It was about 10 years ago.
I was already running about an hour behind and the next patient on my schedule was a familiar one…but not for good reasons. This was a very complicated patient with huge emotional needs, whose visits would routinely go 30-45 minutes, well beyond the 15 minutes allotted. My heart sank. I would either have to hurry a visit with a genuinely needy person, or run even more late in my packed schedule. I chose option B, as I almost always did, but did so with an overwhelming sense of claustrophobia. I felt trapped.
An image came to my head as I entered that exam room. I pictured a line of patients snaking out of each exam room, going out into the lobby, out the building, and as far as the eye could see in all directions. It was a never-ending river of need flowing at me. If I solved one problem, another was soon to follow. If I made one person happy, the next would be frustrated. If I had a good day, a bad one would always be around the corner. It kept coming at me. Day after day, week after week, month after month, year after year.
That was the beginning of my struggle with burnout. The image of the never-ending line of need waiting on each exam room was depressing, anxiety-provoking, and ultimately the thing that pushed me away from fee-for-service medicine and into my direct care practice. I made that change nearly 7 years ago, and I believe it saved my life as a primary care doctor.
The real problem was that I cared too much. I couldn’t short-change the patient once I was with them in the exam room. I couldn’t force them to only give me one problem, make them reschedule for something I could handle that day, or refuse to check the ear of the child who happened to be in the exam room with the patient. I am a caretaker. I am a giver. Yeah, I get taken advantage of because of that, but I thrive off of taking care of people. It’s what gets me out of bed in the morning. It’s what I’m on this planet to do.
And I was being robbed of that.
Over the past 7 years since I left, things have just gotten worse. A new survey by Medical Economics Magazine (full disclosure: I write for them) involving more than 1200 physicians showed a deepening of the already bad situation of physician burnout.
92% of surveyed physicians reported feeling burnout during their career.
68% reported feeling burned out now.
73% said that the feelings of burnout made them want to quit medicine.
Of those, only 13% sought professional help for dealing with their burnout.
There are many reasons for this growing despair among doctors:
Too much paperwork and government/payer regulations.
Poor work-life balance/work too many hours
Electronic Health Records
Lack of Autonomy/Career control
Insufficient pay/declining reimbursement
Overwhelmed by patient needs
The first five items on this list are non patient-related. These are the things distracting the doctor before they come to the exam room to see you. Patients aren’t more needy than before; they just have a smaller and smaller portion of the doctor’s time and attention. I probably spent 50% of my time on direct patient care, and saw between 20 and 30 patients per day, with the remainder spent on documentation, billing, and making sure all the appropriate boxes were checked for the government. In contrast, I now spend about 80% of my time on direct patient care and see between 8 and 12 patients per day.
But, I have to confess, I still feel some of the emotional fatigue and claustrophobia I felt in my old practice. Perhaps it’s just PTSD from my past life as an abused fee-for-service PCP But I think there’s something more than that. I was talking to a retired pastor recently, and the subject of burnout and professional fatigue came up. I mentioned the image of the never-ending line of need, and he nodded. “Yep. Pastors definitely feel that. You give your heart out to someone and then there’s another person coming in the room when they leave.” The teachers I’ve talked about this with deal with this as well.
Add to that the stresses and strains of life we all face, and things get harder. I have big financial stress caused by the lean years as I started my practice. I also have aging parents I want to see as much as possible. And I went through a divorce (which I don’t blame on my work, but it definitely played a part). My life is not harder than most, but it’s not easy either.
So I find myself having moments of struggle. Do I have it in my tank to do another week, month, year, or decade? I find myself wishing I didn’t care so much. I wish I could treat my work as a job — just a means to make an income.
I guess I could do that. But I’d have to give up my soul. I’d have to give the compassion that drove me to risk everything by starting this new practice. I’d have to see this profession as a job, not as a calling.
And I couldn’t look at myself in the mirror if I did that.
I know that doctors are not alone in these feelings, and am not implying that we are being victimized. But I am saying that the system as it stands selects against the very type of doctor most people want: a compassionate person who listens and gives time when needed. Those doctors are eaten alive by they system and forced either to conform to the fast-moving conveyor belt of modern healthcare, or they retire early, work in corporate medicine, or escape completely (like I did).
Medicine will always have some degree of burn-out. But we must find a way to reward doctors who are caring and compassionate, not chew them up and spit them out. It’s a hard job. Even the best of situations (like mine) can weigh heavily.
Especially if you care.