What ails the medical profession--and ways to heal it

Steven J. Stack, MD
Immediate Past President
American Medical Association
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It’s ironic and deeply distressing that the very people who have devoted their lives to keeping others healthy are most at risk of suffering from the work-induced syndrome of burnout. As more than one-half of the medical community suffers from burnout—a percentage on the rise—it’s time to turn toward healing our own profession. Several medical societies have begun to do just that.

Prevalence and roots of the problem

A new study in Mayo Clinic Proceedings found that 54.4 percent of physicians reported at least one symptom of burnout in 2014, up from 45.5 percent in 2011. In comparison, prevalence of burnout among the general working population was about 28.5 percent.

And physician burnout seems to be directly tied to our environment. Authors of the study, who are AMA and Mayo Clinic experts on physician burnout, note that future physicians begin medical school with mental health profiles that are better than those of college graduates who pursue other fields. But those profiles are reversed within two years of beginning med school.

Similarly, a study the AMA released with the RAND Corporation in 2013 found that the major drivers of professional dissatisfaction among physicians were environmentally driven barriers to providing high-quality care, such as burdensome governmental regulations, insurers that refuse to cover medically necessary services and unsupportive practice leadership.

What’s being done to address the problem

The findings of studies such as these beg the question, “What can be done to prevent physician burnout?”

The AMA has made physicians’ wellness and ability to thrive a top priority. In fact, one of our three strategic focus areas is Professional Satisfaction and Practice Sustainability. As part of this initiative, we have created our STEPS Forward™ collection of online modules, which offer proven solutions by physicians for physicians.

Three modules are specifically focused on physician wellness: One gives steps for preventing burnout, another module outlines solutions for enhancing joy in practice and mitigating stress, and a third module focuses on ways to promote the well-being of physicians in training.

Other modules provide ways to improve elements of your practice environment that can be risk factors for burnout, such as improving work flow through team documentation, expanded rooming and discharge protocols, pre-visit planning, and synchronized prescription renewal.

We’re also hosting the International Conference on Physician Health™ Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.

If you’re interested in presenting, abstract submissions are welcome through Feb. 1 for research and perspectives into physicians’ health as well as practical, evidence-based skills and strategies that focus on staying healthy.

Other medical associations are offering practical ways to help physicians as well. My own specialty of emergency medicine is the hardest hit by burnout, and the American College of Emergency Physicians (ACEP) has created the 2016 Emergency Medicine Wellness Week™ to give all emergency physicians and their colleagues an opportunity to take the time to self-renew while staying dedicated to the highest quality patient care. 

This event will take place Jan. 24-30. You can visit the wellness week website to sign up for daily wellness tips, print a personal pledge card, find resources and videos about better wellness, and share your stories of personal improvement.

At the local level, physicians may find additional programs or resources. In my hometown, the Lexington Medical Society in Kentucky began offering its Physician Wellness Program this year. Designed as a safe harbor, the program gives members of the society up to six free, anonymous counselling sessions each calendar year so they can address normal life difficulties in a confidential and professional environment at a local psychiatry group. This program is modeled after a highly successful program of the Lane County Medical Society in Eugene, Oregon.

Take steps to improve your well-being today

As we look to the year ahead, I encourage you to make your own health and well-being a top priority.

First, be sure to learn the eight things that can put you at risk of burnout, regardless of your career stage.

Next, familiarize yourself with the resources that can help you in your current situation. Whether you choose to use the STEPS Forward modules, participate in the ACEP wellness week, attend the International Conference on Physician Health, or take advantage of counseling or other wellness programs, be sure to make the most of the resources available to you.

As service-oriented people, we physicians often put our own needs after those of others. But it’s important for us to be physically and mentally well both for ourselves and for the many people who rely on us—our families, our friends and our patients. Make this a New Year’s resolution you keep. Putting your well-being first is essential for keeping those you care about healthy.

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Comments

Dear Dr Stack,<br/> <br/> As an ED physician, I hope you can appreciate my perspective. There are several problems at the forefront of what confronts ED physicians and causes burnout. First problem is that hospital based physicians have little job security. They can be eliminated by the cancellation of a contract and do not have the same due process protections as surgeons, internists, FPs, etc. This allows large hospital systems to impose their will on physicians who are essentially defenseless. This leads to loss of professionalism, as hospital based physicians are treated essentially as assembly line workers, and subjected to all sorts of demands to improve "efficiency", with consequent negative effects on patients. In addition, with pay to surgeons and procedure-oriented specialties tilted heavily in their favor, to the detriment of cognitively oriented specialties, there is considerable resentment amongst those of us who do not do a lot of procedures. These are 2 major areas the AMA needs to work on; job insecurity with lack of due process, and pay. Please let me know how you are addressing these issues and I will consider joining the AMA. As far as I can tell, the AMA hasn't done much for me lately.
How about putting all of the Doctors on heroin. For goodness sake use your brain. Point out what caused the 'burn out' and remove that cause. Isn't that how we are taught to practice medicine? These silly recommendations are what we call 'Symptomatic Treatment'. THAT my dear Doctor is horrible medicine. Get rid of the government intervention and force insurance companies through class action law suits to open the books as far as what they promised that they would do. Turn the latter over to attorneys and practice medicine properly. If the attorneys are found monetarily intertwined with the insurance company then find a new attorney recently out of Law School and hand it over to him or her and tell them that they will soon be millionaires.
Dear Dr. Stack, The AMA made a deal with our current President during the passage of Obamacare in which the AMA would support Obamacare if the AMA would be the one who determines how much each doctor would make. This is called 'Frothing Power Schizophrenia'. The bill was passed and the promise to the AMA was ignored. Doctors who think that they are politician?. Idiot Savants would be closer.
The biggest cause of burnout is our frustration with ridiculous non-productive busy work that is mandated by not only the Feds, but also from the medical autocracy from the AMA on down. Can you say EMR, ICD-10, or MOC??? I went from 4 patients an hour to 2 per hour after I was saddled with the EMR. I was board recertified in the AAFP every 7 years for 4 times, but dropped out rather than do the ongoing hassle of the MOC process. I know many older docs that had many good years left in them that quit rather than suffer the indignities of EMR and ICD-10. The AMA and organized medicine are part of the problem and are complicit with the Feds. Is there any surprise that a majority of physicians don't see the AMA as representing them and are not members?? I am a member of the AMA but would not be if our group did not pay my dues.
I am a 71 year old solo practice physician. I love my work and want to continue. It is becoming impossible since I can't afford the EMS. I do use a computer and eprescribe. However, Medicare is now taking 2% of my reimbursement (I have a geriatric practice) since I did not show MU. My med managements are 25 minutes long--how do I let the patient ventilate and be empathetic, enter the ERx, do the CPT, ICD-10, MU codes in those 25 minutes.? without office staff. Office costs keep rising and my income is decreasing. I want to continue practicing medicine but the government is making it impossible. I do not think that the AMA has understood the situation or done anything about it on the government or insurance company level. Many MD's are angry and have cancelled this memberships. My patients have no idea about what we are going through. Many others in my specialty are opting out of Medicare. I believe that physicians must unite and explain what is happening in Medicine through the media. County medical societies must do a better job of publicizing our plight.
Has anyone tried "Deep Thoughts" by Jack Handey? How about a soft rubber ball to be sqeezed during stressful periods!
As an ED physician are you being facetious with this post to Stack? He works for Team Health a corporation that controls much of ED practice and uses termination without cause as a means to control physicians and appease administrators. Lack of autonomy is a key cause of burnout and these corporations are a prime source of that in EM. Don't look now but ACEP just elected an EmCare physician to be its next President.
I think it is a shame that clinical practice is losing out and physicians will become extinct. In the future, after 4 years of medical school and 3-16 years of residency and fellowship, MTs (no longer MDs/DOs but medical technicians fully trained in EHR documentation to satisfy i10, MU, PQRS, patient satisfaction, and all manner of other administrative duties) will see 1 patient an hour. Each patient will have been evaluated by Watson, 1-3 EMTs/NPs/PAs and authorized by a high school graduate civil servant (HSGCS) to be seen by the MT, after which a different HSGCS will review for authorization all treatments, referrals, and instructions. The only things MTs will keep in all of this is stress, malpractice fears, and total responsibility if something goes wrong. Retirement looks better and better...
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