A different kind of health care crisis - physician burnout

[dish rag]

One thing is for sure. Something major needs done with health care in the United States. It's just awful. I just don't see much that can be done. I hear doctors complain about how tough they have it. But I know LOTS of doctors. Still living in big homes and driving German luxury cars, kids in private schools. I don't begrudge them what they earn, just stop complaining. For all that there are people going bankrupt to pay them and hospitals. I'm covered under the Canadian health plan. I have a year long policy with no deducible or co pay through CAA when in the US for $260US A YEAR. I was paying over $800 a month in the US and had to spend $7000 before I could use it, even then it had limits.

 

[DopeyDame]

I work for my states flag ship medical school and we hear about it. Burnout, like physician suicide rates is not something that we shy away from addressing students. Rather we encourage them to seek mental health treatment, to break stigmas, and in the case of burnout, to take take time for themselves. To practice wellness. Unfortunately burnout is going to happen regardless. There is high demand for physicians, and not enough availability everywhere which means they are potentially working more.

Sadly burnout is happening in many disciplines. I work in education where we are accustomed to doing more with less. It's frustrating. It's a reality that needs to addressed more.

I think a huge part of the problem is the lack of medical school slots and/or over reliance on MDs when an NP or PA would be perfectly sufficient.
Everyone gets sick. Everyone needs medical care. We need a lot more people in the profession, which would help with the overwork of those currently there.

 

[RangerPooh]

I think a huge part of the problem is the lack of medical school slots and/or over reliance on MDs when an NP or PA would be perfectly sufficient.
Everyone gets sick. Everyone needs medical care. We need a lot more people in the profession, which would help with the overwork of those currently there.

At our school we receive thousands of applicants for about 200 spots, but we also have a PA and DNP program. I do know that an hour away there is a university that has a Osteopathic MD program, and another university in town is starting one as well to address the shortage. But even then, we need to make sure that there are people to fill these roles in all communities.

I'm fine seeing a DNP and that's who our family sees as she has more availability than the MD, but not everyone is open to the idea of seeing a DNP or PA instead.

 

[sam_gordon]

But there are still ppl getting rich. That’s where the change needs to happen. Not making nurses work longer hours with more patients per shift.

Are there limits on how long nurses/doctors are allowed to work or how long a break needs to be between shifts? We do it for truck drivers and pilots, presumably for safety, so why not do it for the medical profession?

 

[LSUmiss]

Are there limits on how long nurses/doctors are allowed to work or how long a break needs to be between shifts? We do it for truck drivers and pilots, presumably for safety, so why not do it for the medical profession?

There used to be for MDs I thought, but I don’t 100% know.

 

[longboard55]

Have a patient enter his symptoms online before even making appointment and I think we find many visits could be handled online or in an off site testing facility. The problem is the medical field refuses to become efficient because appointments and procedures is where they make all their money.

If the insurance company could see both sides of a visit, patient and doctor, they could probably ask for a lot less back up.

 

[Floridaman999]

My doctor changed to a membership system and it's amazing in my opinion. He has a set number of patients that all pay a set amount per year for treatment. I now get to actually spend time talking about my health issues and concerns without feeling like the doctor is rushed and moving on before I even begin. I didn't realize how much I missed a quality doctor/patient relationship until he made the change. He used to work for a local medical group, which is how I found him, but his decision to branch out on his own with the concierge service was the best thing for all of us who are part of his group. He seems much happier and is able to perform his job in a way he'd always dreamed. Absolutely love it.

 

[sam_gordon]

My doctor changed to a membership system and it's amazing in my opinion. He has a set number of patients that all pay a set amount per year for treatment. I now get to actually spend time talking about my health issues and concerns without feeling like the doctor is rushed and moving on before I even begin. I didn't realize how much I missed a quality doctor/patient relationship until he made the change. He used to work for a local medical group, which is how I found him, but his decision to branch out on his own with the concierge service was the best thing for all of us who are part of his group. He seems much happier and is able to perform his job in a way he'd always dreamed. Absolutely love it.

How much is the yearly membership? Do you get 'x' number of visits for that price or unlimited? What the cost cover? Is it "practical" for the masses?

 

[Mackenzie Click-Mickelson]

My doctor changed to a membership system and it's amazing in my opinion. He has a set number of patients that all pay a set amount per year for treatment. I now get to actually spend time talking about my health issues and concerns without feeling like the doctor is rushed and moving on before I even begin. I didn't realize how much I missed a quality doctor/patient relationship until he made the change. He used to work for a local medical group, which is how I found him, but his decision to branch out on his own with the concierge service was the best thing for all of us who are part of his group. He seems much happier and is able to perform his job in a way he'd always dreamed. Absolutely love it.

My in-laws dr did that as well. But he had to reduce the pricing drastically and increase the number of patients he would accept. People, even people loyal to going only to him, just weren't will to pay the pricing he was charging. He was one of those too that didn't take new patients often. I don't remember the costs though.

 

[Floridaman999]

How much is the yearly membership? Do you get 'x' number of visits for that price or unlimited? What the cost cover? Is it "practical" for the masses?

I'd have to look at the contract to be sure so I don't want to misquote the amount, but I do know it wasn't exactly cheap. There is no limit to visits as some people in the group will have good years while others may need lots of attention. I think it averages well for the most part because I've been able to see him same day almost every time I've needed to.

 

[PollyannaMom]

Have a patient enter his symptoms online before even making appointment and I think we find many visits could be handled online or in an off site testing facility.

That might be something to look at - sort of a "Do I have to come in or not?" flow chart, and then less data entry in the appointment itself. But I do worry about replacing the human interaction too much. - Sometimes patients don't realize when an "unrelated" thing might be important.

 

[longboard55]

How much is the yearly membership? Do you get 'x' number of visits for that price or unlimited? What the cost cover? Is it "practical" for the masses?

As I recall they were charging around $2500/year to be a member, plus they still billed the insurance company for services and insurance rules till apply, they money just is for better service. Its pretty popular, but it is not cheap, concierge is what they call it locally

 

[Floridaman999]

As I recall they were charging around $2500/year to be a member, plus they still billed the insurance company for services and insurance rules till apply, they money just is for better service. Its pretty popular, but it is not cheap, concierge is what they call it locally

Ours doesn't use our insurance for his services, but we use it for tests, treatments, and hospitalizations as needed. I believe ours was more expensive than the $2500 you listed as well, so that's probably why.

 

[Happyinwonerland]

Are there limits on how long nurses/doctors are allowed to work or how long a break needs to be between shifts? We do it for truck drivers and pilots, presumably for safety, so why not do it for the medical profession?

I know in my state that nurses are legally only allowed to work 20 hrs in one shift, although I have gone a bit over that because there was nobody to relieve me and I will go to jail if I abandon patients As far as time between breaks, it isn't regulated, and many days we don't get a true break at all. I'm not sure about the minimum time between shifts.

 

[LSUmiss]

That might be something to look at - sort of a "Do I have to come in or not?" flow chart, and then less data entry in the appointment itself. But I do worry about replacing the human interaction too much. - Sometimes patients don't realize when an "unrelated" thing might be important.

And it probably won’t happen without tort reform. No one wants to be liable for missing something. Hence, all the diagnostics usually ordered. And, I get it. My dad died of pancreatic cancer & had it (undetected) while under the care of an oncologist. We didn’t sue b/c pancreatic cancer is pretty much a death sentence even when caught early. But, it still sucks to know that it was missed. That’s part of why healthcare is so expensive...so many “just in case” tests & procedures. And, I don’t know the answer. If it’s you or your loved one, the cost of catching something early or missing something before it’s too late seems worth it to me.

 

[sam_gordon]

I know in my state that nurses are legally only allowed to work 20 hrs in one shift

Let's start there (with doctors too). Truckers are only allowed to drive for 10 (I'm pretty sure that's right) hours in one day and need to be "off duty" 8 hours before it resets. IIRC, they can only drive 60 hours in 7 days or 70 hours in 8 days. This is all for the safety of other drivers. Why does it make sense for nurses to be allowed to work 20 hours? Cut that down to 12, with 8 hours off before it resets. Same with doctors.

 

[usnuzuloose]

The problem is that reimbursement from insurance is going down. One can't afford to take less patients or hire more staff. DH and I are both medical professionals and advised our kids not to go into health care. I was able to retire in October. (I turn 66 next month.) I couldn't take it any more. DH is trying to hold on a little longer but financially, it is tough. Health care is not what is was when we started in it.

We rented a home from a dr. We did not know that until they came and gave us a 60 day notice to move as they were selling the home. They also said they were probably closing their office because insurance was not really paying the bills. It is a sad thing.

 

[Disney Doll]

If the extra work (file keeping, etc) is what's bringing the doctor's down, couldn't they hire more help? Or take on less patients?

Hiring more help costs $. Taking on fewer patients means you are making less $. Making less $ and having more people to pay doesn’t work as an equation. Plus most doctors and hospitals are part of “systems” now and systems have productivity levels that they require their employees to meet. Doctors are told “your productivity was down 3% last month so this month you need to see X more patients to make up for that”. Hospitals are told they need to cut staffing to meet productivity levels but when patients fall, develop bedsores or whatever, the hospital gets fined. So I have 20 patients on a nursing unit that used to have 5 RNs and 2 CNAs caring for them and now there are 4 RNs and 1 CNA (because that staff mix meets productivity levels) but I’m still expected to provide the same level of care, do the same amount of documentation, and not let any adverse events happen.

As I always say “pray you die in your sleep”.

 

[Disney Doll]

It’s not just healthcare, it’s education, retail, & food industry. It’s do more with less mentality. It’s generally less about the patient, student, and customer and more about meeting those required standards and technology to cut costs including payroll.

The burnout too is coming from not being able to leave work at work. With smart phones, you’re expected to be locked into work 24/7 including your PTO days. We might be physically working less then prior generations statistics wise, yet we’re mentally and emotionally working practicality almost all the time and even more due to technology.

This is also true. I am no longer a bedside nurse. My hospital is owned by a national corporation that owns hospitals all over the country. I work a regular 40 hour days workweek. I will often get to work in the morning and have a new meeting request for 830am with attached “pre-reads” that was sent out the night before at 11pm. I want to say to the person “do you think I sit at home all night with my work email open waiting for emails so I can read them?”

 

[Disney Doll]

But none of this is new and limited to the medical field. I used to work in television news. When I started, scripts were typed on typewriters on 6ply paper. Rundowns were done by hand. We were at least working on videotape, not film. 30 years later, server based software is used for writing and computers take care of all the math. We went over to PCs almost 20 years ago. There are still people who need almost constant hand holding.

I'm guessing the medical field is still only about 10 years into the "computer age". It will take time to adjust, and those who are used to doing things "the old way" will figure it out.

ETA: I'm not saying "burn out" in the medical profession isn't a thing, but simply that other fields have gone through a similar change in technology and survived.

Actually more like 15 years and the difference between the medical field and television news, media or retail is that no one’s going to die if your computer system screws up or if someone doesn’t quite know how to use it.