Higher Workloads Are Leaving US Doctors In Distress

Fireworks in Oakley, July 3, 2010

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Long hours, higher patient load, financial pressures, and a pile of bureaucracy: Physician burnout is on the rise in the United States.

“I think that medicine is all encompassing,” said Dr. Lisa Robbins, a primary care physician with a practice in Stone Mountain. “It just takes up so much of your energy, your time, your whole self.”

Robbins has been a doctor for over 20 years. She said there have been many moments in her career where she felt empty, exhausted, without joy. “It got to the point where there was nothing else in my life outside of medicine,” she said.

The burnout rate among physicians in the United States has jumped 10 percent in the last five years. According to a study by the Mayo clinic, more than half suffer from one form or another of burnout. A recent Medscape survey confirms those findings. In addition, it’s been long known and was recently confirmed by a Medscape study, that the suicide rate among physicians is higher than the national average. Also, some doctors are prone to substance abuse.

Burnout affects doctors in all settings, hospitals as well private practice. Family doctors are at higher risk, but so are surgeons and emergency room physicians.

“The reality is that this is hard work, hard patients and a high acuity,” said Dr. Sheryl Heron, who is an ER doctor at Emory University Hospital and vice chair of administration at the Department of Emergency Medicine. “You will be impacted. In fact, if you are not, something may be wrong with you.”

Robbins said for a doctor in private practice, the stressors are different. “Insurance, insurance, insurance,” she said with a sigh. “There are quite a number of hoops that we as practitioners have to jump through in order to get paid by the insurance company.”

One of those hoops is electronic health records and all the metrics for proper documentation and coding that physicians have to abide by.

Iris Grimm, a German-born physician coach in Atlanta, specializes in consulting burned-out doctors. “I hear from a lot of physicians who are struggling with the software and the different templates and all the increased bureaucracy, “ she said.

“Being a physician is highly demanding by itself,” Grimm said. In addition, there’s the constant fear of malpractice claims, and the financial burden of paying back hefty student loans, all while living up to the social expectations that come with being a doctor in America.

“Many physicians live a high quality lifestyle, where the kids are in private school; they have the nice house; they drive the luxury car,” she said. “All of that comes with a price tag. And they have to produce a certain income in order to provide this quality of life to their family.

Add declining reimbursement rates to the list, and fewer doctors are taking care of ever more patients. That’s particularly true for family physicians. They often see 40 or more patients a day, spend their evenings and weekends catching up on documentation, and end up overworked and frustrated.

Dr. Frenesa Hall used to be one of them, a primary care doctor in Atlanta. Until she decided 13 years ago to hang up her white coat for good. She now works for a life insurance company in Greensboro, North Carolina. She decided to quit when she started to feel annoyed by her own patients.

“Medical care became a commodity,” she said, adding that patients became consumers in the worst sense of the word, often demanding and sometimes disrespectful.

Over the years, Hall developed the classic symptoms of burnout. “I was withdrawn. I was angry. I had a very short temper all the time. I had anxiety attacks,” she recalls. “Sunday nights I couldn’t sleep, and Monday mornings, I was hyperventilating on the way to work.”

Physician coach Grimm has seen more drastic cases. While the proverbial surgeon throwing instruments in the operating room may be rare, she sees unprofessional and disruptive behavior all the time.

“There are, for example, physicians who belittle their nurses and speak to them in a tone that is very demeaning,” she said. She has worked with doctors who are “yelling and screaming, smashing doors into the face of staff members and talking badly about their staff in front of patients.”

Grimm said those hissy fits may reflect a volatile personality rather than the profession as a whole. But, she said, there certainly is one reason physicians are prone to burnout. “It’s their drive for perfectionism,” she said. “Doctors have high expectations of themselves and the people working with them.”

Physicians may find it more difficult to seek help than most people, male doctors more so than their female colleagues. For one, it goes against their self-image and authority as healers. Also, the harsh training in medical school with long hours and little sleep has conditioned doctors to be resilient, to simply suck it up.

Yet burnout not only affects physicians’ health and happiness, it can also have a negative impact on patient care, said ER doctor Sheryl Heron.

“Taking care of very acutely ill patients over long periods of time, at high volumes, can certainly lead to increased medical errors,” she said.

A study by Erasmus University in Rotterdam, the Netherlands, concluded that if physicians have a negative bias towards their patients, which often is a sign of stress, there is a greater risk of diagnostic errors.

Physician burnout has moved on to the radar of healthcare administrators and academic institutions. More and more hospitals are now implementing programs for doctors on burnout prevention and work-life balance. Also, most medicals schools have made physician wellness part of their curricula.

Emory is one of them. “The School of Medicine now has a committee looking at creating a culture of wellness for physicians, trainees and staff,” said Heron.

Meanwhile, Hall has no regrets about leaving clinical practice. “Oh gosh. I actually have a life now,” she said. “It’s fantastic.”

Her colleague Lisa Robbins isn’t quite ready for such a drastic move. She said she loves working with patients. “It just is something that I can’t seem to get away from,” Robbins said.

Instead of quitting, she decided to make some changes to her practice. She now puts stronger focus on holistic medicine, a field she’s always felt drawn to. She has also reduced her office hours. Her main advice to younger doctors is simple.

“Try to take time for yourself,” she said. Doctors wouldn’t make as much money as they would if they were working around the clock. “But you have to think about it this way: It doesn’t make a difference if you’re making all this money and you really can’t enjoy it.”

Katja Ridderbusch is an Atlanta-based independent producer for German national public radio.