Doctor Burnout

Our medical system has many problems that need to be fixed. One of the bigger ones is a doctor training system that seem designed to make doctors cynical, insensitive and money grubbing. Doctors are required to go into debt to pay for medical school, and during their residencies they are paid poverty wages. Then once they finish they are expected to make out like bandits. They earn too little in residency and too much as regular working physicians.

The other nonsense is the crazy and unnecessary working hours, which seem to be put into place not for the benefit of the doctors and patients, but-quite the contrary-to act as a kink of hazing exercise. Aside from the fact that sleep deprived doctors are dangerous, it also helps to harden them and make them cynical about practicing health care.

With all of this built into our system it is no wonder that many doctors do not bother even to wash their hands, because it would take time away from making money. Medicine can never serve the needs of patients if it is reduced to little more than profit maximization at any cost. That unfortunately is too much of what our modern American medical system has become, and peole are suffering.

Dr. Mercola has a video and text explaining these problems (below).

By Dr. Mercola

A substantial portion of U.S. doctors suffer from burnout on the job, according to a study published in the Archives of Internal Medicine.1

Of the nearly 7,300 doctors who participated in the survey, nearly half had at least one symptom of burnout; 38 percent had high emotional exhaustion scores; and 30 percent had high depersonalization scores (viewing patients more like objects than human beings) – twice the rate of the general population of working adults.

Burnout was most common among doctors at the “frontline of care,” such as those working in emergency rooms, general internal medicine, or in family medicine. Nearly 60 percent of doctors in these specialties reported high levels of burnout.

Doctors also report being dissatisfied with work-life balance more frequently than other working adults, with more than 40 percent of doctors reporting dissatisfaction compared to 23 percent in other professions.

The main complaint was excessive work hours – on average, doctors worked 50 hour weeks, with nearly 38 percent of doctors working 60 hours a week.

According to the authors of the study, US doctors are burning out “at an alarming level,” as previous years’ polls have placed physician burnout levels between 30-40 percent.

“This high rate of burnout has consequences not only for the individual physicians, but also for the patients they are caring for,” said Dr. Tait Shanafelt of the Mayo Clinic in Rochester, Minnesota, who led the research, Reuters reports.2

“‘Previous studies have shown burned-out doctors are more prone to thinking about suicide and to making medical errors than are their peers,’ Shanafelt added…

‘It’s not clear why burnout strikes so many doctors, said Shanafelt, adding that excessive workloads are only part of the equation. Other possible reasons include too much paperwork, loss of professional autonomy and a higher patient load to make up for declining reimbursement rates.

There is a sense that the volume of patients that need to be seen is increasing and it’s taking away some of the time needed to build a relationship and give the best care possible,’ Shanafelt told Reuters Health. ‘That starts to build cynicism, I think.’

Shanafelt worried that as more and more people get health insurance under President Obama’s Affordable Care Act, the pressure on primary care providers would increase ‘at a time where those individuals are already quite stretched.'”

My Experience with the Flawed System

Having gone through conventional medical training, I can tell you the entire system seems to set the physician up for burnout. I spent four years in medical school after four years of college and then did a three year family medicine residency. After that I served as the chairman of the family medicine department at St. Alexius Medical Center for some time while I was starting my private practice.

Internship and residency training typically, and certainly in my case, was exhausting both physically and emotionally. The schedule provides little free time to do much of anything besides patient care.

Residency work weeks can often reach 80 hours, which leave little time for exercise, shopping, preparing meals, or cleaning your home, let alone maintain close personal relationships. This acute time pressure is combined with an enormous responsibility of caring for very sick individuals in precarious situations, where a misdiagnosis or incorrect order could frequently be a matter of life or death.

I did virtually all of my residency training in an inner city hospital very similar to Cook County Hospital in Chicago, which one of my old favorite TV series, ER, was based out of. I really enjoyed that show and even wrote a eulogy for Dr. Greene when he died I actually did spend about three months at Cook County doing an endocrinology rotation so I have a strong basis to make the comparison.

The hardest rotations though were the medicine and surgery rotations, as you were on call in the hospital and were available to be paged at any time during the night by the nursing staff for new admissions or medical emergencies. Not only is it a challenge to provide reasonable care at night, but even more so the following day when you were sleep deprived, as some nights you simply did not sleep much, if at all.

The Bullying Culture of Medical School

Then there’s the medical hazing that regularly occurs during rounds, in which you review the patients with students and senior medical staff who grill the residents and students for complex differential diagnosis or obscure bits of information about the pathology of the patients’ disease.

This certainly has its purpose in molding students and residents to morph into professionals who can assume the responsibly and provide competent care to patients when there’s no supervision. However, knowing what I know now of course, a good portion of the process was fatally flawed as they were simply training you to become skilled in the administration of drugs, and rarely, if ever, addressed the foundational cause of why that person was in the hospital. (Of course, this doesn’t apply to all cases, especially in emergency room situations or cases of acute trauma.)

But there are other forms of bullying taking place as well – something most people would never consider possible. After all, isn’t the medical industry run by adult professionals?

A recent article in The New York Times discusses the bullying culture of medical school, stating:3

“For 30 years, medical educators have known that becoming a doctor requires more than an endless array of standardized exams, long hours on the wards and years spent in training. For many medical students, verbal and physical harassment and intimidation are part of the exhausting process, too.

It was a pediatrician, a pioneer in work with abused children, who first noted the problem. And early studies found that abuse of medical students was most pronounced in the third year of medical school, when students began working one on one or in small teams with senior physicians and residents in the hospital. The first surveys found that as many as 85 percent of students felt they had been abused during their third year.

They described mistreatment that ranged from being yelled at and told they were ‘worthless’ or ‘the stupidest medical student,’ to being threatened with bad grades or a ruined career and even getting hit, pushed or made the target of a thrown medical tool.”

What could be the root of such mistreatment? While I don’t proclaim to have the answer, I have to wonder if over-work and exhaustion isn’t at the heart of this problem as well. Virtually any parent with more than one child who has suffered many sleepless nights nursing and tending children will probably be able to tell you it’s tough keeping your cool when you’re flat out exhausted and emotionally drained.

At What Price is Freedom to Practice Medicine?

After surviving the medical training, the next step is to earn a living, which comes with enormous financial pressures. This was a bit easier when I started my practice nearly 30 years ago and student loan debt was far lower. At the time, you could get a medical degree for about $50,000, but now students graduate with loans three times that; some as high as $250,000, not including any undergraduate debt they might have accumulated. This is before any rent, mortgage or auto expenses.

This financial pressure really limits their opportunity to go into private practice, where they would incur yet additional expenses and an even longer time to develop the revenues to become debt free. So the vast majority of physicians, over two-thirds, are not in private practice but employed by hospitals or large medical groups

Private practice allows physicians to enjoy the autonomy of running their own practice. Setting their own schedule, developing their own philosophy of care, deciding how much time to spend with each patient, and even something as simple as choosing how to decorate the office, which can boost morale, are some of the freedoms of private practice.

All of these factors tend to help prevent burnout, but most physicians are not able to reap these benefits.

However, for the minority of physicians who are able to start a private practice, the challenges certainly continue, as one needs to address reimbursement concerns from insurance companies whose major business purpose seems to be denying payment.

Making matters worse, physicians with integrity, who seek to practice what they are convinced will help their patients even if it conflicts with the “standard of care” are regularly paraded through hospital committees to defend their positions.

State medical boards will typically seek to have a day with outliers who choose to practice natural medicine. I personally have had to defend my license twice before the medical board in Illinois. Both times it was a result of anonymous skeptics who felt the information I was providing on the website was medical heresy and I should be prosecuted for it. I prevailed each time, but at significant cost and time. Ten years ago I even had to sue them in the Supreme Court for freedom of speech issues, but I prevailed.

Many other natural medicine physicians have to defend their license with the state medical board as a result of peer harassment for not complying with the drug model. It’s a sad and frustrating fact that many doctors will do everything in their power to defend this model by attacking those who have differences of opinion about its merit.

The Challenges of Patient Care

Even once the factors mentioned above are addressed, one has to take care of patients. Some will follow your advice and implement the nutritional and lifestyle changes prescribed and typically experience profound improvements after having seen the best and brightest in conventional medicine and come up short-handed… Those provide the kind of joyful feedback that makes the entire process worthwhile.

However, there are a fair number of people who remain unconvinced that natural medicine can actually “work,” or worse yet, simply are non-compliant with the program and less than honest in their follow-up visits. This makes it very difficult to determine what precisely is the problem – their non-compliance or that they are truly non-responsive to the treatment.

To top it all off there is the issue of scheduling. How do you schedule patients in a way that makes everyone happy? To balance the time necessary to properly address their problems yet still create enough revenue to pay all your expenses?

Once you have that nut cracked, then you have to solve the challenge of how to address patients who have some new problem that takes much longer than you anticipated, and you have a waiting room full of patients you are scheduled to see. This is compounded by ‘no-shows’ and patients who come late for their appointment.

In addition to the challenges of patient care, one has to adeptly manage all the clinical staff and keep them happy, while following the complex array of federal rules and regulations applied to a small business owner.

Physician Burnout: Part of the Puzzle of Why U.S. Health Care is So Dangerous

Last but not least, there’s the ever-increasing cost of medical malpractice insurance, which, aside from being just the cost of doing business as a doctor, raises health care costs across the board. According to a 2010 report4, medical malpractice liability costs the U.S. healthcare system more than $55 billion a year, the vast majority of it – nearly $46 billion annually – in “defensive” medical practices such as extra tests and scans, which are often ordered by doctors in order to ‘cover their behinds.’

This causes virtually any doctor you interact with to order expensive and very frequently unnecessary tests, not so much to figure out what is going on with you but to protect themselves against future litigation or reprimands from hospital committees or state medical boards. These statistics alone hint at the problems inherent with conventional medicine, which has been, and still remains, one of the leading causes of death in the U.S.

Eight years ago, I posted the comprehensive, footnoted research article, Death by Medicine, on this website. Authored in two parts by Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD, Debora Rasio MD, and Dorothy Smith PhD, it described in excruciating detail how the modern American medical system had bumbled its way into becoming the leading cause of death and injury in the United States. From medical errors to adverse drug reactions to unnecessary procedures, the authors took statistics straight from the most respected medical and scientific journals and investigative reports by the Institutes of Medicine (IOM), and showed that on the whole American medicine caused more harm than good.

A 2010 analysis in the New England Journal of Medicine found that, despite efforts to improve patient safety in the past few years, the health care system hasn’t changed much at all. Instead, 18 percent of patients were harmed by medical care (some repeatedly) and over 63 percent of the injuries could have been prevented. In nearly 2.5 percent of these cases, the problems caused or contributed to a person’s death. In another 3 percent, patients suffered from permanent injury, while over 8 percent experienced life-threatening issues, such as severe bleeding during surgery. In all there were over 25 injuries per 100 hospital admissions!

Can physician burnout have something to do with these abysmal statistics? Of course it must play a rather significant role…

For the Record – What is a D.O.?

As most of you probably know, but might forget from time to time, I am an osteopathic physician, also known as a “DO”. DOs are licensed physicians who, similar to MDs, can prescribe medication and perform surgery in all 50 states. DOs and MDs have similar training, requiring four years of study in the basic and clinical sciences, and the successful completion of licensing exams. But DOs bring something extra to the practice of medicine.

Osteopathic physicians philosophically are committed and more likely to practice a “whole person” approach, treating the entire person rather than just symptoms. Focusing on preventive health care, DOs help patients develop attitudes and lifestyles that don’t just fight illness, but help prevent it, too. Unfortunately from my perspective there is no significant difference between DOs and MDs in using conventional allopathic strategies for chronic disease, as they typically rely on drugs and surgery rather than lifestyle changes.

As a Patient, How Can You Avoid the Risks Inherent with Physician Burnout?

Hopefully, this helps give you a peek into the complexities that can easily contribute to physician burnout.

So what is the solution?

Well, from my perspective there isn’t any easy one, other than to simply minimize your interactions with the conventional system, because even if they have successfully navigated all the land mines above, they will likely still be advising strategies that in no way shape or form address the underlying cause of your disease. One of the reasons I am so passionate about sharing the information on this site about healthy eating, exercise, and stress management is because it can help keep you OUT of the doctor’s office, or even worse, the hospital.

In her book, Death by Modern Medicine, Dr. Carolyn Dean talks about how, for well over a century, the definition of health care has been pills-and-drugs. It’s a deliberately schemed and manipulated paradigm that’s been packaged and sold through:

The insurance industry’s (including Medicare’s and Medicaid’s) methodology for payment, which doesn’t recognize nutritional care or proven naturopathic approaches to health care

Direct-to-Consumer advertising

Influencing physicians and other health care providers through gifts, honoraria for speaking engagements, and financial support for training programs, which is simply another form of advertising

Intense lobbying by PhRMA and individual drug makers

You can use the internet, and this site, to find well-proven strategies that will address the vast majority of ANY chronic health problem you struggle with. If you have an acute injury, of course you need to seek immediate competent care. However the very first step for any chronic health challenge would be to follow my Nutrition Plan as that will likely improve, if not completely eliminate, more than 80 percent of your health challenges.

I want to emphasize that it doesn’t really matter what your health problem is, applying the Nutrition Plan is the first step to getting better. It has the absolute best information I have learned over the last 30 years to help you Take Control of Your Health.

In the unusual case where you are not getting better, it will be wise to seek a health coach or medical professional that can guide you through complicating factors that may be impairing your progress. Typically, it is best to use the time honored local social networking strategy of asking as many people in your community who the best practitioners are for your problem. You can typically find many good referrals from people in independently-owned health food stores. But be sure to get a clear consensus and ask as many people as you can, as choosing a doctor is a very important step, and you want to make sure you get it right.