BY DR. LAURA FLECK
It may seem strange to think about physicians needing to be taken care of. After all, aren’t they the healers? If they can take care of dozens of patients daily, can’t they take care of themselves? Why do they need care anyway?
I have practiced medicine for over 30 years, the past 16 of which have been in Western North Carolina. Like most of my colleagues, I have seen dramatic changes in how I am able to practice medicine. Gone are the days when our medical practice was our own business. There were very few bureaucratic tasks and no electronic health records. Most of our time was spent face to face, treating people. We loved what we were trained to do: care for patients.
All of that has changed. We now find ourselves practicing medicine in an ever-changing, bureaucratic health care system. Most of us are working 60-plus hours a week, taking time away from our families. How we practice is to a large degree mandated by burgeoning government-reporting requirements. According to a study published in the Annals of Family Medicine, primary care providers spend 50 percent of their time doing data entry and computer-related tasks, time that is no longer reserved for patients.
The reality of this fact recently became very clear to me when I overheard a patient sharing her personal observations with a family member while they waited in the exam room for me to complete her care plan. I had previously treated this patient, but I had not seen her in 10 years. The patient, with concern in her voice, stated that this visit had been very different from previous: It was much more brief, my staff seemed focused on their computers, and it was unlikely her insurance would pay for the testing I had recommended. In one brief conversation, she summarized much of what frustrates physicians daily.
According to a 2016 survey, physicians in the United States are currently more discouraged and hopeless (“burned-out”) than any other profession. Fifty-one percent of physicians have experienced burnout in the last 12 months. Forty-eight percent of practicing physicians stated they would choose another profession if they could make their career choice all over again.
Having been through the rigors of medical training and practice, I can attest to the fact that physicians are a tough breed. We are encouraged to be tough. What we have to go through in order to obtain our degree alone is a feat of physical and mental endurance. So, the fact that, according to a recent survey, more than half of the physician respondents plan to leave the practice of medicine entirely or take early retirement to escape their present circumstances is a critical reason why they need to be cared for.
In 2017 alone, I witnessed three physicians leave busy practices that had taken them decades to build because they felt they could no longer tolerate the current medical environment. One told me he would rather leave medicine than continue to give patients less than what they deserve. Another felt he wasn’t actually practicing medicine at all anymore.
And, if that weren’t enough, every day physicians in the United States decide they can no longer cope with the stress of being a doctor. Their hands, once used for healing, become the instruments by which they take their own life. “Over a million patients lose their physician to suicide each year,” stated Dr. Shaun Gillis, co-author of the book The Other Side of Burnout: Solutions for Healthcare Professionals, at a 2016 American College of Physicians meeting. We are losing doctors’ lives to burnout.
If we are in agreement that care providers need support, what do they need and how do they get it? Physician awareness is the first step. Physicians must recognize that they may be at risk for burnout due to the difficulties of practicing medicine, and that it is OK to need help. Burnout screening tools can provide a confidential means for physicians to examine their own wellness. For example, at the hospital where I work, medical providers are being screened for burnout on an annual basis, utilizing the Maslach Burnout Inventory. It is a simple and effective tool that assesses the level of physician burnout and is also available to any physician online.
It isn’t enough to identify physician needs. We must also create a culture in the medical and local community that appreciates the personal needs of care providers. Physicians have been trained to be strong and self-sufficient. Admitting they may need help is not always easy, particularly if they feel they will be criticized or penalized. An environment must exist that makes the pursuit of support and assistance by a physician a noble thing ― not a shameful one.
In this time of significant change and challenge, helping physicians find and value balance in their lives is probably the most essential part of caring for them. Physicians, like all humans, are complex beings with a wide range of needs: physical, emotional and spiritual. Physicians should not feel guilty for the time they take to fill these other vital roles. They must be reminded that their lives hold value and meaning separate from the role they play as a care provider.
I recently received an email from a friend who is an ophthalmologist. She had struggled throughout her busy workday, wondering if she would finish up in time to make her daughter’s dance recital. Backed up in clinic, she called her daughter to break the bad news that she wouldn’t be there in time. Her daughter sadly said, “It’s OK, Mom, I understand. Your patients are more important than I am.” My friend broke into tears, canceled the remainder of her clinic and made it to the recital ― but not before moving the remaining patients to her already fully booked schedule the next day.
The practice of medicine has changed. Physicians are faced with challenges and demands that take them away from patients, as well as friends and family. The result is increasing physician burnout with its devastating consequences. Now, more than ever, care providers need to be cared for. This requires heightening physician awareness of the challenges they face, providing tools to identify needs and resources to address them. It necessitates encouraging physicians to live healthy lifestyles and find balance in their own lives. But to be successful, we must first transform our culture to embrace the human side of medical providers, with all their vulnerabilities, and remember that physicians’ lives hold value and meaning separate from the role they play as care providers.
Laura Fleck, M.D., is a board-certified medical neurologist at Foundation in Spine Health, a service of Park Ridge Health in Hendersonville, specializing in the evaluation and nonsurgical management of spine conditions that cause pain in the neck, midback or low back. She can be reached via www.parkridgehealth.org or by calling 855-PRH-LIFE (855-774-5433).