banner by Sarah Burns
Physician Burn-Out: An Ongoing Problem in Modern Medicine
by Charlotte Couch
At the tender age of 17, I thought I wanted to be a doctor. On my first day of shadowing an anesthesiologist, I walked into the hospital ready to begin my journey toward becoming a physician. Strangely enough, what affected me most was not the knee surgery, during which the surgeon grinded the bone off into feathery bits, nor the heart visible through a steel, metal tube, but the grim demeanors of the doctors: the disgruntled husband and wife, who were both anesthesiologists, the nurse who was five seconds from imploding and the ever-present aura of tension that permeated throughout the hospital.
It was not surprising to learn that there is a high rate of exhaustion and frustration associated with the health professions. In fact, The Journal of the American Medical Association cites that approximately 30 to 40 percent of doctors report burn out a year. Some of the main sources of stress for physicians include long hours, as well as arguments with insurance companies and hospital administrators over patient care.
Dr. Mike Manolas, a specialist in internal medicine, explains that a heavy workload at the hospital can take up to 90 to 100 percent of his day. “There are times when I pretty much spend the whole day at work, and then when I get home I’m only able to see my son for about an hour before I put him to bed,” Manolas recounts.
Residency, the training period a doctor completes after medical school, is known for its grueling work schedule. While there have been legislative reforms enacted to shorten hours, results have been mixed. Residents are limited to working 80 hours a week, as opposed to the 90 to 100 hours that served as the pervious norm. There is also a limit on how many consecutive hours they can work, thus lessening the chance of medical errors due to exhaustion. However, because of the lowered hours, residents are not always able to follow a patient’s case to the end. As a result, some patients may be switched from doctor to doctor throughout their stay. Some physicians believe that this inhibits a resident’s education and is a barrier to patient outcomes.
Another source of frustration for physicians is dealing with certain insurance companies that limit clinical autonomy. While companies cannot tell doctors how to do their jobs, they can dictate what medication or treatments their plans will cover. “If I order a test on a patient, I have to get this insurance company’s approval. If I order a medication for a patient, they may tell me they won’t cover it,” Dr. Ellen Smith, a cardiologist, explains. Even though the insurance company has never seen the patient to garner a complete comprehension of their condition, they can still deny a doctor’s recommended treatment plan.
The insurance companies use strict guidelines to decide whether a treatment that a doctor prescribes will actually help the patient. They are statistically based and rely on studies that have been promulgated by experts in the field. However, not all cases strictly adhere to those on which the insurance companies base their guidelines, so the patient can end up suffering as a result. For example, Smith recalls times in which insurance companies wrote to patients claiming that they were on the wrong therapy, when in most circumstances, the company simply had the wrong case information.
Physicians are also facing pressure from hospitals to produce fast patient output. Rather than focusing on delivering the best patient care possible, hospitals tend to center their attention on the financial aspects of care in order to turn a profit. Not surprisingly, the frequent disconnect between the interests of these two parties causes stress for physicians who must balance the needs of their patient with the demands of their employer.
Finally, the personal sacrifices that physicians make also take a toll. Due to the nature of the job, doctors are often in situations where they must put others’ needs before their own. According to Manolas, putting the patient before one’s personal life and family was engrained in his head throughout his residency. For weeks he would spend extra time at the hospital, hoping that things would slow down in the near future. After years of experience, however, Manolas now sees the danger of focusing only on his patients at the expense of his own health. Ironically, the BC Medical Journal reports that physicians oftentimes do not adhere to the nutritional or exercise guidelines that they themselves recommend to their patients.
This is not to say that physician satisfaction has gone completely down the drain. Being able to help a patient recover from a sickness or injury is incredibly gratifying. However, many physicians are burned out by the long hours, demanding insurance companies and red tape that takes time away from patient care.
When considering the health of doctors themselves, it is clear that we still have a long way to go before we figure out a healthcare system that is beneficial for both doctors and patients. While my shadowing experience was composed mainly of following doctors and getting lost hundreds of times, there was still one doctor who encouraged me to go into medicine. Despite all of the sleepless nights and the stress of being responsible for a human life, it was all worth it.
“So, if you, had to do it all again, would you?” I asked with a skeptical look in my eyes.