Providers Overcome Healthcare Burnout By Changing Their Practice Model
Providers Overcome Healthcare Burnout By Changing Their Practice Model
Every occupation has its occupational hazards.
Nurses get stuck with needles. Police officers and military personnel get shot with real bullets in the line of duty. Firefighters get burned and suffer from smoke inhalation.
In 1860, Orange, New Jersey physician J. Addison Freeman published an article in The Transactions of the Medical Society of New Jersey entitled “Mercurial Disease Among Hatters.” (1) Dr. Freeman gave a clinical account of symptoms common among people who worked in the hat-making industry. This occupational hazard earned affected hat makers the term “Mad Hatter” for the psychological and neurological symptoms of erethism or mercury poisoning. (18)
What if we discovered that members of a specific occupation group had high rates of depression, physical and emotional exhaustion, depersonalization, and lack of a sense of personal accomplishment?
What if 34% to 68% of those workers experienced at least 1 of these symptoms and the rates continued to climb, year after year?
What if the results of these symptoms led to devastating consequences, including death, for a large percentage of these workers and their families?
Wouldn’t we want to figure out what’s behind this occupational hazard?
Would there be a public outcry demanding a regulatory investigation, systemic change, and accountability for those responsible for placing people in danger? Maybe we’d even call for hazard pay or compensation?
This is exactly what’s happening to a group of workers you’re very familiar with.
Medical Burnout — By The Numbers
- 34% — In 2016, 34% of physicians self-reported burnout to a survey by Stanford Medicine’s WellMD Center (2)
- 54.4% — The Mayo Clinic reported 54.4% of physicians it surveyed in 2014 as experiencing at least 1 symptom of burnout, up from 45.5% in 2011 (3)
- 68% — In 2019, Medical Economics asked physicians, “Do you feel burned out right now?” More than 2/3rds of physicians surveyed (68%) said, “Yes!” (4)
- 45.6% — The Journal of the American Medical Association reported an increase in burnout responses in their surveys from 40.6% in 2014 to 45.6% in 2017 (5)
- 42% — Medscape runs a burnout and depression survey for physicians every year and has reported a slight decline in physician burnout from 46% in 2015 to 42% in 2020. (6)
Physician Burnout: A Crisis of Epidemic Proportions
Whether the rate of burnout is 34%, 68%, or somewhere in between, medicine has a huge problem. The word epidemic has been used in dozens of articles and blog posts over the past few years to characterize medical burnout.
- “There is a severe and worsening epidemic of physician burnout in the United States, which threatens the health of doctors and patients alike.” (8)
- “There is an epidemic of physician burnout in the United States, and it has a pervasive negative effect on all aspects of medical care, including your career satisfaction.” (9)
- “Physician burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment, is not only a serious concern in China but also has reached global epidemic levels. Evidence shows that burnout affects more than half of practising physicians in the USA and is rising.” (10)
- “There is a burnout epidemic that affects both physicians and patients. With a majority of American physicians experiencing some sign of burnout, it is a condition that affects all specialties and all practice settings.” (11)
- “There’s a dangerous epidemic among medical professionals: Forty-four percent of all doctors surveyed in a 2019 Medscape report said that they feel long-term, unresolvable job stress, detachment and burnout from their work.” (12)
- “When over half of all physicians are burned out and the trend is continuing to rise, there is a silent healthcare in this country that needs to be addressed. How long can we continue to ignore what is becoming a ‘critical condition’? “ (13)
When over half of all physicians are burned out and the trend is continuing to rise, there is a silent healthcare in this country that needs to be addressed. How long can we continue to ignore what is becoming a ‘critical condition’?
The Root Problem in Burnout
“Physicians between the ages of 40 and 54 experience a higher rate of burnout than older or younger doctors, according to a recent survey of more than 15,000 physicians who cited administrative tasks and work hours as key drivers of their stress. “ (14)
Electronic medical records, charting/paperwork, and work-life balance concerns show up repeatedly in these surveys as contributing to feelings of burnout.
Physicians Simon Talbot and Wendy Dean see a deeper root cause underneath concerns reported in surveys. The real issue, they say, has to do with healthcare providers who have lost any sense of control or autonomy. Their relationship to patients (and their lives) are controlled by insurance companies, physician groups, guidelines, electronic medical record systems, administrators, and bureaucratic busywork. They’ve lost the ability to do what they feel morally obligated, by their calling in medicine, to do, which is to care for patients.
The real issue has to do with healthcare providers who have lost any sense of control or autonomy.
Talbot and Dean draw a chilling parallel between PTSD suffered by combat veterans and burnout suffered by physicians.
“The term ‘moral injury’ was first used to describe soldiers’ responses to their actions in war. It represents ‘perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.’ Journalist Diane Silver describes it as ‘a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.’
The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.” (15)
Suicide Among Healthcare Providers
Burnout plays a role in the suicides of roughly 300 to 400 healthcare providers every year. Physicians take their own lives at the rate of one per day. The suicide rate among doctors is 28 to 40 per 100,000, twice that of the general population and the highest of any profession. (7)
By comparison, the suicide rate among combat veterans is 30 per 100,000 . . . about the same as the rate among physicians, a statistic that makes the case for the “moral injury” of healthcare practitioners even more chilling. (16,17)
The suicide rate among doctors is 28 to 40 per 100,000, twice that of the general population and the highest of any profession. By comparison, the suicide rate among combat veterans is 30 per 100,000.
What Can Be Done?
Healthcare provider burnout is a huge problem, an epidemic that’s leading people to take their own lives at alarming rates. But what can we do about moral injury and the lack of control providers experience in the healthcare system?
Change The System
Many voices in the healthcare community advocate changing the system, allowing doctors more autonomy and giving them more time face-to-face with patients and less time pecking away at a computer screen. The problem with that solution is that the healthcare system is less about health or care and more about money.
Insurance companies, big pharma, hospital chains, medical investment groups, physician groups like AMA, ACOG, and NAMS . . . they all take a piece of the pie. All of them have vested interests in keeping the system as it is. The physician has nothing to say about dwindling reimbursements, forced EMRs, and endless administrative tasks. The likelihood of real change in the current healthcare system is slim.
Get Out While You Still Can
A second response is providers choosing to cut back their hours, retire early, or quit medicine altogether. This option has appealed to a growing number of physicians and the bleeding may contribute to a medical crisis of another kind. There’s a shortage of physicians in the U.S., especially in family practice and primary care.
Is There Another Way to Practice Medicine?
Some healthcare providers still hear the call on their lives to care for patients. For them, many are finding it is possible to stay in medicine and build a different type of healthcare practice that allows them to do what they feel destined to do.
They’re making a difference in health and wellness . . . one patient at a time.
There’s no one-size-fits-all medical practice. Each provider is unique, with an individualized approach to caring for patients and building a sustainable, fulfilling, even profitable practice.
Alternative medical practice models include:
Cash-based Direct Primary Care (DPC) Model
Patients pay a low monthly membership fee ($55 to $90/month) for the basic preventive healthcare — there are currently over 1200 DPC clinics all around the US.
Nurse practitioner Karl Lambert developed a cash-only direct primary care clinic in Wenatchee, Washington, a town of just 30,000. RediMedi Integrative Clinic charges $20 to $90 a month for basic primary care, less than the average monthly cell phone bill.
Karl says RediMedi has around 1100 patients and is growing rapidly. He doesn’t pay a dime or spend a minute hassling with insurance. He’s especially happy to be able to spend 40–60 minutes with each patient, give them his cell number and answer their questions any time they text or email. He’s implementing hormone optimization and wellness programs that are helping his patients improve their health, something he’s never been able to accomplish before and his patients love it.
Cash-based Concierge Model
Patients pay a higher fee and get comprehensive wellness care and personalized attention from a physician, PA, or nurse practitioner, primarily aimed at higher wage earners.
Takes insurance and also has a cash-based program for patients who want more extensive services like hormone optimization.
Internist Scott Elsbree, MD from Sarasota, Florida, has created a hybrid concierge practice that allows him to have dinner with his wife every night at 7. Before he changed his business model, he was making rounds, seeing patients, and charting until 9 or 10 PM. His concierge practice has allowed him to see fewer patients, have more time, and make more money than he did in his traditional practice.
Blaze Your Own Trail
As a healthcare practitioner, you can choose to blaze your own trail. Take insurance, build a cash-based practice, or make a hybrid of both. Each of these options can lead to a better practice and life for not only you and your loved ones but also for your patients and your staff. It is possible to move toward the fulfilling practice of medicine you dreamed of when you went to medical school and to avoid the ravages of burnout.
Healthcare practitioners just like you have made the leap into a practice where they’re spending more time caring for patients and their families and less time doing meaningless administrative tasks (read “prior authorizations”) dictated by insurance companies. They understand the courage it takes to make that leap of faith. Their stories are inspiring, especially considering the roadblocks they’ve overcome. You too can build a legally compliant, financially sustainable, emotionally fulfilling medical practice that fits the way you want to treat patients.
APIM has developed an accredited CME conference that helps you as a provider discover ways to blaze your own trail. It’s called The Business of Creating Health. Whether you choose to take insurance, build a cash-based practice, or make a hybrid of both, our team of expert speakers can help you move toward the fulfilling practice of medicine you dreamed of when you went to medical school.
The Business of Creating Health is an on demand experience where you’ll get expert advice and input from attorneys, physicians, and qualified consultants who’ve helped hundreds of providers transform their practices into what they really can be. You’ll hear from colleagues who have been where you are. They’ve made the leap into a practice where they’re spending more time caring for patients and their families and less time doing meaningless administrative tasks. You’ll hear their success stories and the pitfalls they faced along the way. You’ll understand how to build a legally compliant, financially sustainable, fulfilling medical practice that fits the way you want to treat patients.
Take control of your medical destiny and create the practice you’ve always dreamed of!
- Freeman, JA (1860). “Mercurial Disease Among Hatters”. Transactions of the Medical Society of New Jersey: 61–64.
- 2016 Physician Wellness Survey – Full Report, Stanford Medicine WellMD Center https://wellmd.stanford.edu/content/dam/sm/wellmd/documents/Full-2016-Physician-Wellness-Survey-Report-16-Aug-2017-Final-rd.pdf
- Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014 [published correction appears in Mayo Clin Proc. 2016 Feb;91(2):276]. Mayo Clin Proc. 2015;90(12):1600–1613. doi:10.1016/j.mayocp.2015.08.023 https://pubmed.ncbi.nlm.nih.gov/26653297-changes-in-burnout-and-satisfaction-with-work-life-balance-in-physicians-and-the-general-us-working-population-between-2011-and-2014/
- 2019 Physician Burnout Survey: Results show growing crisis in medicine Medical Economics August 12,2019 https://www.medicaleconomics.com/news/2019-physician-burnout-survey-results-show-growing-crisis-medicine
- del Carmen MG, Herman J, Rao S, et al. Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization. JAMA Netw Open. 2019;2(3):e190554. doi:10.1001/jamanetworkopen.2019.0554 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2727998
- Medscape National Physician Burnout & Suicide Report 2020 https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#1
- Physicians Experience Highest Suicide Rate of Any Profession Medscape Medical News May 7, 2018 https://www.medscape.com/viewarticle/896257
- Peter Grinspoon, MD, Harvard Medical School June 22, 2018 https://www.health.harvard.edu/blog/physician-burnout-can-affect-your-health-2018062214093
- Dike Drummond, MD Family Practice Management, September, 2015 https://www.aafp.org/fpm/2015/0900/p42.html
- Editorial, The Lancet, July 13, 2019 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31573-9/fulltext?rss=yes
- American Medical Association website https://www.ama-assn.org/practice-management/physician-health/what-should-be-done-about-physician-burnout-epidemic
- Lauren Steussy, New York Post, February 19,2019 https://nypost.com/2019/02/19/a-burnout-epidemic-is-hurting-doctors-and-their-patients/
- Agnees Chagpar, MD, The Health Care Blog, February 5, 2016 https://thehealthcareblog.com/blog/2016/02/05/physician-burnout-is-an-epidemic/
- Brianna Abbott, The Wall Street Journal, January 15, 2020 https://www.wsj.com/articles/physician-burnout-widespread-especially-among-those-midcareer-report-says-11579086008
- Physicians aren’t ‘burning out.’ They’re suffering from moral injury. Simon G. Talbot MD, Wendy Dean MD, Stat July 26, 2018 https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/
- Why suicide rate among veterans may be more than 22 a day, Moni Basu, CNN, November 14, 2013. Retrieved: 25 December 2014 https://www.cnn.com/2013/09/21/us/22-veteran-suicides-a-day/
- Veteran Suicides Twice as High as Civilian Rates, Jeff Hargarten, Forrest Burnson, Bonnie Campo and Chase Cook, News21, Aug. 24, 2013. Retrieved: 25 December 2014. https://backhome.news21.com/article/suicide/
- Erethism. Wikipedia. https://en.wikipedia.org/wiki/Erethism