A primary care physician may see 20 to 25 patients a day for five days a week, or more.
Many patients need prescriptions or procedures that require scheduling and a health plan's approval – time-consuming, mind-numbing tasks. And while some of these duties can be delegated to others, many administrative chores require a doctor's approval.
"Physicians still spend hours on the phone waiting for an insurance company to pre-authorize something, which is insanity. It's a huge issue," Greenawald says.
Surgeons and emergency room physicians, meanwhile, may spend 10 to 18 hours a day at the hospital, caring for grievously ill or injured patients.
New performance improvement mandates from federal and state governments, insurers and professional organizations add another layer of bureaucracy and assure that doctors, who have long coveted their independence and authority, now work under a microscope.
Physicians now face greater demands for productivity, an increased reliance on often user-unfriendly electronic medical records, and cascading changes in the way care is delivered.
In one of the biggest shifts, doctors who once ran their own practices often now work for major hospital systems, leading many to feel they've become cogs in a corporate health care world where business demands often overshadow the mission to heal patients.
"A lot of them started out being their own boss, and now over half of all physicians are employed. They have patient quotas. Their patient engagement scores are on the internet, and they're being held accountable for how they're being rated. They're told when they can, and cannot, go on vacation," says Lynne Hughes, director of development at the Medical Society of Virginia Foundation. "These guys are grieving. They don't know they're grieving, but they are."
http://www.usnews.com/news/articles/2016-09-08/doctors-battle-burnout-to-save-themselves-and-their-patients?int=news-rec
Many patients need prescriptions or procedures that require scheduling and a health plan's approval – time-consuming, mind-numbing tasks. And while some of these duties can be delegated to others, many administrative chores require a doctor's approval.
"Physicians still spend hours on the phone waiting for an insurance company to pre-authorize something, which is insanity. It's a huge issue," Greenawald says.
Surgeons and emergency room physicians, meanwhile, may spend 10 to 18 hours a day at the hospital, caring for grievously ill or injured patients.
New performance improvement mandates from federal and state governments, insurers and professional organizations add another layer of bureaucracy and assure that doctors, who have long coveted their independence and authority, now work under a microscope.
Physicians now face greater demands for productivity, an increased reliance on often user-unfriendly electronic medical records, and cascading changes in the way care is delivered.
In one of the biggest shifts, doctors who once ran their own practices often now work for major hospital systems, leading many to feel they've become cogs in a corporate health care world where business demands often overshadow the mission to heal patients.
"A lot of them started out being their own boss, and now over half of all physicians are employed. They have patient quotas. Their patient engagement scores are on the internet, and they're being held accountable for how they're being rated. They're told when they can, and cannot, go on vacation," says Lynne Hughes, director of development at the Medical Society of Virginia Foundation. "These guys are grieving. They don't know they're grieving, but they are."
Dire Consequences
Proving that burnout harms patients is a challenge, because it is difficult to study its impact on patient care.
But existing research has turned up disturbing clues.
One study of more than 10,000 nurses and 230,000 surgery patients, published in the Journal of the American Medical Association, examined the specific relationship between workload and patient deaths. Researchers found that increasing a nurse's workload by one surgical patient was associated with a 7 percent increase in a patient's odds of dying within 30 days of admission. Boosting the workload from four to six patients would increase the death rate by 14 percent, while going from six to eight patients would be tied to a 31 percent increase.
A separate survey of nearly 8,000 surgeons published in the Annals of Surgery found that 9 percent reported they had made a major medical error in the last three months. Approximately 70 percent attributed those perceived errors to a personal issue such as fatigue, stress or a lapse in judgment. The worse the surgeon's burnout, the more likely he or she was to report making a medical error. Specifically, each 1-point increase in how a surgeon scored on a scale of emotional exhaustion was associated with a 5 percent increase in the odds of reporting an error, while a 1-point rise in to a surgeon's depersonalization score was tied to an 11 percent increase.
The stress of making countless decisions that profoundly affect patients and their families quickly becomes overwhelming, Damania says, adding that young physicians learn to wall off their emotions in self-defense.
Seeking Solutions
Carilion Clinic offers a window into how one system is attempting to bring burnout under control. Its setting, in a scenic valley surrounded by the Blue Ridge and Allegheny mountains, is a big selling point for the physicians who work here. They relish the small-town atmosphere of Roanoke (population 100,000) and its easy access to outdoor activities. The clinic's flagship hospital, Carilion Roanoke Memorial, nestles so close to the Roanoke River that the health system is building a kayak landing for employees and locals eager to glide down the river and get some exercise.
Still, despite the idyllic surroundings, Carilion's nearly 700 doctors have their hands full. They serve more than a million people in 20 counties stretching from West Virginia coal country to Franklin County, Virginia, near the North Carolina border, which has been branded the moonshine capital of the world. Each year, the system logs around 1 million primary care visits, 169,000 visits for emergency care and nearly 50,000 admissions.
Poverty among those Carilion serves is widespread. The population is aging, with nearly 40 percent of patients qualifying for Medicare. One in 6 people qualify for Medicaid, the government health insurance program for the poor, and another 20 percent say they lack health insurance entirely. Many of the most common diagnoses stem from unhealthy lifestyle choices: chronic lung diseases, cirrhosis, diabetes, high blood pressure, heart failure and infections tied to illicit drug abuse.
Caring for patients who don't take care of themselves can be frustrating. There is also a widespread belief that doctors are responsible for making them better.
http://www.usnews.com/news/articles/2016-09-08/doctors-battle-burnout-to-save-themselves-and-their-patients?int=news-rec
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