures performed by private practice physicians. This disparity has forced many physicians into employment with larger health care groups or private equity-owned practices, further exacerbating the problem.

The takeover by hospitals and private equity firms

When a family member was seen by an employed physician from one of the largest hospital groups in my state, I was shocked by what my insurance approved for the visit reimbursement. The same insurance plan that paid my private practice surgeon $360 for a hernia surgery allowed a reimbursement of $315 for an office visit! The point of this is not about the specialist fee or allowed reimbursement but more about the inequity of reimbursement of the private practice physician versus the hospital-employed physician and how the hospital enjoys significantly higher reimbursement rates not afforded to small practices.

These larger health care entities enjoy an unfair advantage over private practice due to their inflated reimbursement rates. This allows them to profit excessively from physicians’ work. Employed physicians face immense pressure to increase productivity or risk termination. This demand for increased patient interaction and procedures to justify their employment adds another layer of stress to their already burdened existence.

The insurance company conundrum

I recently had a conversation with an Uber driver about health care costs. When I told him about my procedure and the allowed reimbursement by my insurance company of $360, he was shocked. He said all this time he thought the doctors were the problem billing thousands of dollars and thinking physicians make what we bill. I explained to him that the insurance company pays what they want to pay for our services, which is typically a fraction of the billed charges. The insurance companies have done so much damage to physicians’ reputations among the public and have turned us into villains.

Dealing with insurance companies presents further complications for physicians. Beyond the low reimbursement to private practice physicians, there are many other problems. Prior authorizations, denials for necessary procedures or diagnostic studies, and protracted appeals for reimbursement are just a few of the many challenges physicians face. Furthermore, insurance companies often demand repayment after initially settling a claim, adding to the administrative load and contributing to physician burnout.

The erosion of respect for physicians

The respect traditionally accorded to physicians has diminished significantly. No longer are they revered members of the health care community but are now viewed as mere service providers. This shift in perception has had a profound impact on physician morale, further contributing to the moral injury they experience.

We are now on par with so-called “physician extenders.” These are nurse practitioners and physician assistants. Although they play a crucial role in health care, they are not substitutes or equivalent to physicians. By labeling us as providers, they have reduced the role of a physician to that of anyone wearing a white coat.

The solution: Addressing the root causes

While the health care industry acknowledges the problem of physician burnout, it often fails to address the root causes. Instead, physicians are encouraged to participate in meditation, positive thinking, and team-building activities such as pizza parties and golf outings. While these initiatives sound great, they fall short of addressing the systemic issues plaguing the profession. The time has come for a complete overhaul of the system, starting with the EHR, physician workloads, and the manner in which physicians are treated and compensated. Only by addressing these fundamental issues can the crisis of physician burnout be truly resolved.

In conclusion, the crisis of physician burnout is not a simple issue with a quick fix. It is a systemic problem requiring a comprehensive solution. By understanding the root causes of this moral injury and working towards their resolution, we can restore the nobility of the medical profession and ensure the well-being of the physicians who dedicate their lives to caring for others.

Emil Shakov is a general surgeon.