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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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

More Physicians need to look at gomerblog.com!

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.

anniexf
anniexf

Oh my word, these comments are ridiculous.  Please refrain from commenting if you haven't used a blue interpreter phone with a broken computer and a patient with multiple, vague medical complaints.  If you're not a doctor, you don't get it.  And you have no idea how it feels when you pour your heart and soul into helping a patient, often neglecting your own family, and then see comments about how "all doctors care about is the money".  If it wasn't hard, then everyone would do it.  Heck, *you* would be a doctor.  But give us some credit for the $250k that WE paid to work in a job that is completely underappreciated by people with ridiculous concepts about how we care only about ourselves and money.  I'm glad the article tries to have an optimistic tone, but physician burnout is rampant and 40% of medical students are burned out even before they start working.  It's not a good time to be a doctor.  Even a female in primary care.

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docstew
docstew

Interesting, "Danielle", most of my female colleagues/doctors work part-time.  Maybe this is why they are happier.  I'm not saying...I'm just saying...go figure.

SmurphLin
SmurphLin

I think this is probably something that has been happening for a long time. Either that, or there are more people going into this field than there were before, and this is resulting in a larger number leaving it as well. Whatever the case is, I feel like most people should get a family doctor they know and trust (like those at http://www.ipmsak.com/)

maxfabella103136@yahoo.com
maxfabella103136@yahoo.com

We can always get doctors from third world countries, and they  will  work. Starting from State prison,s and unserved areas,

like Native American reservations

armana
armana

As if other professions do not have similar work-related stress. If you can't handle stress as a doctor and quit, do not expect life will be easier in any other job. What a stupid elitist.

adnan7631
adnan7631

Ok, this article is rather stupid. 

It opens up with a terrible and depressing story that illustrates that the career of a doctor can kind of suck. It then goes on to mention that a huge percentage of doctors feel burnt out to the extent that patients are being affected and the doctor's are becoming suicidal. Then, it says that there will be more younger, female doctors and that will make everything better. 

WHAT. 

Is it possible that older people are more cynical about their professions because they have more experience and have less energy/ability to handle more work? If that is the case, then guess what, one day, all those young doctors will be old and cynical, too. 

Here's some other news. The percentage of older people is going up, with the 65+ age group about to expand extremely rapidly as the baby-boomers hit retirement age. Old people generally have a lot more medical problems than the rest of the populous. There aren't more medical schools opening up. They aren't taking more students. The work each doctor is going to face is only going to increase, and the stress with it. There needs to be more to address the problem than demographic changes. 

CalebMurdock
CalebMurdock

Someone sent me this note.  I can't find it here, so I am going to paste it and reply to it.

"As a current medical student, I am beyond offended at how misinformed Americans are about medical practice. In fact, I'm even more offended that medical professionals don't even know why MDs get paid more (but barely more than NPs or PAs). MDs have licenses that are much more prone to being lost, and a lot of the time they are the head of a healthcare team. If the team screws up, most of the time the MD gets the flak. There are always exceptions, but my RN and NP associates generally agree.Secondly, most primary care physicians don't make much more than an NP or PA, and a lot of them won't see their student loans paid off until they get closer to retirement."

I'm 62 and I've seen plenty of doctors in my life.  Most of them seemed pretty happy, and most of them (I've noticed) work part-time.  I've also seen the statistics that show that the average doctor makes around $200,000 (dentists, amazingly, make more).  Below, someone said that a doctor can leave school with $300,000 in debt.  That certainly must be a burden, but it is also true that if new doctors are making $100,000 or more, that can be paid off in ten years.  After that, they have a comfortable life.  The notion that doctors aren't making more than nurses is ridiculous.

I can imagine that seeing 20 patients in a day can be stressful, and the paperwork certainly isn't enjoyable, but then most jobs have their stressful aspects.

EricHoffer
EricHoffer

So, female MD's are the saviors??

Perhaps studies have shown a slightly higher level of 'optimism,' but in the long run they will not want to work as 'full time' as their male colleagues.  

Having children, cutting hours wanting to stay at home etc. will predominate.  I worked 20 yrs as a hospital RN. 

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".

vara411
vara411

@armana You're a moron without a clue. Have a nice day.

Carlangaman
Carlangaman

@CalebMurdock you are missing payments to rent or own your office space, paying nurses & secretaries, paying the computer record system, buying materials, paying electricity and all other bills, just paying the basic staff is hard, then pay someone to help you with taxes or wight the running of costs of the office.  You are also forgetting that the 300K in debt has a 7% to be paid in that 10 year bill, so it goes upwards to 400K just in the debt.  You have to do all this AFTER doing a 10-12 hr day.  Doing the right choices for patient health is no relaxing task, one always in the back of his/her mind is deciding if they did the right choice for your patients.  

The 'average' doctor does not make 200K, more 120-160K a year before all his costs.

aggiedoc
aggiedoc

@EricHoffer  A female nurse that disparages female doctors. Shocking. Never encountered that before. #sarcasm

bdholtzman
bdholtzman

@EricHoffer  Actually, factoring in time for and cost of education, unpaid time off for children and such, female physicians make less over a lifetime than a female physician's assistant. Recent study -Google it.

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.

CalebMurdock
CalebMurdock

The doctors that I have known in my life (beyond interns in hospitals) did not work 12-hour days.  Furthermore, the $200,000 a year that doctors make (according to statistics) would be AFTER expenses.  Doctors are not poor.  I agree that our education system needs to be reformed, but that's another topic.  I make $15,000 a year, so you can see why I have little sympathy.

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.

CalebMurdock
CalebMurdock

@NancyBaumgartner@CalebMurdock@vara411-- I don't know what you're talking about -- "inconvenient work"?  If doctors are unhappy, then their issues need to be addressed.  But the fact that some of them are unhappy doesn't mean that they automtically deserve to make six times the national median wage.  Most people are unhappy in their jobs, but we don't reward them with extra pay for it.

I think that there are solutions to all the problems that doctors face.  I think that medical educations should be subsidized by the government in order to reduce the doctor shortage.  I think that we need nurse practitioners who are trained to treat mild illnesses and/or diagose illnesses and refer patients to specialists.  I am in favor of subsidized malpractice insurance.  And I am in favor of such things as the sharing of medical equipment (such as CAT scanners) to reduce costs.  All I can tell you is this:  Medicine is too important for doctors to be part of the wealthy class and to charge fees that most people cannot afford.

NancyBaumgartner
NancyBaumgartner

@CalebMurdock @vara411 I trust you subjected yourself to roughly 10-12 years of rigorous education and training, and before that busted your...rump to earn top grades in high school so you could get into a great college and then med school?  If not- shut your  pie hole- you could have done what doctors do, but didn't.  Moreover, inconvenient work isn't the same as hard work. Something tells me your job's greatest challenge was inconvenience.

CalebMurdock
CalebMurdock

@vara411@CalebMurdockWhat I resent is that one person can work hard for 40 hours a week and make $20,000, while another person can work 40 hours a week and make $300,000 or $3,000,000.  I'm not saying that all salaries should be equal, but hard work should be rewarded with a living wage, and there should be less disparity in income.  As for me, I'm retired on just Social Security, never having made enough money to save up for my retirement.  Thank God for FDR or I'd be on the street.

vara411
vara411

@CalebMurdock Caleb, how much you make versus how much doctors make should not be your determining factor in doling out your "sympathy." If you don't like your lot, step away from your laptop, stop resenting those who EARN more than you, and do something more with your life. God speed.