Doctors, nurses, psychiatrists and other medical professionals are getting burned out, and the Asheville-based physicians organization Western Carolina Medical Society has taken notice. A 2014 survey showed that the problem is prevalent in the region, says Miriam Schwarz, WCMS director.
Asheville psychiatrist Dr. Adrienne Coopey, for example, had been working repeated stretches of 12 days in a row.
“I was really trying to do my best at work in meeting everyone’s expectations,” Coopey says. “But I was tired. I didn’t really want to go to work. There’s a lack of motivation to continue your work because you don’t feel effective at it. It can be very much like depression.
“I deal with traumatized children, which can be a pretty stressful work environment. I was experiencing conversations with insurance companies telling me a child didn’t need to be in the hospital and I should discharge them, but I knew that was wrong.”
Coopey says she was able to make changes in her personal and professional life that helped her to better manage the stress. But with the recognition that doctors across the region are facing similar problems, WCMS members and leaders are trying to do something to address it.
The issue of physician burnout came to the medical society’s attention last year during its strategic planning process, which involved interviewing more than 100 doctors, practice managers, CEOs and others across the region, says Schwarz.
“We take all the data we collect and look for trends,” she says.
Interviews with both private physicians and those employed by hospitals revealed that burnout is widespread and growing.
“This was startling to us, because physicians tend to keep these kind of issues internalized,” Schwarz says. “Physicians have very rigorous educational requirements that they need to fulfill, and expectations are very, very high for them to excel. I think there’s an expectation that physicians need to appear externally to be strong, unflappable, compassionate and frankly to be more composed human beings than most of the rest of us.”
In a recent Medscape.com nationwide survey, 46 percent of doctors said they were experiencing burnout.
“The study validated what we were seeing locally,” Schwarz says. “When we identified burnout as a key issue, we decided to develop a strategic plan to address it. Because the medical society is a physicians organization supporting physicians across Western North Carolina, it made a lot of sense for us to take action.”
The society plans to bring in a physician-burnout expert who will conduct a forum for doctors, spouses and partners, she explains. The goal is to work together to define burnout and come up with personal and organizational plans to address it.
The society also is researching physician wellness programs in preparation for establishing one here, Schwarz says. WCMS will consider a mentoring program, too — one that would match experienced doctors with those who need help to “navigate the choppy waters of health care,” she says.
“We’re seeing a sharp increase in burnout because in addition to their high-stress jobs, they are in the midst of great upheaval and experimentation and uncertainty about their future in health care,” she says. “We think that if we don’t address this problem, we’ll see physicians leaving the practice of medicine, and those who stay will continue to spiral downward if we don’t give them the help they need.”
Asheville obstetrician/gynecologist Dr. Robert Henderson says he experienced burnout while in private practice in Texas and serving as director of resident education at a medical school. Now president of WCMS, he says that pushing himself too hard took its toll.
“You reach a point where you don’t enjoy the practice of medicine like you used to,” says Henderson. “And you want to withdraw from people when you’re not working. You reach a point where you don’t have satisfaction and pleasure in engaging with your family. That’s what I experienced.”
Burnout can become severe enough that it affects patient care, he adds. When he served on the Texas Medical Board, violations by doctors cited by the board nearly always involved physician burnout, Henderson recalls.
Further, with fundamental changes in the structure of the country’s health care system, doctors increasingly have more to worry about, Schwarz says. There is a growing emphasis on data collection and other time-consuming administrative requirements, including the introduction of electronic health records.
The Affordable Care Act is changing the way doctors and hospitals are reimbursed from the traditional fee-for-service model to a system that rewards keeping people healthy and out of the hospital, she continues.
“It’s really turning the health care system on its head,” Schwarz says. “We’re in a transition from volume-based care to getting paid to manage population health. That brings a whole host of additional skill sets that physicians need to learn and apply. They’ve never done it before, hence the uncertainty and the feeling that they’re in a great experiment.”
Coopey says the new method of reimbursement means more doctors are forced to become employees of hospital systems, adding to a lack of control. Then there’s the frustration and paperwork involved in dealing with insurance companies for doctors trying to do what’s best for their patients, she says.
“So even when physicians know they are making the right decision for patients, they may have to argue with an insurance company or a hospital system to get that need met … or the system doesn’t give us the tools we need to help,” she says.
Respect for doctors has declined, too, leading to decreased job satisfaction, Coopey believes. She regularly talks with doctors considering leaving the profession, she says.
“What they hoped and dreamt as a child for being a doctor has not come to fruition,” Coopey says. “We’ve lost physicians in this community because of burnout. They no longer practice clinical medicine at all.”
Henderson says young doctors feel the stress of large debts accumulated to obtain their education and training, while revenues have declined. He cites “government intrusion into the physician-patient relationship,” including a Florida law preventing doctors from discussing the dangers of firearms in the home and a proposal in the N.C. General Assembly to restrict what physicians can discuss with their patients regarding abortion services.
Coopey says being a doctor is stressful enough even without the added burdens.
“People are dealing with death and illness and things that are out of their control, but as physicians we feel responsible for our patients and we want to help them get better,” she says. “There is a lack of recognition for all the years of hard work we’ve put in when we have to argue with an insurance company to give patients what they need, or the system we’re working in doesn’t give us the tools we need to help the patient.”
MORE INFO
Western Carolina Medical Society: mywcms.org
A “for profit” health care system is an oxymoron and the primary cause of physician burn out… American Healthcare is over priced and few people adequate have access to it. The insurance companies pit patients against their physicians by providing minimal coverage; causing inadequate care… then the physicians get blamed for being horrible doctors being it only for the money”. I ought to know; I used to practice.
“Repeated stretches of 12 days in a row”. I would suggest that the psychiatrist try-on-for-size 24-7 inpatient call for 6 weeks or more in a row. That’s what this Pediatric Hospitalist was more-or-less forced to do in Eastern North Carolina (by a Vidant affiliate), when the “parent company” was too cheap to bring in additional people to help cover someone else’s absences. When I finally worked up the courage to complain, I was tossed out on the street like so much garbage (after YEARS of faithful service) – treated like a criminal – just six weeks after having knee surgery (I was back at work in a week – in a wheelchair/on crutches), and while I was still in rehab (certainly in NO shape for a job search).
I don’t care now who knows what I think about what this hospital did to me. NO ONE in a position of oversight lifted a finger to help. What’s the life, health and career of one doctor? Burnout? I was HIT BY A TRAIN OF GREED.
Pediatric wards and nurseries in community hospitals all over this state are in free fall because hospitals have driven good, long-suffering doctors out/away. Those who come in and try to rescue these disasters are treated quite horribly compared to their medical colleagues in surgery, the ED and OB – forced to take obscene amounts of call and be paid comparative peanuts for it. There are no standards of care – or limits on shifts. And God forbid if you, as a physician, dare stand up for what’s best for a patient.
The hospitals and conglomerates in this “right-to-work” state are getting away with this kind garbage because our Medical & Pediatric Societies – and our Medical Board – and our Legislature – are letting suits and lawyers run the Medicine shows. They’ve all just rolled over and looked the other way – for years – they’ve not so much as tweaked employment laws to recognize that unique responsibilities should engender certain protections/rights. It’s not about care – it’s always about money – about getting out on the cheap – and cranking up the bonuses for someone other than the doctors and nurses holding down the forts.
I hung on for seventeen years. I kept hoping someone would get their act together. It hasn’t happened. I will be practicing somewhere else. And it’s NC’s loss.
This article is spot on. I have devoted recent years outside of medicine to see to the needs of burned out physicians and other professionals and part of my mission is to help raise awareness of this tragic epidemic within the house of medicine. It is possible to restore happiness and balance to the everyday practice of medicine but it will take the concerted effort of all stakeholders. The NC Medical Board is showing some interest in physician wellness and hopefully this will serve as a spark to help reignite our burned out colleagues.
Clark Gaither, MD, FAAPF
clarkgaither.com (Dr. Burnout)
As I walk away from my home state, let me add that, IF in these days of provider (hate the word) shortages, the NC Medical Board is truly “worried about physician burn-out, then the NC Medical Board needs to sit down with “burned-out”/”done-wrong” doctors (instead of IGNORING or BLAMING them), and the NC Medical/Pediatric Societies, and introduce some legislation that affords doctors BASIC protections (in our “right-to-work” state) in terms of dealing with these giant hospital systems and conglomerates (and their interconnected lawyers). Start with hospital privileging (unlike the “old days”, no protection AT ALL if you are employed) and insurance/hospital credentialing/licensure reform. Whistle-blower protection. Basic staffing/minimal pay guidelines. Protected ethical codes of conduct – standardized protocols for review and/or reporting problems – that can cut through all of the legal garbage piled upon us by the Three-to-Five-Letter Federal Acronyms that have taken over our lives.
For nearly two decades, these organizations have ROUTINELY look the other way as their own were viciously brutalized. But then they turn around and tell the public they’re concerned about burn-out and physician wellness. It’s hypocrisy at its highest level.
In worked in military medicine (socialized)
for 5 years and loved it! I transitioned in to private practice and loathed it!
I’d like to mention that I’ve been going to the VA for 16 years… Every few years I get a new primary care Doctor.. When I first meet them; I always dig into their past… NOT one hasnt said they were in private practice and got burned out and what a relief it is to now work at the VA. They’re working a “skate for 8” with no staff to Manage, no “ever decreasing” insurance reimbursments to deal with. Weekends and federal holidays off; All while they’re making just as much money with consistent raises; nearly impossible to get fired… Having the most secure job in the world; AND a to die for retirement package to boot…. Gotta love socialized medicine!!
Your comment reeks of ignorance; you obama voter. YOU and your attitude are part of the problem. that’s the nicest way I could muster to tell you what I think of your comment.
Ignorant? I have 12 years combined of socialized AND private practice healthcare under my belt…. I grew up utilizing a single payer healthcare systems, then utilized (socialized) military medicine while on active duty; now I use the VA (again socialized medicine)… You know; nothing but the best for our nation’s heroes . “OBAMA voter”??? What relevance would that be?? Sadly, you prefer the CEO of an insurance company dictate healthcare decisions for your patients by dictating “what’s covered”… I assure you, if either one of us are ignorant; it’s not I.
Oh AND the board of examiners are just a bunch of politic bureaucrats; tits on a bulls…. Being there as a figure heads… Mucky mucks heavily petting each other!