Solving Physician Burnout: The Beatings Will Continue Until Morale Improves

Dr. Craniotomy

It's 9 p.m. on a Friday and I'm waiting for my hospital's slow, clunky electronic health record (EHR) to load. I'm logging in from home because the administration emails became threatening.  I have about 25 unsigned notes that, according to the emails, are holding up more than $1,000,000 in hospital charges (and that's just this week alone).  They always point out the exact figure, as if that will motivate me.

The patients were already seen by me, and the notes written by either a resident or nurse practitioner.  The hospital just can't bill until I click the "cosign" button.  With the glacial speed at which the EHR servers work, simply clicking that button is quite a time burden, up to an hour if the mouse running the wheel powering the server is having a bad day.

So I put it off until my kids have gone to bed and I can settle down with a glass of scotch for my "catch up on meaningless administrative work" time.

Meanwhile, there's this JAMA article outlining how the National Academy of Medicine is going to tackle physician burnout.

The plan revolves around installing a "culture of well-being" into the healthcare workplace.  They want to develop training protocols to address discrimination, bullying, and harassment while increasing leadership roles such as Chief Wellness Officers.

This sounds like more bureaucratic busywork to complete and administrators to answer to.  I would be shocked to find out that there was a single aliquot of improved wellness from a wellness module.

They advocate that workplaces must accommodate workers who need time off.  That's great.  Nobody should be forced to go to work sick.  But there's a fine line beyond which it can become too permissive.  Patient care can't always wait until it's convenient.  When patients need urgent surgery, I don't get to go home until the surgery is completed.  If there's not enough nursing staff to work all the operating rooms, I'm stuck waiting around all day.  Routinely missing dinner with my family because there's no staffing doesn't exemplify a "culture of well-being."

I'm booking patients months in advance because the OR is run so inefficiently that we can't get multiple cases done in a single day.  Some services have year-plus backlogs.  I see unionized nurses (who make more money than most of the doctors) running the OR, telling me my surgery can't be done, forcing me to explain to the patient why they must continue to wait for their procedure.  When I actually get to do a case, I'm dealing with equipment that is past expiration and literally breaks down in my hand.  I'm told we can't afford working surgical instruments or backup OR staffing.  I'm the one who gets sued when there's a bad outcome.

While the hospital is reminding me how much money I'm making them with my meaningless clicks, I'm reading about an 8% cut to physician reimbursement (forget an inflation-adjusted cost-of-living increase).  Meanwhile, hospital CEO pay has increased 93% (not a typo!) over the last decade and hospitals are getting a 4.3% pay raise from the government in 2023.

My case mix is over 80% Medicaid, so I also have the government telling me my time and effort is worth less than half that of my colleagues who exclusively take private insurance.

I have governmentally mandated appropriate use criteria that questions every imaging order I place on a patient, forcing me to click box after box, justifying an MRI that I know is clinically indicated because I spent 12 years training in neurological surgery to know exactly when an MRI is indicated.

I have the joint commission telling me I'm not prescribing enough pain medication one day and the next day, I'm being threatened with manslaughter charges if I don't check a slow, cumbersome, often nonfunctional online database every time I write a prescription.

If the right wants to be the voice of reason on healthcare (which we are), we need to address these issues.  More government control of healthcare keeps exacerbating the burnout problem.  Medicare For All will only make these issues worse, as Medicare regulations are the driver for nearly all the problems listed here.  The younger generation of physicians thinks that single payor is the way to solve burnout.  We need to show otherwise.

Healthcare regulation keeps funneling more money to hospitals, driving consolidation.  It makes private practice financially untenable, so doctors have no choice but to be employees of these conglomerates.  This monopsony power means the hospitals can treat us like revenue-generating click machines.  Free-market-based healthcare that empowers patient choice would reverse this trend.  We need to make that our rallying cry.

It's either that or hire more wellness officers.  I certainly need more people to point out exactly how much revenue my meaningless clicks generate.

Published in Healthcare

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