Feeling the Burn
It’s no secret that physician burnout is at an all-time high, and it appears to be increasing every year. That tracks with what I’ve observed (and experienced) over three decades as a family physician. Compared to my practice when I started, over 30 years ago, primary care medicine today feels harder and less rewarding than ever before. But what isn’t clear is exactly why that happened.
Although it can be difficult to get exact comparisons, we can extrapolate from known data to see how the practice of medicine in the 1990s differed from that of today. Surprisingly, some things have gotten better. Real income, adjusted for inflation, has risen substantially. The number of patients seen each day has decreased, and so has the average size of patient panels. Most surprising of all, the actual number of hours we spend at work hasn’t changed much at all.
But if all of that is true, what accounts for the plummeting job satisfaction of many physicians? Here are a few likely culprits:
The rise of asynchronous work. The number of hours we spend on non-patient-facing tasks has tripled, and now comprises up to 35% of our time. This not only increases the amount of tedious paperwork and documentation we do, but it reduces the time for patient care that feels most consequential, and concentrates that work into shorter visit times. Strangely, the job of physician has become more boring and more intense at the same time.
The increase in non-work responsibilities. The rapid rise in both female physicians and in two-income households has meant that fewer and fewer physicians have a spouse or partner managing child-rearing and household tasks. What used to be a full-time job that physicians delegated to their partners is now a second job that they have to manage on their own.
The loss of control. The percentage of physicians who are self-employed has dropped steadily over the past several decades. Though owning a business has stresses and problems of its own, it does afford a sense of control over one’s working life and conditions. The trade-offs were always there, but they were chosen rather than imposed.
I often hear older healthcare leaders lament the “attitude” of younger physicians today.
“Why are they always complaining?” they ask.
“They’re well-paid and well-treated--why do they seem so resentful?”
“Why can’t they act the way doctors used to act?”
What these leaders fail to see is that the practice of medicine is substantially different than it was twenty or thirty years ago--and most of the changes have made it more difficult and less enjoyable.
If burnout continues to rise, it will become an existential threat to our healthcare system. To get this wildfire under control, we need to starve it of fuel. Let’s start by reducing physicians’ asynchronous work and putting them back in the room with the patient, where they belong. Let’s create scheduling and systems that support their need to manage full and busy lives outside of work. And let’s engage them as real partners in decision-making and problem-solving.
Money, time and visit volumes are all important. But if we focus on these while ignoring the other causes of burnout, it’s like installing smoke alarms in a house full of oil-soaked rags.
