Physician Burnout

Think about this the next time you complain to your doctor. From a real doctor in the comments in Naked Capitalism:

About PCP burnout – I am not meaning this as a rant. But I think it is important for people to understand the time pressure and world their general internists are facing.

This week – Monday the 8th of Dec through Friday the 12th of Dec – in my office hours of 9:30-5:30 PM every day, I saw a total of 108 patients myself. The MAs and PAs and RNs who work under me saw an additional 57. In the AM before the office, I have had an average of 3 people in the hospital whom I try to see every day at lunchtime. Because life since COVID has become so overwhelming, I now have hospitalists doing all the work, but I do all I can to see the patients. I have 11 people in nursing home care. So all 11 are seen once a week at various times where they can be fit. My office staff typically fields about 200-250 phone calls a day. I have very good staff but they are also involved with other MDs in my office. Of those calls, I have about 30-50 that I must deal with every day mostly by telling the staff what to do. There are all kinds of patients who demand to speak with me only about test results, etc…….and there are several who because of the severe nature of their results, I need to speak to. I typically try to do this 1 patient at a time in between visits. Despite how obviously crazy medicine has become, so many patients think when I call them it is time to have a visit – and these calls can often become very involved. I am looking at my leftover calls that I need to make from the week on this Sat AM – and the number totals 34. There is simply not enough time in the day to do this. When people do not get immediate feedback some of them can become explosively anger and yell at the staff – causing very high turnover at times. The staffing in modern internist offices has been cut to a third or so of what it was when I started – at the same time the admin bloat in the hospitals and the insurance companies I would guess is 5 times as high. I am plagued with an EMR that is simply tedious in every aspect. Bring back the paper charts and I would save an hour or two of clicks every day. My staff and I have to field every day about 10-12 insurance denials, almost all of which are very involved and are regarding critical meds and tests, etc. In all of this chaos throughout the day, 3-4 times daily I have to take 10-15 minutes to do peer-to-peer discussions with insurance companies about meds or tests. About 90% of the time they just prima facie approve stuff – demonstrating what a waste of time the entire process is – the other 10% are often heated battles that leave me absolutely drained and angry. At any given time, I have about a dozen fully-insured patients who have been denied care and testing with whom I have to spitball all kinds of ideas to keep them going. All the while, almost every day there is a curveball or two that no one sees coming that are often very time-intense. For example, a patient was sent to the NH for terminal hospice care on Friday. The hospital doctors forgot to turn off their ICD – defibrillator – so even though the patient was passed, their heat was not allowed to pass until I left my busy practice, ran to the NH, and turned it off myself. Critical mistakes like this in modern hospitals are just every day now. It is hard not to make them when there is a different physician every day on the case.

So, this AM on Saturday, I will do my best to work through as many phone calls as I can – knowing I will not get them all – and knowing that people will be screaming next week. I understand how expensive the insurance premiums are and I understand exactly how people feel they are due Cadillac service. But there is nowhere in the USA that is staffing their MD offices for this service. The 24 million dollar/year CEOs though and all the million dollar year C suite people in Big Hospital and Big Insurance have all the help they can dream up – coffee-pourers, armies of Ad people, Marketing, etc.

The students that come through this mess tell me that actually my office is one of the best run that they have seen- again – read the paragraph above and really think about that – but these students all see what a complete disaster this is and don’t just walk away – they run. Dermatology is becoming quite the draw. The best minds in medicine are literally wasted on Dermatology and there are so many of them.

People really do wonder why MDs are so burned out. And even a little psycho. I do not wonder at all. My goal every day is no longer to do the best I can do – it is literally not to let anyone die. And to do everything I can to minimize the anger and vitriol knowing there is nothing I can do to eliminate these bad feelings. The entire leadership of the profession knows all about these problems – I cannot think of a thing they have done about it in decades.