The Epidemic of Disillusioned Doctors

We all know medicine has become a frustrating profession. But surveys show that a younger generation of doctors are more resilient to burnout

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Last week I was ready to quit medicine. I was seeing a new patient with diabetes, heart disease, anemia, hypertension, osteopenia, hypothyroidism, reflux, depression and pain in every part of her body. From a bag she produced 18 pill bottles — from about as many doctors — and piled them onto my desk. She pulled out a form from her job that needed to be filled out, plus a prior-approval form that her insurance company required, as well as a stack of photocopied records from the other doctors. She didn’t speak English, so we waded through her complicated medical history via a telephone interpreter. I don’t like to write while I am talking with a patient, but I couldn’t afford to fall behind in my documentation, so I typed madly into the 50 required fields of our electronic medical record while the patient recounted her complex medical history.

In the middle of this, the computer seized up, then turned a shade of gray that in an ICU would elicit the code team. I didn’t want to lose the interpreter on the phone, so I fiddled with the control-alt-delete buttons while I continued the interview, moving on to the refresh buttons, the escape buttons, finally squatting awkwardly under the desk to yank the on-off switch of the computer.

Forty-five minutes into our 15-minute visit, with an interpreter telephone in one ear translating back and forth into Bengali, my office phone in the other ear, on hold to tech support, my desk swimming with insurance forms, pill bottles, MRI reports, and mammogram referrals, the computer flashing ominous error messages, plus six more patients waiting outside, eight phone messages from yesterday still to return, I thought: “That’s it, I quit!”

(MORE: Bitter Pill: Why Medical Bills Are Killing Us)

It’s a thought that crosses the minds of the majority of doctors, it seems. Patients have more complex medical conditions, practices are much busier, insurance companies require more paperwork, administrative mandates multiply like rabbits, electronic medical records are more byzantine, support systems are fewer — and the 15-minute visit hasn’t gotten any longer.

A survey of more than 13,000 doctors by the Physicians Foundation found that more than two-thirds of them feel negatively about their profession. Too much paperwork and regulations, plus the burden of defensive medicine, are the strongest contributors to this bleak outlook. These erode the doctor-patient relationship and the clinical autonomy that doctors have always cherished. What once seemed a higher calling increasingly feels like an assembly-line job.

(MORE: Doctors Go Shopping: Price Comparisons Lead MDs to Lower Testing Costs)

What does this mean for patients? For those of you who’ve had trouble getting an appointment with your doctor, consider this: on average, American doctors spend more than 22% of their time on nonclinical paperwork. That’s the equivalent of 165,000 doctors idling with busy work instead of seeing patients.

Evidence is starting to accumulate that disillusioned and burned-out doctors make more errors and are more prone to substance abuse and depression. One American doctor takes his or her own life nearly every day — a rate that is much higher than in other professions.

It’s much harder for disillusioned doctors to muster empathy for their patients. This too is a danger. Patients of doctors who score lower on the empathy scale have worse clinical outcomes.

(MORE: An End to Medical-Billing Secrecy?)

Many of the things that ail the medical profession — sicker patients, convoluted insurance requirements — are not so easy to change. But some things are. Electronic medical records, if done smartly, could ease the paperwork burden. Team-based approaches involving nurses, social workers and care managers could distribute the workload in a way that is less taxing on the doctor and more beneficial for the patient.

The good news is that doctors are not a homogeneous bunch. The Physicians Foundation study found that female doctors were more optimistic about medicine than their male counterparts. Doctors under 40 were more satisfied than older doctors, suggesting that younger people in the profession are more used to these demands. Salaried doctors were happier than doctors in private practice. Primary-care doctors had higher morale than specialists.

The rate of women in medical schools has been increasing steadily such that women are about 50% of medical students. Primary-care fields — internal medicine, ob-gyn, pediatrics, family medicine — are already dominated by women. And the trend of medicine is toward the salaried model, with new “accountable-care organizations” placing primary care front and center.

(MORE: Why the Drugstore May Be the Last Place You Should Buy Prescription Drugs)

Putting this together, the newer generation of female, salaried, primary-care doctors have the most optimistic outlook on medicine. This bodes well for patients, whose doctors will increasingly fall into this category. Perhaps the current epidemic of physician disillusionment will abate as the new waves of doctors remake the face of medicine. This of course does not dismiss the shortcomings of medicine that frustrate doctors on a daily basis, but it does suggest that all is not dismal. To me, the most salient finding of the Physicians Foundation study was that when asked what was the most satisfying aspect of medical practice, the No. 1 answer was relationships with patients. This is what keeps us going even on the most trying of days.

When I finally ended the visit with my patient, we were both worn out. We’d made some headway, but there were more issues unresolved than resolved. However, the fact that we’d plowed through the morass together, however agonizingly, seemed to provide common ground. We smiled wearily at each other, but our parting handshake was solid. We were now in this together.

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AngerterMaria
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Good day,

I just stumbled at this your post and I must say that I was in a similar situation some few months ago and I really needed some sort of loan to renovate some apartments my husband bought so we could renovate the buildings and put them up for rent, we searched and searched but no luck, I even got burnt sending about $4,500usd abroad to secure a loan, but was introduced to some sort of a private lender Mr Anderson Klint and i was skeptical at first because i had to contact them via email and i just did out of curiosity and was surprised when they replied that they could be of help, and could loan me $80,000usd i needed. I almost turned down the offer when I was asked to pay the sum of $480usd as an insurance fee to insure my lump sum loan of $80,000usd.I was told it was the only form of security they needed to secure the loan. My husband advised that i pay it because to him it made sense and if we were scammed like the other loan dealer he could manage it. I was asked to make the payment via western union and that really made me worried because something told me it wasn’t going to pull through, but i was shocked after i made the payment on 15th of SEPTEMBER 2014, I got my bank account wired with a transfer of $80,000usd which I cashed on 20th of SEPTEMBER 2014 and work is ongoing at our sites. I was given a 5 months grace to start paying back my first repayment which is spread over 10Years. It was later I understood why they needed to insure the money by me before letting me have it, in case I cant meet up to my obligation the insurance company takes up the liability to pay back. I am happy that by next week our project will be ready and we would start making our money and can start paying back my loan.Am so happy at last Mr Anderson Did it for family You can contact them via their email...andersonklintloancompany12@gmail.com, and I can assure you that there’s nothing to fear about, they will deliver like they did to me, but its just a suggestion/recommendation. God bless you.




 Angerter Maria

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boffo!
boffo!

Putting this together, the newer generation of female, salaried, primary-care doctors have the most optimistic outlook on medicine. This bodes well for patients, whose doctors will increasingly fall into this category. "


really? salaried female physicians are the answer? That works until said physician starts to get too busy, then what?? is she going fit more patients in? why? she is on salary.....there is no vested interest and in 3 years she moves on.. or the hospital moves her along for lack of prodcutivity. Basically making physicians cogs in a gigantic corporate wheel dominated by adminstators and insurance execs. Here is a thought, pay the private docs more, we have a vested interest we are going to try harder for our patients. getting paid for things that originally weren't reimbursed is a good start. This way we have more money for more staff and better infrastructure. ANd guess what we don't have the bargaining power of a large hospital so that small capital investment by payers can save them a lot of money You think that gorgeous tertiary care facility with big screen TV's and fountains in the lobby just happens magically, it's because they get 2-20x times more per procedure than a community practice that does the same thing.. if you want everyone salaried as physicians by large orgs, health care costs will continue to skyrocket, wait times will continue to rise and you can forget about having a doc for any signficant period of time. 


Also men aren't that bad dr. Ofri, especially young engaged men who have huge debt loads and young families to take care of, they are doing everything they can to be nice to the patients and make themselves available. In addition to that men have lower rates of suicide, depression and substance abuse compared to their female counterparts. We work longer hours and see more patients. Oh but we dont spend enough time??? please i don't feel like talking about the weather with my patients,and i don't really need to debate politics with them, don't mistake efficiency with lack of empathy.  

JudithBarnes
JudithBarnes

Seeing firsthand what is going on with EHR and Meaningful Use, here is my prediction. Many doctors will abandon their profession due to the healthcare mess. There will be a new Government program that will pay a young person's way to medical school in exchange for a contract to "serve their country" as a medical provider for X years. (Akin to the military.) "But don't worry, young doctor, everything is all computerized for you. We have a database of demographics, diagnosis, treatments and outcomes. You just put in the symptoms and voila! Instant treatment plan. We developed this system by paying good doctors stimulus money to provide us with their expert knowledge". "Oh, and Mister Patient? We have a record here that we told you to stop smoking on 2 separate occasions and you didn't quit smoking, so too bad.  You're not covered for lung cancer. "  

JudithBarnes
JudithBarnes

Realizing this, my company developed a simple to use, speech recognition based, fully certified EHR that puts a friendly, easy to use interface between the provider and their EHR. Too bad our company-paid health insurance and taxes have gone up so much for my employees that I can't afford to advertise our revolutionary software. Ugh. We are not a huge company so spending $100,000 on software development for ICD-10 and Meaningful Use Phase II has had a huge financial impact on our bottom line. The delay of ICD-10 is making it worse for EHR vendors. HELP You can see what we have at www.charttalk.net (please). 

zman3000
zman3000

Nice. By the way, the patients waiting in the office have written that you are scum on Angie's List, and the company that is paying you wants to know why your productivity is low. Your 45 minutes reimbursed about $140.00, and there are at least 5 people making an average of $20.00 in your office. You haven't paid your malpractice nor your rent, and the supplies cost you at least $5-10. You trained until you were at least 30 years old, and you are pulling in too little in salary to pay back your $200,000 in medical school debt. Expect the patient to call you at 3 AM, when she mistakenly takes the wrong medication because you didn't have a translator in your office. Nice job. 

I bet you are happy.



cilozanin
cilozanin

Gladly, you had more than 45 minutes to spend wtih your patient. Lack of time is one of the most annoying demands in medical practice.

EpikMani
EpikMani

Putting this together, the newer generation of female, salaried, primary-care doctors have the most optimistic outlook on medicine. This bodes well for patients, whose doctors will increasingly fall into this category. Perhaps the current epidemic of physician disillusionment will abate as the new waves of doctors remake the face of medicine.


Yet more feminism at work. *yawn*

gomerblog
gomerblog

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JohnMorrison
JohnMorrison

Try being a teacher. We have a nation of dunderheads who have never set foot in a classroom other than during their school-time who think it's a "simple job." The ululate epithets and throw faeces at those of us who do the difficult job of making schools go.  Want to learn about disillusionment?  Try a school for a few days.

NancyBaumgartner
NancyBaumgartner

The concierge model seems to be an attractive way to practice.  I would gladly pay a doctor/practice of my choosing a reasonable monthly fee in exchange for services when I need them instead of the huge costs each month for insurance, now worse under Marxistcare.  I am low-maintenance (eat right, exercise, sauna, use holistic remedies when need be)- so it would be a really good deal for the both of us.  My understanding is that some doctors like this arrangement.

newbornatlantic
newbornatlantic

I'm a fresh-out-of-residency physician (Internal Medicine). Pretty much got sick of dealing with the current healthcare system while in residency. Have yet to start practicing. Mainly because I make double an IM physician's salary by tweeting (no joke). Physicians, if anything, are highly underpaid for the crap they deal with. Busting your ass 12 hours a day, 5-6 days a week, to deal with problems that are MASSIVELY preventative (Diabetes, Hypertension, Hypercholesterolemia) and only get paid 120K, only to slowly chip away at an enormous debt...


You're delusional if you try to defend that kind of lifestyle.  

Threehils
Threehils

What do you think a doctor SHOULD be paid, per hour? (salaries are just too convoluted). In the middle of the night, when you are dying (or at least feel like you are), how much, per hour, do you think that person, who knows how to fix your problem, to potentially save your life when you actually are dying, deserves to be paid. How much are you willing to pay to have someone at the other end who knows what they are doing, who has had the training, acquired the knowledge and skill necessary to accurately, safely and expediently, fix what ails you? 


Because that's why you come to the hospital in the middle of the night. You want to know exactly what's wrong, right now, and to have it instantly be all better. If you didn't care about those things, you would ask your Starbuck's barrista why you are short of breath, or your Walmart greeter why you chest hurts so bad, or the guy who cuts your lawn how to make the bleeding stop.  


So, what exactly IS the amount to pay for safe, accurate, and expedient care. I'm curious to hear the dollar amount, per hour, that this is worth to everyone.  

bdbrl
bdbrl

28 years old here. First year of residency. 260k in debt. I work 5-6 days a week, 13 hour days. Try to study another day. I have no pension, I never will. I will pay an exorbitant tax rate to help pay for the roads and healthcare of others. I have sacrificed the last decade of my life and have 3 more years. By the time I am out of debt, I will be approximately 43 years old. I could have worked for a union, the government or a company with a pension starting at 22 and retire at 65 with a huge pension and a lot less stress. I will likely work until the day I no longer can and then I'll hopefully teach. I would be stupid to be doing it for the money, but, as a resident in NYC at 28 yo I can't even afford to live in a 1 bedroom apt alone.

CSquared913
CSquared913

These comments are horrific.

I'm a board -certified Emergency Physician. I love my job. I love my patients. No, I'm not being sarcastic. I say this kindly, but the non-medical public will never understand the work and sacrifice a physician has went through. You can't, because you haven't lived it. It's not something that can be explained. Its not your fault that you don't understand, I can see where you're coming from. Sometimes physicians need to complain, but when your salary is well above average I can see why the general public gives zero sympathy. Honestly, I would probably feel the same way being on the other end, but I also feel the public is misinformed.

I make a lot of money, when you look at the number. So I can understand when someone who makes $30k a year will be quick to discriminate a physician or anyone making 6 figures. What people don't know, is where that $250k goes. As an example, I will break it down for you:

My monthly check is roughly $24,000. Before taxes. . . . When you make a certain amount of money, you get taxed. A lot. Way more than that 25-30% most Americans pay. Mine are 43%. Yes, I said 43%. It is what it is, I make the money so seems legit to tax. Now that I'm eligible to contribute to a 401k, my check is less. But let's just keep it simple.

$24,000 - 10,320= 13,680. This is usually the amount on my check. Seems awesome, and it would be for the general population who don't have the type of bills I have to pay.

I owe, at this present day, $225,000 for school loans. I started around $260-270k. My monthly payments are $3000. Sometimes I try to pay a few hundred dollars more since the interest is 7% (Thank you George W Bush). I have 8 years left woo hoo!

$13680 -3200= 10480.

House payment $2100. I have a 3 bedroom ranch. No mansion here. I live modestly.

$10,480- 2100= $8380

Disability Insurance $600/month. This is vital, because if anything ever happens to me where I'm incapable if working (I.e. accident, cancer, pregnancy) this will ensure me about 75% of my current income so I can continue to have a house and pay the government. $8380- 600= $7780.

Life Insurance $1000/month. This is also a partial investment, since I've lost out in the ability to invest for the past 13 years, hence why it is expensive, but absolutely worth it since I can cash it in when I'm like 70..

$7780-1000= $6780.

Investments aside from 401k and term life, $1000/month. Again, see above.

$6780-1000= $5780.

Utilities roughly $800/month. Give or take. Includes all the usual utilities plus garbage, ADT system, and lawn/snow removal.

$5780-800= $4980.

No car payment. I still have my car from medical school and residency: a Saturn. A new Audi Q5 would be nice, but I can't justify spending $60k on a car when I'm a half million dollars in the hole, and for now, I like having no car payment.

Car and home owners insurance is $100/month. The Saturn helped.

$4980-100= $4880.

Gas and groceries: My car takes roughly $65 to fill the tank. I do this at least once a week, since my group staffs 4 emergency departments in the city. We will remain keeping it simple, $65 x 4= $260/month. Groceries are about $100/week, or $400/month. I'm glad I don't have teenage boys in the house or I'm sure it would skyrocket.

$4880-660= $4220

I try to put $1-2k away in savings a month for that "rainy day", or when the furnace decides to die. Or anything in my house decides to die. Or the zombie apocalypse.

$4220-1500= $2720.

$2720. Crazy, huh?

There are miscellaneous mandatory expenses, like state license and DEA license renewal ($1000 total), and I have to earn so many continued educational hours a year to even be eligible to renew my medical license. These conferences can be anywhere between $2-5k yearly. Also not included are clothes and other stuff, but whatever you hopefully get the idea.

I am not complaining. I knew exactly what kind of financial debt I was getting into. I live comfortably without struggle, but I just wanted to give people an idea where all that money goes. I HAVE to make that type money to pay for the cost to continue to be a doctor. I can't imagine what family physicians go through, because they make less AND have a business/office to run, staff to pay, etc. So now that we are all educated, everyone needs to play nice in the sandbox and stop being nasty to eachother. Everyone has their own struggles, just on different levels.

GabrielSmith
GabrielSmith

@CSquared913  Although I only make $28,000, I must say I do have some sympathy, not too much because I feel pretty confident that one day you'll get that debt paid off and be a rich man.  However, I think that there are people in this world that do deserve to be rich; and an ER doctor who deals with kids in car accidents, burn victims, gunshot victims, etc. is certainly one of them.  These are certainly things I could never do.  So, the sympathy I feel does not so much come from the idea that you are currently struggling, but that there is anything that might discourage you or any other young doctor from doing something that is so special and vital to our society.  This work deserves to be heavily rewarded.


As long as a physician does not become overly greedy with his or her money, I say let them be highly paid.  We should not hate anyone just because they have more money than us. Wall Street CEO's who exploit the poor and show endless greed are one thing.  But good doctors who help people are another.

wkbansatz
wkbansatz

@CSquared913 The problem with your analysis is that among your "costs" is more than $2500/mo in savings and investments (not including your life insurance policy and your mortgage which are both types of investments) and more than $2500 in money left over for "miscellaneous mandatory expenses".  Do you realize you save (or at least your net worth increases by) about as much in a month as the median american family earns in a month?  Not understanding that is why you get zero sympathy, not because people don't understand how hard you work or why you "HAVE to make that kind of money".

CSquared913
CSquared913

There is no problem with the analysis. It's just data. I don't want sympathy. Im not complaining whatsoever. I knowingly chose my path aware of all consequences. As stated, I live comfortably, but I don't have a bed of $100 bills. I was just reiterating the fact that the general public, at least according to 90% of these posts, thinks doctors are just rolling in it. Some months, I can't save anything because of unforeseen expenses. I have to invest what I can because I'm getting a 15 year late start on investing, while everyone else has already been there done that. 15 years is a lot of catching up to do. I dont know how significantly different my investing would be compared to others, given the huge time gap. A mortgage is not an investment these days, and my term is not guaranteed for the potential it could make, say oh, if I die. I'm not really sure what point you are trying to make in your comment.