Many Family Doctors hate their jobs. They love taking care of patients but direct patient care is on the decline. More and more of each day is spent on administrative work. Staring at a computer screen all day entering useless data that has nothing to do with the patient’s condition is no one's idea of rewarding work. Busy work has taken the place of diagnosis and management of illness. Doctors who routinely saw 25 patients a day 20 years ago (with time to spare) now find themselves struggling to see 15.
At a recent physician meeting I attended I was surprised to hear of how bad things have gotten. Many of my colleagues are spending over three hours a day in charting and other administrative tasks. Work days routinely stretch well into the evening hours with one doctor not leaving the office until after 8 PM (even though his last patient was scheduled at 5).
It is not surprising then that many doctors are looking for a way out. Doctors who once planned on working into their late 60’s are analyzing their retirement plans in the hope that they can retire as soon as possible. When these doctors retire they will leave behind a shortage of primary care providers. The impact on society will be profound, as the resultant lack of access will leave patients waiting weeks or longer to see a doctor.
Those who are too young to consider retirement are looking at other options. “Direct Primary Care” is on the rise, a style of practice in which doctors do not accept any insurance at all. Patients pay cash for the services they receive. In exchange for the personal service and attention doctors charge rates well above what they receive from insurance providers. Physicians also care for far fewer patients, making access, especially for poorer patients, even more difficult.
This dissatisfaction and work stress is in large part due to the advent of electronic medical records. Hailed as a way to improve documentation and limit error they have instead become a burden and a curse. Insurers, particularly Medicare, can now easily review doctor’s charts for “quality”. This sounds wonderful, but the definitions of quality set forth by these outside entities have almost no relationship to actual patient care.
Each month I get an updated report on patients who have not received “needed” tests. It is disheartening to see my performance score lowered because patients with terminal cancer and end stage Alzheimer’s Disease have not had a recent colonoscopy! I find myself wondering, “How did it come to this?”
The loss of longstanding patients is another cause of physician burnout. Primary care physicians typically enjoy having relationships with their patients. More and more we see patients we have known for years leave our practice due to a forced change in insurance. In my practice we see a large number of new patients each week without seeing a significant increase in overall volume. New patients bring new stress as doctors must work to gain confidence and deal with the insecurity of making diagnoses in a patient they do not know well.
Making matters worse is the reality that there is little chance of things getting better. As with many problems in America the problem is likely to get worse over time, ignored until a crisis is reached. None of the health care options under consideration by the government, not Obamacare or its proposed replacements, do anything to address these causes of physician burnout.
This is not to say there are not things patients can do to help their doctors. One of the best ways is for patients to do what they are asked. Get your mammograms, pap smears and colonoscopies the first time you are asked. Go to the lab for your blood work when your doctor requests it, without having to be repeatedly reminded. Keep your appointments and follow up when asked. This seems simple, but it can make a difference!
Finally, be kind. They won’t say anything to you, but your doctors may be hurting. Patience from our patients is desperately needed for doctors who feel overwhelmed.