Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Solving Physician Burnout: The Beatings Will Continue Until Morale Improves
It’s 9 p.m. on a Friday and I’m waiting for my hospital’s slow, clunky electronic health record (EHR) to load. I’m logging in from home because the administration emails became threatening. I have about 25 unsigned notes that, according to the emails, are holding up more than $1,000,000 in hospital charges (and that’s just this week alone). They always point out the exact figure, as if that will motivate me.
The patients were already seen by me, and the notes written by either a resident or nurse practitioner. The hospital just can’t bill until I click the “cosign” button. With the glacial speed at which the EHR servers work, simply clicking that button is quite a time burden, up to an hour if the mouse running the wheel powering the server is having a bad day.
So I put it off until my kids have gone to bed and I can settle down with a glass of scotch for my “catch up on meaningless administrative work” time.
Meanwhile, there’s this JAMA article outlining how the National Academy of Medicine is going to tackle physician burnout.
The plan revolves around installing a “culture of well-being” into the healthcare workplace. They want to develop training protocols to address discrimination, bullying, and harassment while increasing leadership roles such as Chief Wellness Officers.
This sounds like more bureaucratic busywork to complete and administrators to answer to. I would be shocked to find out that there was a single aliquot of improved wellness from a wellness module.
They advocate that workplaces must accommodate workers who need time off. That’s great. Nobody should be forced to go to work sick. But there’s a fine line beyond which it can become too permissive. Patient care can’t always wait until it’s convenient. When patients need urgent surgery, I don’t get to go home until the surgery is completed. If there’s not enough nursing staff to work all the operating rooms, I’m stuck waiting around all day. Routinely missing dinner with my family because there’s no staffing doesn’t exemplify a “culture of well-being.”
I’m booking patients months in advance because the OR is run so inefficiently that we can’t get multiple cases done in a single day. Some services have year-plus backlogs. I see unionized nurses (who make more money than most of the doctors) running the OR, telling me my surgery can’t be done, forcing me to explain to the patient why they must continue to wait for their procedure. When I actually get to do a case, I’m dealing with equipment that is past expiration and literally breaks down in my hand. I’m told we can’t afford working surgical instruments or backup OR staffing. I’m the one who gets sued when there’s a bad outcome.
While the hospital is reminding me how much money I’m making them with my meaningless clicks, I’m reading about an 8% cut to physician reimbursement (forget an inflation-adjusted cost-of-living increase). Meanwhile, hospital CEO pay has increased 93% (not a typo!) over the last decade and hospitals are getting a 4.3% pay raise from the government in 2023.
My case mix is over 80% Medicaid, so I also have the government telling me my time and effort is worth less than half that of my colleagues who exclusively take private insurance.
I have governmentally mandated appropriate use criteria that questions every imaging order I place on a patient, forcing me to click box after box, justifying an MRI that I know is clinically indicated because I spent 12 years training in neurological surgery to know exactly when an MRI is indicated.
I have the joint commission telling me I’m not prescribing enough pain medication one day and the next day, I’m being threatened with manslaughter charges if I don’t check a slow, cumbersome, often nonfunctional online database every time I write a prescription.
If the right wants to be the voice of reason on healthcare (which we are), we need to address these issues. More government control of healthcare keeps exacerbating the burnout problem. Medicare For All will only make these issues worse, as Medicare regulations are the driver for nearly all the problems listed here. The younger generation of physicians thinks that single payor is the way to solve burnout. We need to show otherwise.
Healthcare regulation keeps funneling more money to hospitals, driving consolidation. It makes private practice financially untenable, so doctors have no choice but to be employees of these conglomerates. This monopsony power means the hospitals can treat us like revenue-generating click machines. Free-market-based healthcare that empowers patient choice would reverse this trend. We need to make that our rallying cry.
It’s either that or hire more wellness officers. I certainly need more people to point out exactly how much revenue my meaningless clicks generate.
Published in Healthcare
Doc, going to bed and I suspect I’ll have more to say later, but for now I just wanted to say Thank You.
Hey, Dr C! Good to see you again, it’s been a while!
Busy clicking boxes. Have to find more time for posting here!
Sounds more like waiting for the gerbil (or whatever) to spin the wheel enough that you can click.
I’ve hung em up. I’m down to one day a week of telemedicine just to keep my last toe in the door. But Corporate Medicine has finally driven me to retirement. During the course of my over 30 year career I’ve seen an amazing changes in the ability to deliver quality medical care to patients. And thanks to the changes brought about by the Suits in the Government, Hospital and Academia I’ve seen the patients suffer needlessly, doctors and nurses treated like disposable instruments.
I don’t know what the answer is, but I do know that the way things stand I would not recommend a career in medicine.
It seems to me that we already have “Medicare For All” aka socialized medicine – the govt sets the rates for everything; reimbursement rates drive everything; and patients and practitioners have no choices unless they leave that set up. We (healthy, low maintenance, no medications adults) left a hospital owned internist practice for a direct pay practice and just hope to never get actually sick.
There are no such options for hospital-level needs. When I tripped in the woods running and sliced my knee (badly) I went to the closest urgent care and a very capable doc stitched me up promptly in a clean, well managed environment. (They even went out to my car and checked on my dog waiting in the back seat.) There is no equivalent when say your appendix needs to come out. And now I wonder where the hospital’s priorities are: routine stuff that happens to regular people (maybe reimbursed at low rates), or selling discretionary “procedures” (high margin stuff) to the latest trending demographic.
So – don’t get sick. Easy for me to say.
My doctor retired due to this crap. It hurts us all.
Isn’t the Veterans Administration the poster-child here for the abject failure of single-payer, government-run healthcare which holds an entire population hostage? I can’t imagine anyone who looks at it, and gives a moment’s thought to the matter, concluding that single-payer, government-run healthcare is the answer to anything.
I’m glad you said that. My fear of becoming sick is growing daily.
Actually we seem to have the worst of all possible worlds right now. The government interfering in a huge way with the operation of medicine, while gigantic corporations game the system and manage their pet Congress, reaping unbelievable profits that don’t get down to the hospitals, doctors, nurses or other staff.
Example. The seven largest health care corporations in NC made record profits during the pandemic.
“The North Carolina State Health Plan and the National Academy for State Health Policy found that taxpayer-funded COVID relief gave a huge wealth transfer to North Carolina’s seven dominant hospital systems. While patients and rural hospitals suffered, wealthy hospital systems enjoyed record profits and a $7.1 billion growth in cash and investments during the pandemic.
State Treasurer Dale R. Folwell, CPA, invited National Academy of State Health Policy researchers to analyze the audited financial reports of Atrium, Novant, UNC, Duke, Vidant, Cone and WakeMed Health. The study was peer reviewed by Dr. Ge Bai, Professor of Health Policy & Management at the Johns Hopkins Bloomberg School of Public Health and Professor of Accounting at the Carey Business School.
After taking the lion’s share of the COVID relief dollars, the wealthy hospital systems recorded such a massive growth in cash and investments that it rivaled the state’s 2020 appropriations for K-12 classroom instruction. Duke Health even exceeded the average net profit margins of tobacco and investment banking in 2021. The increase in their charity care spending in 2020 equaled only a fraction of their windfall.”
Meanwhile, hospitals were horribly staffed, with doctors nurses and other employees being worked to death. Patient care was awful with the understaffing and delays in treatment.
This is what happened in Europe too. Then they imported medical staff from other countries while cutting services left and right. It is a result of socialism–which may be just another name for “crony capitalism.”
$1,000,000 waiting for you to click “permission”? Just imagine the revenue stream the administration at Vanderbuilt was expecting from carving up kids.
Trafalgar Day, a couple of days ago, reminded me of some thoughts by a Spanish naval administrator on “why do we keep losing to the British, and what can we do about it?” (yes, this is related to the OP)
(British captain) fix their minds on acting with zeal and judgement upon the spur of the moment, and with the certainty that they will not be deserted. Experience shows, on the contrary, that a Frenchman or a Spaniard, working under a system which leans to formality and strict order being maintained in battle, has no feeling for mutual support, and goes into battle with hesitation, preoccupied with the anxiety of seeing or hearing the commander-in-chief’s signals for such and such maneuvers…
The “culture of compliance” and the micromanagement of employees by bureaucracies and by rigid automated systems, as practiced in America today, bear a disturbing resemblance to the cultural practices that Don de Grandallana identified as the main cause of his country’s repeated defeats. It appears that these things are now very pervasive in the practice of medicine.
See my post Culture, Innovation, Victory, and Defeat and this Washington Post article from 2005.
I understand that worry. I’ll be rude and suggest substituting going for a walk outside when you get stuck in that. It might help – anything that gets me breathing deeper and stronger calms me. And – take comfort from how you’ve lived your life so far. I think our bodies are designed to work well if we do our part using them.
We are lucky – both have good genes to start with and have had lifelong habits of being athletic and enjoying exercise and living so that we can be athletic and generally active. Now we keep doing the same, adjusting for things we can’t do – I can’t swim sprints because my shoulder is wrecked (from years of swimming sprints etc) so I swim long so I don’t hurt and do sprints on the water rower. And we never got habits that would limit being active.
So luck of genes + good habits are the best we can do now.
I tell people who ask – you can start being more active any day. It can’t hurt. And portion control.
My dad was a surgeon and I asked him once when the best time to practice medicine was. He said in the 1960s before all the paperwork. So it’s been a long time coming to this.
You’re talking to a gardener. No worries on the active front. But at my age, it is inevitable that I will get stuck in a hospital with horrible care. Or that someone I love will. Hoping I end with a heart attack at home. :-)
Great post.
I don’t have time to respond to this, because I’m behind on COS (Clicking On Stuff). I’ve got over 200 random things in my box that need to be clicked on. 6-10 clicks for each. There will be a few important things in those 200 complex documents, which I really try not to miss. But there’s so much crap to click on. So, so much.
So, I’ll respond to this great post when I can. But I don’t want to waste my time while I’m trying to waste my time today.
I wish I was kidding about this…
Is that a leading cause of Carpal Finger syndrome? Sorry – sometimes I just have to.
Yes, I’ve developed carpal tunnel syndrome from all the clicking. I have a brace & a special mouse.
I was just talking to a surgeon who is switching over to private practice (basically, fatness management). He said the big city trauma surgeons are really getting screwed, because so many of the cases that come before them are gunshot wounds and people who get shot are, almost if not quite by definition, Medicaid.
The medicine is so freakin’ spiffy…and, as my surgeon friend said, you can go to school for all those years and make less than a personal trainer.
What mouse? I loathe clicky interfaces, and have an IBM Model M that I want to use instead of the mouse. Mousing hurts. We used to move more data and write more words with a keyboard than these retarded mouse interfaces let us do (most of the time). Still, I can’t change the world, so I need a good carpal mouse. I see several — what works for you?
The trauma surgeons are smarter than that. They get paid by the hospital system. And there’s money in the state and federal budgets to make sure the trauma systems stay afloat. The “knife and gun club” trauma systems live off that. The Suburban ” car crash” trauma systems have insured patients.
I use a Lekvey wireless handshake style mouse. It helps quite a bit. I can’t control it as well as a regular mouse, but it’s pretty good. And my fingers aren’t numb anymore.
My gall bladder situation about 3 years ago went pretty well for me, but I was “fortunate” in that I was able to press things into being treated as an “emergent” case, and got surgery the next morning. If not for that, I might have been in pain for a week or more, while arranging for “outpatient” treatment.
Assuming you’re using something normal like Windows or Mac OS, there are “accessiblity” options that might help both of you. And maybe optional ones beyond what Windows/Mac already come with, that could be added.
Being able to use the keyboard rather than the mouse is one of the most common options.
Really, this is the answer:
I have a new-in-box version of WordStar 5, I think it is, for DOS.
Likewise, new-in-box WS3 for DOS.
BUUUUT no 5.25 drive. So it’s just decorative and cool, now.
You can get 5.25″ USB drives now.
I could be wrong! You’d know better—-I’m just repeating what my surgeon friend said over dinner.