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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
Trauma surgeons definitely need their salaries subsidized by the trauma systems. They don’t make enough money off billing the trauma patients, so the hospital must subsidize their salary either with call pay or by employing them directly.
You have to have a certain, shall we say independent, personality to be a surgeon, and that personality just doesn’t jibe with being an employee on a salary. I just don’t get it.
There was a relevant episode of Quincy, M.E. titled “The Golden Hour,” season 7 episode 2. It used to be available on youtube, but those rat bastards are always taking things down for one supposed reason or another.
Waiting to click on forms at home is a common problem. Wait time has been much exacerbated by sending more clerical staff home to work (Covid), and not widening the remote access to the hospital system (would cost money).
When I did IT in healthcare we got daily calls from people who were at home, wasting enormous amounts of time waiting for the hospital system to respond. We couldn’t do much for them. Remote access has turned into a HUUGE thing on a scale that was never planned or budgeted for.
To say nothing of video conferencing.
As for EHR, that was, in my opinion, a complete bait and switch.
And to top it all off, the young doctors in training are 100% indoctrinated in CRT and DEI. They will be impossible for older doctors to work with, since they already know all there is to know about everything.
Along with that, almost 100% support medicare for all and the move to ban private insurance. This movement is growing within medicine. I don’t know how to reverse it and it terrifies me.
How do the young doctors expect to make a living and pay off their loans etc, under those conditions?
They expect the President to forgive their loans, because education (like healthcare!) should be free to all.
Free education for doctors would really screw up the medical profession. That said, it’s the one kind of education that I as a taxpayer would be more than happy to pay for.
There is something in the Bible somewhere that tells us to take care of our doctors. Good advice.
“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.”
Late in my career as a radiologist, I did locum tenens work to pad my retirement account while not really working. For a few weeks I covered a neuroradiology service at a major teaching hospital where the only work I did was click approval on the EHR notes of the residents and fellows under my supervision. To my dismay, when I questioned the residents about their thought processes behind their posts and medical orders, they didn’t seem to have clue about what was the specific diagnosis or condition they were dealing with. They copied and pasted whatever the last resident put in his notes and moved on to the next chart.
I was horrified and resolved to never let any friend or loved one navigate the medical system without some educated assistance.
Yep. Recent JAMA article found that 50% of content in medical notes is simply copied & pasted.
I used to listen to a podcast by a medical doctor who said she was all for government paid medical care (that’s not why I stopped listening to her; it was her full throated embrace of the idea that “woman” was a state of mind rather than a biological reality that told me I could not trust the medical information she was providing on the podcast). But back to the government paid medical care, every time she would bring it up I kept wanting to ask her, “Don’t you see that one of the first things the government would do are limit your salary in order to control costs?”
It’s gotta be a LOT higher than that.
Single payer = single decider.
My brother is a USAF veteran. When he was a young airman on active duty, his wife took a bad fall from a horse and severely injured her knee. The military health care system (socialized, just like the VA) decided she didn’t need any treatment, and sent her home to recover pretty much on her own. (She may have had some physical therapy, but that was about it.). She suffered with pain in that knee for years. It was only resolved last year when she finally had a knee replacement (in her late 50s). Now she has occasional numbness, but that’s a big improvement over constant pain.
When was this? Curious about timleine of decay.
Quality of VA care seems to vary drastically by region, and it really shouldn’t.
I linked this post at my new Chicago Boyz post Trafalgar, 1805, and the USA 2022.
That compares favorably with student online work.
The timeline of decay would be interesting to explore. The episodes I experienced occurred in 2012. I had not worked with residents in an educational situation since I was a resident in the late 80’s. Computers were not part of the process of generating a radiology report at that time. I was stunned that a huge number of radiology reports in 2012 were produced by residents copying and pasting phrases from previous reports without trying to explain what those findings meant. They would describe areas of high intensity signal on T2 weighted images in anatomic regions on an MRI with no attempt to make a firm diagnosis or put it into the context of the patient’s clinical problem.
It is interesting that Jonathon Haidt and Greg Lukianoff thought that the age of intolerable woke college students began in 2013. The dumbing down of education began long before that.
re the cutting and pasting of radiology reports…how do the residents know (guess) what to paste?…presumably they are dealing with many different conditions. Do they just pick one that seems sort of similar, or is there more to it than that?
There’s an extensive laundry list of conditions that could be associated with a radiology finding. For example, a T2 hyperintense lesion in the brain could be tumor, trauma, stroke, infection, multiple sclerosis, ADEM, etc etc etc. By just copying and pasting the laundry list for a specific lesion, the radiologist avoids the malpractice suit that comes with “missing something.”
You have no ideas how many times I get consulted for “can’t rule out acute hemorrhage.” It’s a 2am phone call because a radiologist has no balls.
Beautifully put. The radiologist’s job is to tell what he/she sees and the likely diagnosis which arises from this. Unlikely rule-outs just cloud the patient’s care.
Part of it is the medicolegal climate that ER docs work in. If there’s a speck of something in the brain that a radiologist can’t rule out blood, a competent ER doc should still be able to tell if it’s clinically significant. There’s plenty of data showing a small speck of blood doesn’t need a neurosurgeon consultation, but everybody wants to CYA.
Right. To be fair, radiology is a malpractice nightmare. X-rays are always more clear with your retrospectacles on…
And it’s not just that everybody wants it, but that the hospitals – and the hospital’s lawyers – require it.
There was an episode of JAG where in a medical malpractice case, one of the expert witnesses testifying for the prosecution was shown an ultrasound, I think it was, where he pointed out the “obvious” problem that resulted in the stillbirth of the woman’s child. But the ultrasound turned out to have been of a cow, as I recall.
@craniotomy
Practiced my first 20 years in outpatient family medicine without a computer. Am now in my 13th year of EHRs and hate them. They don’t add one bit to improving patient care, they cause perpetuation of errors without end, they change the way you think about the patient by trying to cram the history into templates, and as far as complex medical decision-making, well, that just doesn’t work on an EHR period. Reading other doctors’ notes is now a nightmare; I search for any tiny bit that is not templated that might mean original thought. Other than making prescription refills (not new ones) easier, EHRs have done nothing to improve patient care. They waste our time, give poorer results, and take the humanity out of seeing patients.
As far as young physicians, if you can even find one who’s not actually a NP or a PA, they tend to be arrogant and rushed and to view patients as problems to be solved, not people with problems they can help. I grieve for what my profession is becoming. And as I get ever older and keep developing more health problems not preventable with keeping a normal weight and exercising, I fear for the care I will get in the future.
As far as bureaucrats, it’s ridiculous that more and more people now have their salaries paid off of what physicians charge, further dividing the pie for everyone. If only the actual people needed to provide real patient care were the ones paid off of the doctors’ work, we’d have no health care payment crisis. It’s hard to see how adding in “wellness” bureaucrats is going to make anything better.
There is a physician burnout guru whose book I read and whose website program I joined. He was helpful and well-meaning, but the essence of his advice is to work less and enjoy the people you love more. He has made a lot of money off physicians and especially off of healthcare entities by addressing physician burnout, after practicing a mere 13 years in family practice before he got too burned out to continue clinical medicine. I find this ironic. But then I am not a “meditate and everything will be all better” sort of person, either. And to be fair, he’s more complex than that, but I don’t think he has the experience base to be the expert he has made himself into.
Anyway, I really enjoyed your post and comments, and look forward to reading more of what you write!
Welcome to Ricochet, ElizabethJ!
Hey, that rhymes!
Amen.
Medicine was once a higher calling – that was what I signed up for. I would willingly give up my family life, my personal life, and honestly my life in general if I were permitted to care for God’s children. And I would be happy about it. With such a noble purpose, I would sacrifice everything else. God gave me this brain for a reason. At least, I think he did.
Once Medicare took over, it became a numbers game. The patients no longer matter as much as the ICD codes.
It’s sick. Perverted, ugly, repulsive, and sick. And here I am – up to my neck in the bureaucratic swamp I sought to avoid. It’s sick.
I hope that my liver will burn out before my heart. Which, I suppose, is entirely appropriate…
I didn’t follow up on this thread because I thought it had run its course and I guess in a way it had, but I am impressed that the physicians on this site seem unanimous in their opinion that there is a failure of the profession we love to provide the care we swore an oath to uphold. I too grieve for what my profession has become. I didn’t want to be rich or famous when I went to medical school, but I did want to be useful.