Dr. Corso's med blog: How is Burnout affecting health care at our local doctor’s office?

Monday, March 05, 2007

How is Burnout affecting health care at our local doctor’s office?

Burnout seems rampant throughout all of our healthcare specialties. As a general internist in a large primary care clinic, we are seeing the effects of two things: Family doctors and internist are retiring earlier than expected due to dissatisfaction with the lifestyle and work environment that now defines medical practice.

In choosing which specialty of medicine to enter, the deal was that family practice and internal medicine would offer less money but you’d get higher satisfaction from knowing your patients well and having a reasonable work day and work week. These were the fields for people who valued lifestyle and career. But that deal has been broken,

It would seem that medical practice is now owned and operated more by the insurance companies and government agencies like Medicare, who have imposed large, expensive and time-consuming bureaucracies on what was once a simple relationship between caregiver and patient.

The result is that the average medical practice, which employed 1.8 office workers per physician in 1980, now must hire between four and five employees to push paper. They must bill, re-bill, request permission for treatments and dozens of other functions that are not directly related to patient care.

So the physician must see his or her first dozen patients of the day just to cover the fixed overhead of being in business. Salary only shows up After that, through the extra patients that must be crammed in to an overfull day. This is why the average patient visit has gone from a half hour down to ten minutes in a typical office.

Burnout comes from the mountains of paperwork after the clinic closes that keeps physicians from getting home at a reasonable hour, and from the unsatisfactory experience of rushing through patient visits. Let’s face it, if the patient is rushed, the relationship becomes strained and it’s more common to have an adversarial relationship between the clinic and the office instead of a collaborative one. This gets very old, very fast.

We’re looking at a doctor shortage of unprecedented size and scope. While politicians dictate what Medicare will and won’t pay and talk about imposing a one payer bureaucracy on us doctors, they forget that this is still a marginally free country. They can’t force us to practice. They are going to drive the best and the brightest further away from the practice of medicine, at a time when the baby boomers will need doctors the most.


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