Why the cure for physician burnout is seeing fewer patients [PODCAST]

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For 15 years, a primary care physician saw more than 22 patients a day and slowly lost herself to exhaustion. It followed her home every night and onto every vacation. In this episode, Jerina Gani explains how she broke that cycle by doing the opposite of what administrators push: she saw fewer patients, gave each one more time, and found her life again. The counterintuitive twist is that slowing down did not cost her money. By billing more accurately and resolving problems in a single visit, she ended up earning more than she did full time. You will hear why “see more patients” is the wrong answer for doctors and patients alike, how to make the case for a lighter schedule even inside a rigid corporate system, and why she believes primary care will keep losing physicians until the grind changes. This episode is based on her article “Physician burnout is quietly costing doctors themselves,” published on KevinMD. Press play to hear how slowing down gave a doctor both a life and a livelihood.

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This episode is cited in the KevinMD record on physician burnout.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jerina Gani. She’s a primary care physician, and today’s KevinMD article is “Physician burnout is quietly costing doctors themselves.” Jerina, welcome back to the show.

Jerina Gani: Thank you. It’s a pleasure.

Kevin Pho: So tell us why you decided to share this particular article on KevinMD.

Jerina Gani: I’ve been a primary care physician for 20 years now, as I’ve mentioned before. For the first 15 years of my career, I was badly burned out, working full time, nonstop. Everything I wrote in this article is exactly what I was living. Then, a little over four years ago, I escaped that burnout and was able to find myself again. That was the bottom line, honestly.

I wanted to share this with all physicians, and with all clinicians, including the nurse practitioners and physician assistants who work in primary care and have now started to join our ranks. But I’m speaking especially to physicians who have been working for many years, because they’re overloaded. They work so much. The prevailing idea has always been to see more patients every day, and more the next day. I don’t think that’s the answer, because when you see more patients every day, you have no time to think.

You have no time for yourself, and medicine consumes your life completely, 24/7, even on the weekends. That was my life before these last four years, before I shifted to part time and slowed down with my patients. I was seeing a patient every 20 minutes, so I saw at least 22 patients a day, and it never stopped.

I couldn’t concentrate well, and I couldn’t think well. By the time the 20th, 21st, or 22nd patient came in, I was doing my best just to look fine in front of them, because to them, you’re the only person, the only physician they have. I didn’t want any patient to feel like a number to me. I wanted that connection, and you can’t connect with someone when you’re exhausted, because you’ve been draining yourself all day, and I was draining myself. On top of that, you go home exhausted, and the next day it’s the same story again. On the weekends, you can’t catch up. It reached the point where the work took so much of my time and energy that I couldn’t focus on anything else.

I couldn’t spend much time with family or friends. Even when I went on vacation, and I’m sure many physicians feel the same way, my mind was depleted. I didn’t want to meet people, because I was already drained. I had no energy left. So I said to myself that in all the years before I became a doctor, when I first came from Europe to New York City in 1995, 30 years ago, I had worked in various jobs.

I didn’t become a doctor right away. For five years, I did different kinds of work, and I noticed that people had a life. At first, when I worked as a waitress or a salesperson, not in fancy places but in ordinary ones, people weren’t making much money, but they had lives. They went out with their friends. They went to a movie or a show, or met up with friends. Doctors don’t have time for that.

Doctors don’t talk to each other. They don’t know each other’s family stories. They can’t go out for coffee together outside of work. Even the meetings happen during lunchtime, which is draining. Why does medicine have to be like this? If we don’t take this on ourselves, if we don’t work on our own situation and try to improve it, I don’t think anyone else will. We have to be our own advocates.

So how could I resolve all of this? I thought it through, and there was no other way. I had to slow down. Of course, I’ve now been a doctor for 20 years, and I only slowed down after 15 years of working that way, which was awful. I wish I had known earlier that I could do this, years before the 15-year mark, because by then I was already so drained. That’s why I want the next generation to change and to think this way. It’s very important to think this way.

When I started slowing down, the first thing I did was cut down on the number of patients each day. Instead of seeing them every 20 minutes, I saw them every 30 minutes. That makes a big difference, because you’re seeing only 16 patients a day. You might add one more if you’re worried about a cancellation, so 17 at the most, but no more than that. That’s a huge difference from the 22 or 23 patients a day I had been seeing. At that pace, you can’t communicate. You’re a human being, not a robot, and the patients are human beings too. You have to think about them. They’re taking time off work to come see you, and then you’re rushing them: “OK, one, two, three problems. Come back another time.” But nobody has time to come back another time.

And do you know what I realized? Even at the beginning of doing this, thinking about both my patients and myself and extending each visit from 20 minutes to 30 minutes, I actually started making more money, as I mentioned before, because I was billing better. I was capturing more of the visit. I was doing everything I needed to do with a patient that day, so they didn’t have to come back right away in two or three months. The funny thing is that it helped in every direction. Most important of all, I found myself again, which is the title of this article.

On the days I don’t work, these four days a week, I do three days of work, and I do work hard. I’m not claiming otherwise. I see 16 or 17 patients a day, sometimes 17 if I add one for an emergency. So on a workday, I put in more than eight hours, of course, because I want to finish. I mostly finish my notes the day before, since I’m very organized that way. But the next day, I wake up at 9:00 and I meditate, things I never did before in my life. I can have breakfast. I can have coffee. Imagine, having a coffee after all these years, relaxing in the kitchen with a cup of coffee. And I thought, does this exist? Could this kind of life exist again? Can I go back to that while still practicing medicine? Because I had always thought I would have to retire first. That was my idea before all this. When will I get to retire? I need so many years before I can retire, and I’m still young.

But I realized that even while working in medicine, working part time, I could still enjoy my life. I’m not saying everyone has to go part time if they don’t want to, but they definitely have to slow down in order to find themselves.

Kevin Pho: So you were on that grind for 15 years, full-time primary care, which is exceedingly difficult, seeing 22 or more patients a day. Was there a specific moment after those 15 years that told you you’d had enough, or was it a gradual buildup? What led you to that change?

Jerina Gani: Good question. It built up gradually, more and more, and I realized I had no desire even to see friends, family, or other people. It reached the point where I was getting sick, in a way. I was getting sick. I was exhausted, exhausted all the time, depleted, with no energy at all. So I started meditating. That was the first thing I did, because I had learned that you can recover a little if you meditate at night. It helped somewhat, but I still had no time for the other things I wanted to dream about or do the next day.

That’s why I slowed down. At first it was frightening, because I thought my salary would drop, and I wondered what I would do. My husband is not a doctor, so I’m the primary earner at home, and we have a son, so my husband handles a lot of the driving and care for him back and forth. He doesn’t work the way I do; I’m the primary provider. So it was a major change, but he was supportive. He said, “Let’s do it. I can see that you’re exhausted. Let’s do this.” I never expected it to turn out to be more successful financially, honestly. I didn’t think that way at all. I just thought I wanted my life back, so I could have some time on my days off for myself and my family. I achieved that, and I achieved even more. That was the main reason.

Kevin Pho: During those 15 years, when administration encouraged you to see more patients, that was really their solution, wasn’t it? See more patients, maybe earn a little more money, be more productive. They never quite emphasized seeing fewer patients and spending a little more time with each one. To administration, that seems unheard of.

Jerina Gani: Exactly. I don’t think they know this option even exists. Everyone assumes that seeing more patients means making more money, and it does make more money for them, because when you make more money, they make more money, wherever you work. That’s how they think. I don’t believe their intent is to burn you out. It’s that they’re not in your shoes. They don’t realize that the work isn’t just seeing the patient. You also have to answer inbox messages and emails. Everything falls on the doctors. Everything is on them. Nobody else can write that email or that reply for you. Even the nurses don’t have the authority they had 20 years ago, when they could say something on your behalf. Now you have to say it yourself. You have to be the one who responds to the patient. So maybe administration doesn’t realize how burned out we are. We are burned out, and maybe they don’t know that, because they’ve never tried it this way.

That’s the crux of it, I think. They don’t realize that if you slow down, if all these doctors and physicians and clinicians slow down, they might feel better and still make more money, both for themselves and for the company, wherever they work, because it works. I’m proof that it works. And on top of everything, these doctors won’t leave medicine.

I’m very concerned, because there’s a big crisis in primary care, as we all know. You work in primary care too, so you see it. The new residents don’t want to go into primary care, because it’s too demanding. It really burns you out. To them, primary care has no future. They prefer specialties, because they think they’ll deal with only one or two problems and make more money, and they may get to do procedures. That’s how they see it. But as I’ve said before, primary care is beautiful if you slow down. It’s beautiful because you don’t see only sick people. You see people who come in for physicals, or for a single problem. They’re ordinary people, and they can talk with you if you have the time. You enjoy it. That’s the difference.

Kevin Pho: No, I completely agree with you, and I think I’m in a similar situation, because I still practice primary care. I work half time, and like you, I see patients three days a week, anywhere between 15 and 19 patients a day, and it’s certainly a much more manageable schedule. Now, what do you say to the physicians who don’t have that flexibility? They work under a corporate system, and they may not be able to say, “I need longer visits with my patients,” because as you know, these corporate systems are very rigid. So what do you say to the majority of primary care physicians who work under a more restrictive system?

Jerina Gani: They have to try. They have to talk to the corporate side. They have to talk to them, because if you talk to these people, they will listen to you. At the beginning, your salary may be cut, because if they’re RVU-based, they’ll calculate the RVUs and say, “OK, for full time you work this many RVUs, and if you go to part time or slow down and see fewer patients, this is what we think you can make, so we’ll start you at this salary.” But if you document correctly, if you connect with your patients and bill better, you’ll make that money back, and they’ll be surprised too.

So I’m telling all physicians that if they don’t want to lose themselves, they have to speak up, nicely, and ask for a better quality of life, because the life they have now will end either in disease, in illness, or in complete burnout. Forget about the future of primary care. I don’t think there will be any doctors left in primary care in the years to come if they keep grinding like this.

Kevin Pho: Now, when it comes to primary care physicians working part time, that sometimes doesn’t get much sympathy outside the medical profession. I don’t know whether you’ve seen the post by Congressman Greg Murphy. He wrote, and I’m looking at it on X now, “Unless our medical schools do a better job screening admission candidates, we won’t have any doctors. If you don’t want to practice full time for at least 20 to 25 years, pick another profession.” What’s your reaction to Congressman Murphy writing that on X?

Jerina Gani: With respect to Congressman Murphy, it seems he has no idea how hard doctors work in primary care, or how hard all doctors work, and I think he’s completely wrong. Physicians shouldn’t have to work full time for 20 years. In my opinion, even after five years they should be able to go part time, because they can still produce more and see more people. And now that we have nurse practitioners and physician associates who can help too, doctors can do this, and everyone can do this. If we all worked this way, slowing down and offering more quality, we’d all be happier, and patients would be happier too. With the way we see patients full time now, do you really think patients are happy? I don’t think so. My patients are so happy now that I have 30 minutes to see them. When I had only 15 or 20 minutes, they weren’t happy at all. We couldn’t connect, and I couldn’t address all the problems they had.

So I think Congressman Murphy is wrong, and he should learn more and ask physicians directly. Physicians should be the ones, or clinicians as a whole should be the ones, to decide what’s best for them and for the future of primary care. I also think it’s worse in America than in any other country, because in Europe it’s very different. I go to Europe every year, and it’s so different there. They don’t get paid as much, but they don’t work the way we do. They have a life. We don’t have a life here, and that’s frightening.

Kevin Pho: And it’s interesting that Congressman Murphy is himself a physician. I believe he’s a urologist. So there are some groups, even within the physician community, that don’t have much sympathy for the challenges their fellow physicians face, or for those who practice part time.

Jerina Gani: I’m sorry to hear that. Honestly, I don’t know. Urology is a specialty, so maybe he doesn’t see it. Urologists have a lot of time. I know that. They get 30 or 45 minutes for a visit, while we get 15 or 20. It’s not fair. It’s not fair.

Kevin Pho: If you knew back then what you know now, maybe you wouldn’t have stayed on that grind for 15 years. Is there anything you would have done differently, knowing then what you know now?

Jerina Gani: Yes, exactly. If I had known this, I wouldn’t have waited 15 years to make the change. Even setting aside the money, because I now make a little more than I did working full time, which is the strange part, even if I weren’t making this much, I would still have done it, because on my days off I can do so many other things. I’ve started learning a bit about trading. I do a little trading, some options calls and stocks, and that’s extra money. I’m even on social media now, making reels for free to educate patients, something I never had time for before. I always wanted to do that for people who don’t have a doctor and need something educational.

Now, hearing you, I realize I’m very lucky in where I work, because my company was so accommodating. They heard me. I told them I wanted to work part time, and they respected that and gave me the opportunity, so I’m very grateful for that. But I want more workplaces, and more physicians, to speak up and do this wherever they are. I think there’s a way. If we work together as human beings, whether in corporate or private settings, physicians and other clinicians alike, and if we sit down and talk, I think a better solution can emerge.

Kevin Pho: We’re talking with Jerina Gani. She’s a primary care physician. Today’s KevinMD article is “Physician burnout is quietly costing doctors themselves.” Jerina, as always, we’ll close with the take-home messages you want to leave with the KevinMD audience.

Jerina Gani: I have a dream for all primary care physicians. I dream of the day they go to work so happy to see patients, without feeling burned out. So that when they offer their expert medical opinion and answer all of the patient’s medical questions, they end the day feeling satisfied rather than burned out, happy to have done the work, and with some energy left for themselves and their own lives. Because our families deserve us too, not just our jobs.

That’s my dream. I hope that one day primary care in the United States will be much better, with everyone happy in their practice. I wish I could see that day, and that it comes soon. That’s my message. But physicians have to work toward it. They have to speak up, nicely. They have to do something, because if they don’t, no one will do it for them. They have to move in that direction to reach that goal.

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

Jerina Gani: It was a pleasure. Thank you.

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