Message from President

Matthew Hardin, MD

doctor exhaustion

Message from President Matthew Hardin, MD

Burnout is an Epidemic

M Hardin President of Academy of Medicine

The Academy was founded on the principle of being an advocacy group, speaking out for physicians and the practice of medicine.

It is with that same goal in mind, that the Academy operates today.

However, now there are numerous external influences that have steadily and efficiently worked their way into the health care system, making patients and physicians relative “bit-players” in the health care “machine.” As the number of “interested parties” increases, so too does the number of entities to whom we, as health care providers, must answer. 

In an opinion piece by Danielle Ofri, MD, in the New York Times from June of this year, she detailed the corporatization of health care and how reliant the system is on the ethical “duty” that most physicians feel to their patients and the profession. A drive that makes us feel it is appropriate to complete everything laid in front of us, tasks that are considered “part of the job.”

These extra burdens may seem like small amounts of time here and there, but it adds up quickly. We all triage patient concerns and work constantly throughout the day. How often do we put off finishing a note on a patient so that we can answer the two “urgent” phone calls that came in? Our midday “breaks” (I hesitate to call them lunch breaks) are filled with doing prior authorization requests, refilling medications, and engaging in stimulating “peer to peer” discussions with insurance company representatives. How frustrating it is when you must explain your thoughts to an individual that is reading an algorithm on “how to approve” a specific medical test with NO KNOWLEDGE of the patient, circumstance, or concerns of the doctor.

We can certainly hire more and more staff to handle this work. But that comes at what cost to the physician, the health care system, and – most importantly – the patients?

Add in the times when the electronic medical record (EMR) decides to freeze. You are trying to be efficient, but at the end of the day, all the documentation has built up, along with several other tasks that have not been completed, and you head home with the “comforting knowledge” that the EMR is already sitting there, in our homes, ready for us to reengage at any time. Going back to Dr. Ofri’s New York Times piece, we feel we need to complete all these tasks prior to being able to relax, prior to being able to complete things for ourselves, e.g., exercise, time with family, or even just getting some fresh air from time to time. 

So what do we do, we wait for our family members to go to bed, then we go back to the comforting glow of our computers, until fatigue sets in.

If you look up the definition of burnout, one of the meanings is this: “physical or mental collapse caused by overwork or stress.”

Burnout is real.

In medical terms, burnout is an epidemic.

Sadly, not only is burnout manifesting in decreased efficiency and the potential for increased medical errors, but also increased rates of mental health illness among physicians. Combine this with immense stress and a penchant for feeling like we are personally responsible for any negative outcome, and there is no surprise that job attrition rates and suicide rates of physicians are among the highest of any profession.

This is why the Academy of Medicine of Cincinnati has chosen physician wellness as one of its key priorities and has partnered with local groups in an effort to offer solutions to physician well being.

With reverence for Abraham Lincoln’s Gettysburg Address, the Academy is an organization OF physicians, governed BY physicians, and FOR THE BETTERMENT of physicians and patients.

As we address issues that affect physician job satisfaction, we must not forget to pay attention to legislation at both the state and federal level. Some changes can be favorable to physicians, but others are detrimental. We all would be in favor of legislative reform that would first, improve our patient’s health care, and second, avoid worsening our already overflowing amount of superfluous work.

Partnering with the Ohio State Medical Association (OSMA), the Academy has reinvigorated its interest in keeping tabs on the proposals coming out of Columbus.

A few examples of recent attempts that have made it through both the Ohio State House and Senate have included:

• Price transparency legislation that would have mandated that prior to all physician and hospital visits, patients be informed in writing of the expected charges, the negotiated rate from the insurance company, and the anticipated out-of-pocket expenses. This made it all the way to the governor’s desk prior to being line-item vetoed. I don’t think physicians are against price transparency, but mandating such measures, ubiquitously across all of health care, and prior to each and every visit would have been both costly for the system and would have resulted in decreased physician availability to patients.
• Another proposal would have limited out-of-network costs to never be more than in-network costs. Again, both the House and Senate passed this bill prior to a gubernatorial line-item veto. This would have removed a key negotiating piece for all physicians and health care groups, while insurance companies try to further drop reimbursement rates.
• Other legislation like the Advanced Practice Nurse (APN) Independent Practice Bill, proposes to allow APNs, who average 500-1,500 clinical hours of training experience (mostly under the guidance of physician), the same independence and reimbursement as a primary care physician who averages of 15,000-16,000 clinical hours of training coming out of residency. While we are, again, for increased access to health care, there is concern that access would increase with a lower quality of patient care.

There are more people in the world now than ever, by far, and each of them is in need of health care. 

The amount of work caring for those people is enough to fill up every physician’s schedule multiple times over. 

Health care is and should be a collaboration among multiple individuals, each bringing a necessary skill set to the evaluation and treatment process. However, all collaborative groups need a voice of leadership to make those final decisions and to instigate the treatment plan. Make no mistake, physicians are that leadership presence that our patients both need and desire. A large number of medical innovations and advances in knowledge have necessitated that others be involved in the process, but so many of them are more focused on the cost, convenience, or patient satisfaction score, and not the OUTCOME. 

We are the ones who are focused on the outcome. We are the ones who make the decisions to achieve it, and who are emotionally and professionally responsible when the outcome is not as desired. 

One of the aspects of the Academy that is most exciting is that is when it comes to physician issues, the walls between the systems are not apparent. The commonality that binds all physicians is tantamount — were the only criteria to membership, is being a physician and having a sincere appreciation in seeing an improvement in patient care and the practice of medicine.

It is more important than ever that we, as a collective voice of health care deliverers, stand together and help to exact positive change.

In this time of chaos, let us be a voice of reason and calm.

Attention to efficiency in health care delivery, decreasing superfluous work, and enhancing physician wellness, can only improve patient experiences and outcomes.

Improvement can occur through sharing our experiences and not being afraid to seek help when we are overwhelmed …

Improvement can occur when the administration seeks out physician concerns, and incorporates a substantial change to their policies with those concerns in mind …

Improvement can occur when physicians and hospital systems stand together against the ever-increasing demands being imposed by insurers …

Improvement can occur when we jointly educate our local and statehouse legislators on the true impact of suggested health care reform and the dangers of new laws that could negatively impact the majority of people while benefitting only a few …

Stemming this tide and invoking positive change WITH ACTIVE PHYSICIAN INPUT is mandatory for the health care “machine” to be sustainable.

— Excerpted from Dr. Hardin’s Annual Meeting address