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.”
Western Carolina Medical Society: mywcms.org