How To Identify Physician Burnout — And How To Prevent It

Physician Burnout - Courtesy FlickrPhysician burnout is becoming increasingly common, especially for new physicians. The combination of changing healthcare environment and debt burden has made medical practice less desirable to practice medicine. If you want to find whining doctors, go no further than Sermo. You will find plenty of disgruntled doctors.

How Does Physician Burnout Occur?

Burnout typically stems from an undesirable work environment. This might mean taking excessive call compared to the senior partners, getting dumped with non-revenue patients, handling scutwork, taking more hospital calls, or not getting compensated for your effort and time. For outpatient specialties, I’ve seen junior employees getting dumped with uninsured patients or taking care of non-revenue postoperative patients. This means that you end up being busy without being credited with revenue. Some practices do not openly disclose their books to their employees and hit them with overhead charges that should not be allocated to the junior doctor. For inpatient doctors, burnout can come from dealing with sick patients, demanding families, and high stress levels. Moreover, many inpatient doctors work for hospitals or larger groups that certainly can control the amount of revenue that is distributed to the doctor.

The practice of medicine is both a healthcare service AND a business. The Hippocratic oath doesn’t say anything about running a business, but it does us no good to care of patients if we can’t keep a roof over our head while doing so. Purists are going to scoff at this mentality, but this the cold, hard truth. Likewise, if you were to argue the financial ramifications of a cosyntropin stim test in your medical school endocrinology class, you’d be viewed as a heretic.

However, once you are out of the protected training environment, you end up dealing with the reality of a medical practice. Even in protected HMO practices like Kaiser Permanente, you still deal with cost containment, busy clinics, and budget cuts.

Take that work stress back home, and you’ve got a recipe for burnout. At home, you are too exhausted to deal with household chores and family. Fights will bound to arise. You not only have an unhappy doctor, but also an unhappy family.

How To Prevent Burnout

There is hope to escape and avoid burnout. The key is to identify what the offending routines that make your job intolerable and get rid of them. Is it the incompetent front desk that your practice has sustained for the past decade? Find a way to replace them. Are your senior partners giving you all of the holiday call? Justify to them that in order for you to be a productive doctor, these responsibilities need to be divided equally.  Are you being charged overhead for a surgical center that you have no hope of owning? Make an argument with your employers that whatever policy that is imposed on you is not commensurate for long-term success for the practice. This is obviously a dicey topic since many of the senior doctors in your practice may have gone through the same process that you are going through (except that income was likely better for them). If they are  truly committed to your success, they should be amenable to some change.

Do you keep getting overnight shifts at your hospital? Do they only pay you an extra $4/hr for taking those shifts? Find out what the problem is. Are there other doctors in your group who are willing to take the graveyard shift? If so, negotiate an arrangement with them. If not, then your administrators need to pay you more for working undesirable hours. If you know exactly how much revenue or charges that you bring in per shift, then you have negotiating power. Remember, administrators need facts. They aren’t going to pay you more simply because you are saving lives and deserve it. You bust your ass in the office to earn $200,000, and they bust their asses going to meetings the entire day for their $240,000. To the objective business mind, the two jobs are identical.

Do you simply hate going to work? Perhaps condensing your hours to four days a week can help reduce the stress by simply reducing the amount of time you spend at work.  If you can accomplish five days of work in four days, by all means go for it.  If you are fortunate enough to have a working spouse and have finances amenable to a part-time job, go for it.  This is why alternative income streams are so important. You need that f-you money.

If all else fails, you need to find a new job. Most doctors cringe at the thought of picking up their families and moving, but sometimes that is all you can do. Remember, if you are stuck in an unfavorable financial and emotional job, you have to live with it daily. Most doctors change employers and jobs at least once during the first five years of their careers. This is more reason why you should not be buying a McMansion right out of residency.

Remember, there is hope. Thousands of doctors have been in your shoes and have survived. Some have struggled through burnout, but remember that you don’t have to in order to be a successful doctor.

 

What strategies have you applied to avoid burnout? What has work, and what hasn’t?

 

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