In just three years, physician burnout increased from
45.5% to 54.4%, according to a paper authored by doctors at the University of
California, Riverside School of Medicine.
“Doctors aren’t depressed or less content at
home,” write coauthors Drs Andrew G. Alexander and Kenneth
A. Ballou in the August 2018 issue of the American Journal of Medicine. “They’re less happy at
Alexander, an associate clinical professor of family
medicine, and Ballou, an assistant clinical professor of family medicine, list
three factors that contribute to physician burnout:
- The doctor-patient relationship has been morphed into an
insurance company-client relationship that imposes limitations upon the
treatment doctors can provide to the insurance company’s members.
- Feelings of cynicism (resulting from patients no longer
expecting continuity of care and routinely changing doctors).
- Lack of enthusiasm for work.
Alexander and Ballou compared data from 2011-14 on physician
burnout and satisfaction with work-life balance to arrive at their conclusions.
They found that physician burnout measures highest in emergency medicine,
family medicine, internal medicine, and paediatrics. They also posit that five
transformational medical practice events that occurred between 2011 and 2014
contributed to the increase in physician burnout.
“These are hospital purchases of medical groups, rising
drug prices, the Affordable Care Act, ‘pay for performance’ in which providers
are offered financial incentives to improve quality and efficiency, and
mandated electronic health records,” Alexander said. “Doctors now
spend more time with electronic health records than they do with patients.
Electronic health records were pushed by the government at great expense and
without regard to the effects upon patient or physician health. Go into any
hospital and look for the nurses and the doctors. You will find them sitting in
front of computers. They are not happy, and their patients are not
Electronic health records (EHRs) snuck up on the medical
community, Alexander noted.
“At first, they were accepted because of the promises
of chartless offices, initial government subsidies, interconnectivity between
health care sites, availability of records from home, faster charting,
e-prescribing direct to the pharmacy, and higher physician pay for
computer-cloning the federal government’s bullet-point reimbursement
formula,” he said. “When the subsidies ran out and the promises
turned into extra cost, less time with patients, time at home finishing EHR
records, unreadable and meaningless cloned patient notes, HIPAA-restricted
access to outside records, and government penalties for not ‘mining’ patient
data that cost money to input, doctors became overworked robots.”
Alexander stressed that doctors need to spend less time on
“EHRs are not going away, but they don’t need to be the
focus of the patient’s visit,” he said. “Doctors should oppose EHRs
that occupy valuable doctor-patient time and which use billing diagnoses rather
than patient assessments. EHRs need to be portable. Computerised notes should
be templated for meaningful patient care notes.
“It should be a treat to care about another person, but
I see that too many of our seasoned physicians are frustrated with medicine,
and it rubs off onto the physicians in training,” Alexander said.
“Doctors have a wonderful job, yet they are inundated with numerous
extraneous burdens that collectively rob them of the joy of medicine.”
Alexander AG, et al. Work–Life Balance, Burnout, and the Electronic Health
Record. The American Journal of Medicine. August 2018, Volume 131, Issue 8,
Pages 857–858. https://www.amjmed.com/article/S0002-9343(18)30286-9/fulltext