‘Alarming’ burnout is making doctors want to kill themselves
nypost.com
nypost.com
Do you think the audo dealership does it because they like spending money? No, it's because they compete and are paid based on quality of customer service, and believe (rightly) that keeping good customer records is an important part of that.
No such incentives exist in the medical industry. Everything is just "how many procedures can you do per hour". Since the industry doesn't encourage good record-keeping, it's seen as a "chore" doctors don't like doing and hence hate doing it, and try to do it as quickly as possible, before they can get back to "making money" doing hip and knee surgery, seeing more patients, etc.
The solution is really pretty simple: there needs to be meaningful competition on the (patient-perceived) quality of care. Our current insurance-driven system doesn't promote that at all. Handing customers cash, whether from employers, the government, whoever, and letting them spend it, gets the incentives a lot closer to right.
A large part of a patient-perceived score is whether they get what they want. This often isn't in the best interest of the patient. With patient-score focused medicine, you get over-prescription of pain-meds, adderall, antibiotics. You also incentivize doctors not to challenge patients with dangerous views like anti-vax.
Take knee surgery. My surgeon friend does 7 of these each day at $30K/surgery (he "only" gets about 10% of the charged amount). If there was even a 10% copay on this, possibly means-tested if you want to make it fair for poor people (meaning it goes up the more income/wealth you have), you'd better believe more people would choose dietetics (my mom's profession, group classes cost like $10 each) over $30K knee replacements.
You're talking about a procedure that costs roughly the yearly pretax median income of a US adult. Some people have multiple of these per life. We can play the "who pays" game all day, pushing the cost of care around on the plate, as it were, but until we stop prescribing high-cost surgeries and expensive solutions to chronic conditions, the needle isn't going to move on how much we spend on health. 20% of GDP and growing, to be exact.
I just don't think there's a way around this without forcing patients to feel a bit more pain.
Competition would require at least a slight oversupply of doctors. Right now there's a shortage: we're training about 80% of the doctors we need for the current levels of procedures. Meanwhile the population is getting older and that means more procedures. This will get worse before it gets better.
So this can only happen if we increase funding quite a bit for medical training programs, essentially country-wide. 25%, absolute minimum.
This quote from the study hit me.
So many people are unhappy with the amount of unproductive work they do (e.g. administration work for doctors). But no one wants to change it?
My takeaway was that while doctors hate the very structured process and busywork, the hospital admins think it is better for the patient and better for the institution.
In some ways it makes sense. It's hard to refine and make a process consistent when every doctor does things different or doesn't properly record everything. On the other hand it removes a lot of agency from the doctors and leaves them unfulfilled.
It's mass production principles applied to "knowledge" work.
There was a time when one person would make a whole chair. I imagine it was at least somewhat fulfilling to transform a bunch of wood into a functional object.
As time went on it became clear that it was more efficient to break it into component parts, blah blah blah, assembly line. After the assembly line (but before automation) there were a lot of people "making" chairs, but I'm sure the guy fixing the right arm in place didn't feel as fulfilled as the original craftsperson.
We're getting that to some degree in hospitals now. Hospital admins want the ability to tinker with procedure, to know what's going on in a real, measured way and maximize efficiency. It just so happens that it leaves the doctors a whole hell of a lot less fulfilled.
[0] https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...
So before "digital" they didn't fill in as many records?
Checking the main article https://www.medscape.com/slideshow/2019-lifestyle-burnout-de... found:
"All that paperwork sucks all of the enjoyment out of being a doctor." -Family physician
"Fear of litigation, bad reviews, and complaints make everything worse." -Dermatologist
I can change the doctor words for any other profession and still found that any profession can argue the same thing
"All that paperwork sucks all of the enjoyment out of being a teacher / lawyer / policeman." -Family teacher / lawyer / policeman
but being the most common reason (paperwork) and want to kill themselves?
It is something doctors don't want, nobody wants to spend money on it, and the EMR vendors know this, so they try to use legal mechanisms (ACA) to require doctors to buy their stuff, vs. competing in an free/open market such as tools like Gmail, Twitter, etc.
Look at incentives. This whole thing is so obvious. Nobody in health wants better records because the current industry provides no economic incentives whatsoever for the industry to keep them.
> “It’s almost like being a cog in a wheel, where they’re going through the motions of what’s necessary, not necessarily using all the knowledge that she or he has gained in the years of training,” Nazario says.
Sounds a whole lot like software engineering. I am guessing that this is how many people with specialized skill sets feel once they've maintained a job utilizing that skill set for some length of time.
Something to consider.
But the question that is being discussed here is not that question.
Doctors need insurance against medical malpractice and other forms of liability. So the insurance companies would develop their own form of standardization/credentialing, much like what happens in other industries like construction or shipping, to determine what are actually the highest risk factors for liability and other losses. You wouldn't be able to get insurance without following these guidelines.
The advantage of this system is that it's not written into law, making it much, much easier for it to change and evolve over time. Insurers would compete for business by pushing up against the minimum allowable standards and innovation would occur.
The thing I think people forget, is that legislated mandates are by their very nature, extremely hard to change. Regulations of the sort the FCC uses are easier, as they can be done by the agency itself, but they have their own problems.
I just don't think it requires MD-level training to do everything we need doctors to do today. Nurse practitioners and other less-credentialed peers are already taking up a lot of workload in medical offices and costs are still exploding.
With that in mind, what is physician morale like in other countries, especially Western European ones? And if it is, as I suspect, significantly better, then what is the reason?
Honestly, I would not be able to do it.
I was on friendly terms with my primary physician and he was also miserable. Insurance kept fighting his decisions to save money. He was getting pushed to see more patients and become more efficient. He often told me he is not happy in medicine and was jealous of me getting a CS degree and considered it himself, but felt too old.
I've had health issues over the years and only met one passionate doctor in Palo Alto, that was wealthy enough to pursue whatever he wanted in medicine.
However, I feel as we push for more efficiency people everywhere will have a lower satisfaction and higher burnout. They may initially be excited to work harder for higher pay but eventually they will realize they miss being able to have a slower day and chat with other people.