Anesthesiologist Burnout

[BLADEMDA]

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Read the medscape 2017 artice on Physician burnout. I'm definitely feeling more "heat" these days on the burnout scale.


http://www.medscape.com/features/slideshow/lifestyle/2017/overview

 

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[BLADEMDA]

The Medscape survey once again asked physicians about burnout, which is defined in this and other major studies as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.[1] Burnout rates for all respondents have been trending up since 2013, the first year that Medscape examined them, when the overall rate was 40%. This year, it is 51%, more than a 25% increase over just 4 years. The results of another recent, major survey support this unfortunate trend, finding that burnout had worsened between 2011 and 2014, with more than half of physicians reporting it.[2]

In this year's Medscape report, 51% of anesthesiologists reported burnout, slightly below the middle among all physicians. The highest percentage occurred among those practicing emergency medicine (59%), followed by ob/gyns (56%) and family physicians, internists, and infectious disease physicians, all at 55%.

 

[caligas]

I think a lot of people don't even realize it.

"I hate going to work and am sick of the fat sick patients, the as$hole surgeons, and the bureaucratic bull$hit. But I'm not burned out!"

 

[BLADEMDA]

I think a lot of people don't even realize it.

"I hate going to work and am sick of the fat sick patients, the as$hole surgeons, and the bureaucratic bull$hit. But I'm not burned out!"

That's a 3 or 4 on the burnout scale so maybe in a few years it starts affecting you even more.

 

[GravelRider]

I have definitely lost some of my enthusiasm for the field and empathy for patients. However, there is always a lot of talk about the widespread problem of physician burnout, but good solutions are rarely offered. The solution that I see offered from big hospital systems that are employing physicians is to provide "classes" on how to cope. To me, that is absurd. It places the blame on physicians themselves for having some sort of personality deficit or for being from a generation that doesn't value hard work. All of that is complete nonsense. There is something wrong with the system that physicians are practicing in and not something wrong with physicians themselves.

 

[aneftp]

EM has always had the highest burnout.

I'm surprise EM is high. But I guess with more patients to see. More corporate overhead. That combination is deadly and contributes to their high burnout.

 

[Consigliere]

EM has always had the highest burnout.

I'm surprise EM is high. But I guess with more patients to see. More corporate overhead. That combination is deadly and contributes to their high burnout.

2 phrases: patient satisfaction scores and narcotic seeking patients.

 

[AdmiralChz]

2 phrases: patient satisfaction scores and narcotic seeking patients.

Yes the thought makes me want to quit already.

Also, Check out their forum sometime, you think AMCs are bad they (apparently?) have it much, much worse with their large national companies.

 

[Consigliere]

Yes the thought makes me want to quit already.

Also, Check out their forum sometime, you think AMCs are bad they (apparently?) have it much, much worse with their large national companies.

I know! I read a fascinating thread by some poster (nineniner I think) about the corporatization of EM.

 

[Ronin2258]

Haven't lost the empathy for the patients. The patients I have in my population are the reasons I wake up to come into work.

The bureaucracy, (THREE 1.5 hour meetings during the day yesterday,) and difficult colleagues and staff are what are making things burnout-able where I am now. To say nothing of questionable backup and support from colleagues.

I would welcome computerized records ( we are the only department that doesn't have them in the hospital, and looking like the end of this year before it does happen.)

 

[Silo004]

I have definitely lost some of my enthusiasm for the field and empathy for patients. However, there is always a lot of talk about the widespread problem of physician burnout, but good solutions are rarely offered. The solution that I see offered from big hospital systems that are employing physicians is to provide "classes" on how to cope. To me, that is absurd. It places the blame on physicians themselves for having some sort of personality deficit or for being from a generation that doesn't value hard work. All of that is complete nonsense. There is something wrong with the system that physicians are practicing in and not something wrong with physicians themselves.

Well that's the same approach taken during medial school, right? What do you expect?

 

[nimbus]

I think you are less likely to burn out if you do your own cases. Spending a day in the OR with your friends is downright pleasant most of the time. Running around supervising 3 or 4 rooms is more stressful.

 

[Lunatik]

The chart seems about right but I don't quite understand how Family Medicine made it to the top 3. At the expense of sounding like a tool, isn't it an easy check for essentially scribbling codeine, amoxicillin, OTC and a specialist referral?

 

[Aether2000]

Part of it may be perspective and where one is in life. I work prn for surgery centers and as a fill in for anesthesiology for vacations, etc. in hospitals and surgery centers. No call, most of the time get out by 3-4pm, enjoy the variety, have no administrative duties, no staff meetings, and thoroughly enjoy my interaction with patients. I work because I want to, not because I have to, therefore my perspective is quite different. My only fear is medical malpractice in Florida where there are no limits on liability, with patients increasingly pursuing personal assets of physicians in malpractice cases, although the state has a few absolute shields against this in home ownership, joint ownership of checking accounts, and retirement funds. Yes, it is the ideal job. For once I think I understand the perspective of the millennials on life 🙂

 

[Planktonmd]

Part of it may be perspective and where one is in life. I work prn for surgery centers and as a fill in for anesthesiology for vacations, etc. in hospitals and surgery centers. No call, most of the time get out by 3-4pm, enjoy the variety, have no administrative duties, no staff meetings, and thoroughly enjoy my interaction with patients. I work because I want to, not because I have to, therefore my perspective is quite different. My only fear is medical malpractice in Florida where there are no limits on liability, with patients increasingly pursuing personal assets of physicians in malpractice cases, although the state has a few absolute shields against this in home ownership, joint ownership of checking accounts, and retirement funds. Yes, it is the ideal job. For once I think I understand the perspective of the millennials on life 🙂

Working because you want to not because you have to is a huge advantage, are you independently wealthy?
I honestly think the main cause of burnout is the transformation of medicine into a business that exists only to make money for the business owners, who are no longer the physicians themselves in most cases.

 

[gasdoc77]

I think you are less likely to burn out if you do your own cases. Spending a day in the OR with your friends is downright pleasant most of the time. Running around supervising 3 or 4 rooms is more stressful.

I have to wonder if the MD only practices that have never had a crna presence have a completely different cultural feel (respect), making the days more pleasant. An AMC model in many ways marginalizes the physician, such that everyone is simply "anesthesia". When supervising, the critical role of the physician anesthesiologist becomes largely behind the scenes and the OR staff/administrators/surgical colleagues suddenly think (mistakenly) that we are unnecessary overpaid middlemen. Over time, this is a recipe for resentment from both sides. Any existing MD only practices should give this serious consideration before selling out. It ain't all about having a few extra digits in your bank account when you die.

 

[GravelRider]

The chart seems about right but I don't quite understand how Family Medicine made it to the top 3. At the expense of sounding like a tool, isn't it an easy check for essentially scribbling codeine, amoxicillin, OTC and a specialist referral?

Have you ever worked in a primary care office? Do you understand what causes burnout?

 

[periopdoc]

I don't quite understand how Family Medicine made it to the top 3.

I would literally kill myself if I was ever forced to practice Family Medicine again in a non-rural environment. (And by non-rural I mean any area where there are more than 2-3 docs within a 244 mile area)

 

[Consigliere]

I would literally kill myself if I was ever forced to practice Family Medicine again in a non-rural environment. (And by non-rural I mean any area where there are more than 2-3 docs within a 244 mile area)

That's an awfully precise catchment area.

 

[Lunatik]

Have you ever worked in a primary care office? Do you understand what causes burnout?

The essence of it? The repetitive realization that you're not doing what you thought you wanted to do.

Look, I certainly see your point. But that's why primary care offices are often staffed and operate in accordance to that daily routine. Strictly doctor to doctor, I just don't see why a PCP would --statistically-- lead a more stressful, unfulfilling lifestyle than, say, an urologist or an internist. Help me see it! I may be mistaken, but by definition, isn't the job more repetitive for a specialist than it is for a GP?

 

[Lunatik]

I would literally kill myself if I was ever forced to practice Family Medicine again in a non-rural environment. (And by non-rural I mean any area where there are more than 2-3 docs within a 244 mile area)

Haha. Sounds like it was a tough town.

 

[bashwell]

The essence of it? The repetitive realization that you're not doing what you thought you wanted to do.

Look, I certainly see your point. But that's why primary care offices are often staffed and operate in accordance to that daily routine. Strictly doctor to doctor, I just don't see why a PCP would --statistically-- lead a more stressful, unfulfilling lifestyle than, say, an urologist or an internist. Help me see it! I may be mistaken, but by definition, isn't the job more repetitive for a specialist than it is for a GP?

Everything is repetitive if you do it long enough. 😉

 

[aneftp]

I'm not burned out. I'm mid career. 12.5 years out. But it's becoming increasingly frustrating with the tight job market in urban area. The take over of anesthesia practices. 2 of the big 3 AMCs took over my last couple of practices.

It's just more work (while keeping pay the same). Which is the same as a paycut. And more income gets exposed as a w2 especially in the $300k and high range with Medicare surtaxes and high marginal tax rates. Add to that state income taxes (for some states)

If you are making $100k extra (from 300-400k). It seems a lot. But whack 35% fed tax plus 6-10% state income taxes. May be seeing 60 cents on the dollar with those high w2 taxes (unlike true private practice where you are shield more taxes into retirement accounts)

I got to the point where 100k extra isn't worth it for me cause I'm gonna to do all that extra work. All the extra calls for what amounts to $60k more after taxes.

I'd rather be at home in my own bed every night and be out of the hospital at reasonable times (3-330pm) daily.

 

[Nivens]

Have you ever worked in a primary care office? Do you understand what causes burnout?

I often wonder why this isn't said about pain medicine more. For all of anesthesiology's frustrations ("When is the doctor going to get here?"), we seem shielded from a lot of the BS of outpatient medicine.

 

[deleted126335]

Working because you want to not because you have to is a huge advantage.

This. I am cutting back and finding work less draining. Giving away some night and weekend calls has made a huge difference. Having a chunk of change in the bank and having kids who have left the nest give one a huge amount of freedom and relief.

Being trapped by debt, needing a high income lifestyle, a noncompete with kids plugged into the community contributes to burnout along with the usual suspects:
Difficult nights
long days
Loss of prestige/respect
Answering to administrator idiots
turf wars with midlevels
lack of security, etc. ,etc.

 

[GravelRider]

The essence of it? The repetitive realization that you're not doing what you thought you wanted to do.

Look, I certainly see your point. But that's why primary care offices are often staffed and operate in accordance to that daily routine. Strictly doctor to doctor, I just don't see why a PCP would --statistically-- lead a more stressful, unfulfilling lifestyle than, say, an urologist or an internist. Help me see it! I may be mistaken, but by definition, isn't the job more repetitive for a specialist than it is for a GP?

It's a factory line...7 minute follow-ups, thousands of patients you are responsible for, but truly know nothing about, piles and piles of paperwork, cumbersome and poorly designed EHRs, checking boxes on some form to meet some quality measure, needy/whiney/angry patients. When I was in my internal medicine clinic, I was given 12 minutes for follow-ups and 20 minutes for new patients...and I was supposedly learning. One remotely, complicated or sick patient and your day is thrown completely off course and by the time you are seeing your afternoon patient an hour late, they are angry. Patients are referred out to specialists because you simply don't have the time to deal with anything complicated. Patients also make demands to see the best cardiologist for their afib even though most primary care docs can comfortably manage it.

I was recently talking to a primary care doc who works for a big hospital system and she was told she would need to increase her daily patient volume by about 20 patients a day to obtain her "bonus."

If you are tired of the stupid quality measures and metrics, nonsense from insurance companies, cumbersome EHR rollouts, increasing workload for decreasing pay, entitled patients...multiple that by 100 for a primary care doc. The days of being a small town doc where you cared for patients in your community, knew all your patients, and were adept at managing a wide variety of problems are over.

 

[Lunatik]

It's a factory line...7 minute follow-ups, thousands of patients you are responsible for, but truly know nothing about, piles and piles of paperwork, cumbersome and poorly designed EHRs, checking boxes on some form to meet some quality measure, needy/whiney/angry patients. When I was in my internal medicine clinic, I was given 12 minutes for follow-ups and 20 minutes for new patients...and I was supposedly learning. One remotely, complicated or sick patient and your day is thrown completely off course and by the time you are seeing your afternoon patient an hour late, they are angry. Patients are referred out to specialists because you simply don't have the time to deal with anything complicated. Patients also make demands to see the best cardiologist for their afib even though most primary care docs can comfortably manage it.

I was recently talking to a primary care doc who works for a big hospital system and she was told she would need to increase her daily patient volume by about 20 patients a day to obtain her "bonus."

If you are tired of the stupid quality measures and metrics, nonsense from insurance companies, cumbersome EHR rollouts, increasing workload for decreasing pay, entitled patients...multiple that by 100 for a primary care doc. The days of being a small town doc where you cared for patients in your community, knew all your patients, and were adept at managing a wide variety of problems are over.

Perhaps a tad of confirmation bias here? A good portion of all this apply to the other branches as well. And the rest have more to do with exactly where you're practicing than the practice itself. As it's always the case, results will vary.

Just to clarify, I'm not saying family practice is a cakewalk. It's just surprising to me to see it burnout-rated in the top 3.

I blame big pharma. 🙂

 

[Consigliere]

Being trapped by debt, needing a high income lifestyle, a noncompete with kids plugged into the community contributes to burnout along with the usual suspects:
Difficult nights
long days
Loss of prestige/respect
Answering to administrator idiots
turf wars with midlevels
lack of security, etc. ,etc.

Damn guy.....you just described my situation perfectly!

 

[GravelRider]

Perhaps a tad of confirmation bias here? A good portion of all this apply to the other branches as well. And the rest have more to do with exactly where you're practicing than the practice itself. As it's always the case, results will vary.

Just to clarify, I'm not saying family practice is a cakewalk. It's just surprising to me to see it burnout-rated in the top 3.

I blame big pharma. 🙂

In the end, it is probably not worth arguing over which specialty subjectively feels more burnt out by single digit percentage points. The point is the majority of doctors are feeling burnt out and the reasons for the burnout are probably similar among all specialties.

 

[BLADEMDA]

A Lawsuit Waiting to Happen

The hostile legal environment causes many us to see each patient as a potential lawsuit. This fear factor adds to the stress of all the points above.

https://www.thehappymd.com/blog/bid/295048/Physician-Burnout-Why-its-not-a-Fair-Fight

 

[BLADEMDA]

Dr. Ray’s malpractice litigation lasted three years, during which time both his wife and father were extremely sympathetic and supportive. Nevertheless, Dr. Ray suffered distress symptoms throughout the course of the litigation. The trial ended with a defense verdict. Dr. Ray was relieved, but continued to suffer from symptoms similar to those who have post-traumatic stress disorder.1

https://www.acep.org/uploadedFiles/...lpractice Stress Syndrome article for web.pdf

 

[BLADEMDA]

Op-Ed
Up to 15% of doctors are drug addicts. I was one of them

Humans in distress have always reached for relief close at hand. In the case of doctors, that's often prescription medicine. A 2013 study in the Journal of Addiction Medicine revealed that 69% of doctors abused prescription medicine “to relieve stress and physical or emotional pain.” Given how immediately, though superficially and transiently, these pills work, the temptation to use them again and again may become overwhelming. Given how addictive they are, that’s like trying to put out a fire by dumping gasoline on it.

My access to prescription medications was virtually unlimited. Drug companies send doctors free samples. Patients bring in their unused painkillers for disposal. Colleagues freely write a scrip or two as a professional courtesy. And I foolishly made illegal use of my own prescription pad.

http://www.latimes.com/opinion/op-ed/la-oe-grinspoon-addicted-doctors-20160605-snap-story.html

 

[Lunatik]

Yes, the lawsuit thing has become crazy and more often than not the cases aren't even legitimate. Too many malicious cases are opened every year without moral merit with the sole purpose of extracting money. It has devolved into a sub-industry of sorts over the last few decades; driving MPLI & E&O costs higher and higher and at times costing whole careers. I mean, at some point, the system has to break and self-correct but I don't see it happening soon given the even more corrupt political background in the US.

 

[BLADEMDA]

Substance Abuse Among Anesthesiologists
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Although it can be difficult to accept, physicians are at risk for the same challenges and illnesses as other people, including drug addiction. Anesthesiologists, in particular, have consistently been shown to have an unusually high rate of drug abuse compared to other physicians. A survey of 260 anesthesiologists from the Medical College of Wisconsin graduating between 1958 and 1988 reported that 32 percent used drugs to “get high” and 15.8 percent had been drug dependent.


Physician health programs (PHPs), which are responsible for managing and monitoring addicted physicians, report that anesthesiologists show up in their programs with substance abuse at approximately 2.5 times the rate of other specialties. Anesthesiologists have also been reported to be similarly over-represented in substance abuse treatment centers that specialize in treating physicians. As a result of the high rates of substance abuse among anesthesiologists, some disability insurance companies have even decided to discontinue coverage for anesthesiologists.

Why are anesthesiologists particularly vulnerable to drug abuse? Studies point to the following factors:

• The proximity to large quantities of addictive drugs
• The relative ease of diverting drugs for personal use
• A high-stress work environment
• Control-oriented personality
• Workplace exposure that sensitizes the brain to substance abuse

https://www.elementsbehavioralhealth.com/featured/substance-abuse-anesthesiologists/

 

[abolt18]

Substance Abuse Among Anesthesiologists
FacebookTwitterGoogle+PinterestLinkedIn
Although it can be difficult to accept, physicians are at risk for the same challenges and illnesses as other people, including drug addiction. Anesthesiologists, in particular, have consistently been shown to have an unusually high rate of drug abuse compared to other physicians. A survey of 260 anesthesiologists from the Medical College of Wisconsin graduating between 1958 and 1988 reported that 32 percent used drugs to “get high” and 15.8 percent had been drug dependent.


Physician health programs (PHPs), which are responsible for managing and monitoring addicted physicians, report that anesthesiologists show up in their programs with substance abuse at approximately 2.5 times the rate of other specialties. Anesthesiologists have also been reported to be similarly over-represented in substance abuse treatment centers that specialize in treating physicians. As a result of the high rates of substance abuse among anesthesiologists, some disability insurance companies have even decided to discontinue coverage for anesthesiologists.

Why are anesthesiologists particularly vulnerable to drug abuse? Studies point to the following factors:

• The proximity to large quantities of addictive drugs
• The relative ease of diverting drugs for personal use
• A high-stress work environment
• Control-oriented personality
• Workplace exposure that sensitizes the brain to substance abuse

https://www.elementsbehavioralhealth.com/featured/substance-abuse-anesthesiologists/

This was a major talking point of one of my anesthesia attendings that I spent a day with. I was very appreciative of his candor and words of wisdom.

 

[deleted126335]

Damn guy.....you just described my situation perfectly!

Been there.
Save more. Spend less. Invest better. Get the kids out of the nest, secure and off the payroll.

Damn guy.....you just described my situation perfectly!

 

[Ignatius J]

Nothing about the day stuff hurts me. It's the night and weekends that grind on me. I've always said when I get to that point, I'm going to march my ass to an ASC in a nice little town, become an employee, take my pay cut, and enjoy life.

 

[aneftp]

Nothing about the day stuff hurts me. It's the night and weekends that grind on me. I've always said when I get to that point, I'm going to march my ass to an ASC in a nice little town, become an employee, take my pay cut, and enjoy life.

Problem these days is its hit or miss with ASC these days.

Some are good to work at and the MDs who are there will ride it out as long as they can.

The ASC that have job openings. A lot of the time there are big issues with the place (Md preop scut monkey covering 3-4 rooms seeing 50-60 patients a day by yourself). Working 10-11 hours a day. Gotta watch out for those ASCs. And it's not cushy. Hospital work 7-3 is easier work than many ASC with similar pay.

 

[Aether2000]

I am not independently wealthy- I worked for 25 years and have made enough to live comfortably without debt. But I do enjoy working part time. It would not be fun at all if I had to stay up nursing one Medicaid epidural along all night long....

 

[Ronin2258]

Strictly doctor to doctor, I just don't see why a PCP would --statistically-- lead a more stressful, unfulfilling lifestyle than, say, an urologist or an internist. Help me see it! I may be mistaken, but by definition, isn't the job more repetitive for a specialist than it is for a GP?

It's the paperwork that probably burns out more primary care physicians than the patients themselves. Most of them have to do billing, the negotiation with the insurance companies to get a reasonable compensation. The horror stories I have heard from classmates who are PCP are that sometimes it may take months to get paid from some insurance companies, and even then it's a smaller fraction than they should have.

Even when I was rotating in family medicine in med school, the physician would stay to 8-9pm to finish all the paperwork and supporting notes. He was driving a car that was at least 20 years old at the time I was rotating with him.

There is also the legendary 15minute encounter per established patients, which with a lot of the population and their problems, is not sufficient. That is why a lot of them are trying to branch out to procedures, (botox, et al.) to try to bring in more income.

 

[abolt18]

This is mostly speculative, but I think a major contributor to burnout could be people's misplaced expectations in their careers.

In medicine we put in all this time and effort pursuing medicine. Then we choose the specialty that is "right for us," thinking that life will be so satisfying and rewarding because we carefully selected the field that we love. The problem being that everything loses novelty, anything can become routine and mundane eventually. Throw in bureacracy and administrators. It can so easily become "just a job to pay the bills."

It's not like when someone goes to become a CPA, knowing that this is just to get the job that will support their family and desired lifestyle. Or the guys over at Dunder Mifflin, I don't think they're all that passionate about paper, but they go to work and sell paper nonetheless so they can pay their bills and live the life they want outside of paper.

Again, this is me just speculating, being that it's all still very exciting and far from mundane to me. I am attempting to brace myself well in advance, long before these things try to leave me disappointed or burned out.

 

[GravelRider]

This is mostly speculative, but I think a major contributor to burnout could be people's misplaced expectations in their careers.

In medicine we put in all this time and effort pursuing medicine. Then we choose the specialty that is "right for us," thinking that life will be so satisfying and rewarding because we carefully selected the field that we love. The problem being that everything loses novelty, anything can become routine and mundane eventually. Throw in bureacracy and administrators. It can so easily become "just a job to pay the bills."

It's not like when someone goes to become a CPA, knowing that this is just to get the job that will support their family and desired lifestyle. Or the guys over at Dunder Mifflin, I don't think they're all that passionate about paper, but they go to work and sell paper nonetheless so they can pay their bills and live the life they want outside of paper.

Again, this is me just speculating, being that it's all still very exciting and far from mundane to me. I am attempting to brace myself well in advance, long before these things try to leave me disappointed or burned out.

No, it is more than just misplaced expectations. The metrics and bureaucracy are well documented at this point. Most people know about them. I'd be perfectly happy to just treat it as a job that pays the bills if I worked normal banker's hours. However, if you are missing your kid's recital, skipping out on Thanksgiving dinner, and spending sleepless nights/weekends in the hospital, you damn better like the job more than just paying the bills.

I will emphasize the point I made above: the cause of physician burnout is not something inherently wrong with physicians. It is not misplaced expectations or some inability to cope with stress or long hours. This problem is widespread among all specialties and physicians of all generations. Something is wrong with the system, not with physicians themselves.

 

[abolt18]

No, it is more than just misplaced expectations. The metrics and bureaucracy are well documented at this point. Most people know about them. I'd be perfectly happy to just treat it as a job that pays the bills if I worked normal banker's hours. However, if you are missing your kid's recital, skipping out on Thanksgiving dinner, and spending sleepless nights/weekends in the hospital, you damn better like the job more than just paying the bills.

I will emphasize the point I made above: the cause of physician burnout is not something inherently wrong with physicians. It is not misplaced expectations or some inability to cope with stress or long hours. This problem is widespread among all specialties and physicians of all generations. Something is wrong with the system, not with physicians themselves.

I obviously am not in a place to comment much in these things because I haven't really experienced them. So I would not be surprised if you are right on the money. And I wasn't saying it's all misplaced expectations, rather that it may only be a contributor.

 

[deleted162650]

Nothing about the day stuff hurts me. It's the night and weekends that grind on me. I've always said when I get to that point, I'm going to march my ass to an ASC in a nice little town, become an employee, take my pay cut, and enjoy life.

I think you're doin' it backwards. When you're young and your kids are young (and want to be with you) is the time to take the cushy job and enjoy life. Then when you're old and your knees and back are shot and your kids are either out of the house or just have more fun things to do than hang out with mom/dad and you're sick of your spouse - that's the time to park it on the stool 60+ hours/week and make up for lost time while you reminisce about the good life you've had up to that point.

 

[Nivens]

This is mostly speculative, but I think a major contributor to burnout could be people's misplaced expectations in their careers.

In medicine we put in all this time and effort pursuing medicine. Then we choose the specialty that is "right for us," thinking that life will be so satisfying and rewarding because we carefully selected the field that we love. The problem being that everything loses novelty, anything can become routine and mundane eventually. Throw in bureacracy and administrators. It can so easily become "just a job to pay the bills."

It's not like when someone goes to become a CPA, knowing that this is just to get the job that will support their family and desired lifestyle. Or the guys over at Dunder Mifflin, I don't think they're all that passionate about paper, but they go to work and sell paper nonetheless so they can pay their bills and live the life they want outside of paper.

Again, this is me just speculating, being that it's all still very exciting and far from mundane to me. I am attempting to brace myself well in advance, long before these things try to leave me disappointed or burned out.

From the perspective of another resident, I think there's a lot of truth in this post. I had options when I applied for residency- was competitive for just about any specialty- but chose anesthesiology by adding up the things I liked reading about the most (cardiopulmonary physiology) and the places I liked to be (the operating room) and subtracting things I didn't think I wanted to do at the time (operate or see patients in clinic). Viola, here we are. My mistake was believing the primary driver of my day-to-day satisfaction was how much I enjoyed opening the textbook or journal for my chosen field- a narrow, but frighteningly common view among medical students. I'm starting to realize the things that make or break my day were nowhere on my radar a few years ago- autonomy, collegiality of working environment, feeling like what you do is valued, etc. We have so little leverage in the healthcare system that we don't really get to determine many of these things for ourselves. I can definitely see that contributing to burnout over time. I am doing my best to choose a subspecialty without repeating past mistakes ("I like reading about hearts and being in the heart room so I should be a CT anesthesiologist"), but the options are limited.

Edit: If your status is accurate, I promoted you to resident on account of your insightful post 😉

 

[abolt18]

From the perspective of another resident, I think there's a lot of truth in this post. I had options when I applied for residency- was competitive for just about any specialty- but chose anesthesiology by adding up the things I liked reading about the most (cardiopulmonary physiology) and the places I liked to be (the operating room) and subtracting things I didn't think I wanted to do at the time (operate or see patients in clinic). Viola, here we are. My mistake was believing the primary driver of my day-to-day satisfaction was how much I enjoyed opening the textbook or journal for my chosen field- a narrow, but frighteningly common view among medical students. I'm starting to realize the things that make or break my day were nowhere on my radar a few years ago- autonomy, collegiality of working environment, feeling like what you do is valued, etc. We have so little leverage in the healthcare system that we don't really get to determine many of these things for ourselves. I can definitely see that contributing to burnout over time. I am doing my best to choose a subspecialty without repeating past mistakes ("I like reading about hearts and being in the heart room so I should be a CT anesthesiologist"), but the options are limited.

Edit: If your status is accurate, I promoted you to resident on account of your insightful post 😉

Indeed, still a med student, at least for a few more months!

 

[Lunatik]

It's the paperwork that probably burns out more primary care physicians than the patients themselves. Most of them have to do billing, the negotiation with the insurance companies to get a reasonable compensation. The horror stories I have heard from classmates who are PCP are that sometimes it may take months to get paid from some insurance companies, and even then it's a smaller fraction than they should have.

Even when I was rotating in family medicine in med school, the physician would stay to 8-9pm to finish all the paperwork and supporting notes. He was driving a car that was at least 20 years old at the time I was rotating with him.

There is also the legendary 15minute encounter per established patients, which with a lot of the population and their problems, is not sufficient. That is why a lot of them are trying to branch out to procedures, (botox, et al.) to try to bring in more income.

Right on, yeah. That makes sense. But I think paperwork will become less and less of a problem in the coming years as we get more millennials & gen-Y MDs joining the ranks who have the skill set and the aptitude to automate a lot of the tasks the boomers and gen-X docs did and are doing by hand. I mean, just look at the progress with cloud storage and computing in the last decade. Better utilization of technology helps with minimizing the burnout and churn and keeps the staff saner and cheaper too.

Now, if we could also find a way for technology to better deal with the lawsuits, it'd be just great.

That is, of course, until eventually the robots take over. 🙂

 

[Consigliere]

. Better utilization of technology helps with minimizing the burnout and churn and keeps the staff saner and cheaper too.

Now, if we could also find a way for technology to better deal with the lawsuits, it'd be just great.

That is, of course, until eventually the robots take over. 🙂

Tell that to all the doctors who are forced to attend mandatory EPIC training (often 8 hours or more) on their own time. Uncompensated of course.