Do You Feel Burned Out Today?
Physician burnout is a critical problem. You are not alone – over two-thirds of physicians today indicate that they are currently experiencing burnout. One study recently found that serious clinical errors occur twice as often amongst physicians suffering from burnout. This is concerning for both patients and physicians as these numbers illustrate the increasing pressure and prolonged stress we as physicians are facing today.
Symptoms of Physician Burn Out
Burnout has become a crisis not just in medicine, but in other careers as well. Just this year, the World Health Organization (WHO) updated the international classification of diseases (ICD-11) to include burnout under the code QD85. The WHO defines: “burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.” Sound familiar: exhausted, cynical and less effective?
I personally burned out well over a decade ago when I found I was no longer able to manage the daily stress of being a surgeon. I not only burned out, but I spiraled into a major depression and a suicide attempt before I found help. I was one of the lucky ones – physicians have double the suicide rate of non-physicians. I am glad to say that with professional assistance and the support of friends, I was able balance my life and manage to find happiness again. I joined Vohra and found wound care was part of my solution to burnout. Vohra offered me autonomy, balance, and restored the feeling that I was making a difference. These were all things I had lost and that had originally led me to medicine. Burnout has been attributed to a variety of factors and among physicians surveyed EHRs, excess paperwork, practice administration, poor work-life balance and loss of autonomy were the leading causes.
Twenty years ago, with the rise of new tools including EHRs, meaningful use, and comparative reports a data transformation started that has fundamentally changed medicine. Some of these changes have been good, for example medication interaction warnings and allergy alerts at the bedside, but others are not so good. For instance, it is deplorable that the patient interaction is now focused on putting data into a machine instead of looking someone in the eye and having a meaningful conversation. Physicians burnout when day after day documenting simple things like “Mr. Jones returned for a repeat blood pressure check and it has improved to 132/78” have become burdensome and have turned into 14 mandatory fields reached only after logging in with a password that must be remembered and changed every 90 days. To reduce burnout, we need EHRs that are relevant, intuitive, specialty specific, and provide tools like augmented intelligence and clinical decision support. The EMR I use at Vohra was developed by practicing physicians and to this day is designed and led by physician insight from the bedside. It was not developed in some dark room or produced from some poorly legislated design spec. Rather, it was created as a tool to manage efficiency and help reduce unnecessary and arbitrary documentation demands.
Paperwork goes hand in hand with EHR and has come to be synonymous with it. Piles of paper both virtual and real occur because of increased requirements from insurance companies, regulators, governments, and the ever-present plaintiff’s attorney. An Annals of Internal Medicine study found that physicians now spend two hours filling in forms, completing EMR data entry and other “paper” related activities for every hour they spend seeing patients. No wonder we are burning out! We didn’t go to medical school to fill out voluminous amounts of paper and fight with insurance companies. Yet few options exist that allows us to practice without having to worry about paperwork and administrative functions. Large practices that efficiently leverage their size, scale, and utilize technology well, can help physicians with these problems. A practice that allows you to come to work each day to care for patients, document just what is needed for care, and be paid well for your work, is the ideal.
Poor work-life balance
Often as physicians we train in a demanding residency, maybe add a few more years in fellowship, then we finally start working in a practice. Along the way we struggle to have time for ourselves. We try to balance family, friends, and hobbies with work and often we fail. Ten or fifteen or twenty years into practice, we might wake up and find we are just going through the motions and have no balance. We have sacrificed our health and well-being, and some of us find ourselves looking for other options. Maybe we go into another specialty, or maybe we start working part-time, or perhaps we quit medicine altogether.
What we are looking for is balance, an opportunity to practice medicine with clinical satisfaction but without the nights and weekends on call and extensive hours spent doing administrative work. We don’t want to miss out on life and our families. We want to have a career, but we don’t want that career to make us exhausted, worn out, or turn us into ineffective cynics.
I can’t tell you what to do to achieve balance in your life or escape from burnout; that solution is different for everyone. What I can tell you is that I have seen hundreds of physicians join the specialty of wound care and love it. They get to see their families again, they fly planes, they race bicycles, they serve on medical missions, they give back to their communities, and they publish books. They enjoy going to work again, they find medicine rewarding, and enjoy making a difference. Solving burnout is not just about us as physicians, it is also about our patients and providing better care again.