by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
“Physician happiness is inversely proportional to the amount of bureaucratic drag on their lives,” says Dr. Doug Farrago. Farrago, a “recovering” hospital-employed physician, was one of many speakers to address an audience of 250 physicians at a Direct Primary Care (DPC) conference that was recently held in Orlando, Florida.
Now a DPC physician, Farrago practices apart from big medicine. He no longer works for hospitals or insurance companies. He works directly for his patients, offering them around-the-clock care in exchange for a $75 monthly fee. And, because he sees fewer patients compared to the going average of 2,300 per physician, he can devote more attention to their individual health needs.
I’ve written a lot about the many benefits DPC brings to patients, but not enough about how it’s saving doctors from burnout.
What triggers burnout is “bureaucratic drag,” a toxic amalgamation of clerical work that erodes the physician-patient relationship. It’s time spent on getting approval from insurance companies to prescribe medications or request an MRI. It’s the opportunity cost for physicians to prove to the Center for Medicare and Medicaid Services (CMS) how their government-certified electronic health record (EHR) system is an “effective tool” for tracking patient care. It’s the frustration of learning how to correctly document patient quality metrics to receive either a meager Medicare bonus or a “negative payment adjustment” two years down the road. A physician’s workday is now evenly split between direct patient care and paperwork, reports a Health Affairs study.
This is why nine out of ten physicians do not recommend others to pursue medicine. Almost one in two physicians experience exhaustion, cynicism, or hopelessness.
Even when medicine is compared with other professions that require extensive education, doctors are at a higher risk of burnout. Specialists, specifically emergency and family physicians, are even more likely to suffer. Much of this data is based on the Maslach Burnout Inventory (MBI), a psychological test revered as the gold standard for diagnosing burnout among professionals who are immersed in intense work environments.
What’s most alarming is that bureaucratic medicine is killing doctors. Physicians are twice as likely to commit suicide compared to the U.S. population. It’s a sad reality to face when the profession loses over 300 doctors per year to suicide. These are gifted people who are trained to save the lives of others, yet who struggle to save their own.
Burnout’s severe side effects have since prompted the medical community to add “physician engagement” to the health care industry’s three main goals: reduce health care costs, maximize patient satisfaction, and improve health outcomes.
Obviously, this can only happen with motivated physicians.
Some physicians are trying to stay ahead of burnout by simply avoiding technology that interferes with patient care. The New England Journal of Medicine (NEJM) features clinics in which doctors delegate electronic health record tasks to nurses and other support staff. For example, before a patient’s appointment, nurses pull the relevant needed from their EHR. They also enter the physician’s patient dictation into the EHR after the appointment. Physicians employ other practice efficiencies when necessary, such as substituting in-person visits with telemedicine.
Still, these clinics admit that the patient load is “unsustainable” for full-time employees and are experiencing high turnover rates among primary care physicians.
As physician satisfaction continues at a steep decline, a Medscape survey reports that hospital-employed physicians are unhappier than self-employed.
Losing control over schedules is a big part of it. Forty percent of employed physicians are required to meet patient quotas set forth by their employer’s contract. From a business perspective, it makes sense to project necessary patient volumes for a health system to be sustainable. However, The Maslach Burnout Inventory (MBI) reminds us that physician burnout correlates with deteriorating quality care. And lower quality care is a result of primary care doctors being forced to treat as many as 35 patients in one day so that they can feed hospitals’ bottom lines.
“The good news about this poisonous toxic environment is usually that’s what heroes are made from,” Farrago says in his closing remarks. Doctors are happier once they realize that they can, in fact, keep health care simple. There is a way to practice medicine in an environment without the government or administration walking into the exam room with the patient.
This is what makes Direct Primary Care a successful practice model.
(To view Dr. Farrago’s keynote in its entirety, click here.)