Moral injury

[anbuitachi]

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Many of you probably have already seen it but i thought id share it here for those who hasnt. Z dogg released a good video about it .

It's Not Burnout, It's Moral Injury | AMA 15 w/ZDoggMD

 

[RaidenXVC]

I have mixed feelings about this. I think that what Dr. Damania is describing in the video is indeed moral injury. But I also think that burnout is still a valid term which simply stems from working too hard for too long which is something that most of us experience at one point or another, and is still difficult to bounce back from once encountered.

 

[deleted245139]

Call it what you want... It's that the term feels weaponized by administration. The system causes it, deepens it... So while they hand down productivity expectations, take you away from the bedside..... The jump on the buzzword to act like they care, like it matters.
I like the acknowledgement in the vid that it's an issue that yoga won't solve. It's deeper than that.
I'm also not saying there IS a solution. .. this whole thing is reaching critical mass.
Aging population, increasing co-morbidities, lack of resources - going to be an interesting next several decades

 

[Angus Avagadro]

I dont think what we are seeing now is from overwork per se. Our parent and grandparent physicians worked every 2nd and 3rd night for their residencies. We have significantly limited work hours for residents now at 80 hrs per week. Yet physician suicide rates continue to climb? Its not from a lazy generation, far from it. I believe physicians are no longer a valued profession. We can hire someone else, we can get a midlevel to do the same thing cheaper, etc. Physicians are not valued for excellent practice, only RVUs throughput, and charting correctly so coders can get the bill out quicker. Physicians are having their compensation docked if too many patients have elevated A1C or anticoagulation goals are not met in their practice. Yes, our colleagues are being docked for noncompliant patients. Sadly, things will get worse before they get better
We need an insurrection in organized medicine as our leadership is bought and paid for.

 

[mistafab]

I’m going psych and hope to long term open PP cash only.

Only then will you beat the system, young padawan

Just like me... someday.

 

[Waldeinsamkeit]

I am very uncomfortable being compared to a soldier.
Almost every other profession has corporate and administrative nonsense people have to deal with.
I honestly feel like if we all could get sleep things would drastically improve.

Most of all, I do not want doctors to join some new victim narrative. I do not think we are particularly special. I think his arguments make a lot of blanket statements and assumptions about all doctors. We should not treat this like some ethical, moral issue. Let's treat this like what it actually is, a labor rights issue.

 

[evilbooyaa]

I honestly feel like if we all could get sleep things would drastically improve.

Most of all, I do not want doctors to join some new victim narrative. I do not think we are particularly special. I think his arguments make a lot of blanket statements and assumptions about all doctors. We should not treat this like some ethical, moral issue. Let's treat this like what it actually is, a labor rights issue.

What are you talking about? Work hour restrictions ensure that physicians in training are getting more sleep now than they did 15 years ago.

The moral injury in question (I am not a huge fan of ZDogg but liked the video) is that less and less of physicians time are spent doing CLINICAL tasks. More and more is spent on documentation, scut work, arguing for pre-authorization, etc. Not spending time with patients.

I imagine every field has more and more barriers between a physician and the patient they want to care for, between insurance, documentation requirements, etc. In the past, a physician note was something that let the physician know what was going on with the patient. Now, it is used as a billing document above all else. Crap like a 10 point review of systems has to be included. A statement saying "I have reviewed the relevant labs and imaging".

That being said, I don't think this is a ONE matter issue - for some real 'burnout' does exist, where you're just doing too much stuff without an ability to cut-back. I imagine this is more likely for residents and junior faculty. However, the bigger drain is the amount of time we spend doing non-clinical things (at the expense of clinical time with patients). The main reasons I could not do FM is because dealing with the volume of pre-auths as a medical student made me more frustrated than anything else, especially when they failed because the insurance company just does stuff by an algorithm and doesn't give 2 ****s what a doctor thinks about their "preferred drug list". That and the incredibly short clinic visits where patients were more like sheep to be herded into and out of the office than humans to be listened and taken care of. That and dealing with diabetes/hypertension in non-compliant patients but that can't really be changed.

 

[RaidenXVC]

am very uncomfortable being compared to a soldier.
Almost every other profession has corporate and administrative nonsense people have to deal with.
I honestly feel like if we all could get sleep things would drastically improve.

To be fair, virtually every job in the military is probably the only other profession that comes close (or possibly exceeds) the amount of bureaucracy and paperwork experienced in medicine. Not to mention that you get crapped on by superiors who don't know how to do your job. So in that sense there are a lot of parallels.

 

[SurfingDoctor]

Burnout = depression. Calling it something else, “moral injury” is not particularly helpful.The fact that people don't equate that burnout is depression is part of the issue in seeking help.

But that being said, the only cure I've seen for it is changing professions. It is what it is... but if you don't enjoy what you do... why do it?

 

[863168]

Do physicians really want us to state that they must have suffered some traumatic "moral injury" in the line of their daily work?

"Doc. Z, God bless your service on Patient X. You served admirably and there are hot blankets and a hot cocoa waiting for you in the doc box."

I wish I could type that physicians should be treated with respect like our veterans. But I think that we live in such times where veterans are treated horribly and often times discarded with social services being too little and too late. Even the statement "Thoughts and Prayers" has been parodied for its lack of underlying emotion. For Doctor Damania who escaped the lifestyle of being a zombie doctor, I'm sure that minor changes such as shifting the lexicon from "burnout" to "moral injury" is achievable, but I think it shows that he is pushing his goal post significantly back from actually making substantial changes to achieve Healthcare 3.0.

 

[jdh71]

Many of you probably have already seen it but i thought id share it here for those who hasnt. Z dogg released a good video about it .

It's Not Burnout, It's Moral Injury | AMA 15 w/ZDoggMD

He’s correct.

 

[jdh71]

To be fair, virtually every job in the military is probably the only other profession that comes close (or possibly exceeds) the amount of bureaucracy and paperwork experienced in medicine. Not to mention that you get crapped on by superiors who don't know how to do your job. So in that sense there are a lot of parallels.

Some specialties can keep some of this at arms length but anyone who belongs to those specialties that need to be available 24/7/365, nights, weekends, holidays, anniversaries, birthdays, kids volleyball games . . . EM, critical care, cardiology, general, thoracic, and neuro surgery (etc) . . . What we do is akin to the marines in the sense there is an expectation tfat we are ready and willing. And that we will throw ourselves on these patient problems sacrificing our sleep, health, time with families. I don’t know if there is a more apt comparison and analogy with front line soldiers out there in the non military world. Medicine is hierarchical and bureaucratic.

 

[jdh71]

Burnout = depression. Calling it something else, “moral injury” is not particularly helpful.The fact that people don't equate that burnout is depression is part of the issue in seeking help.

But that being said, the only cure I've seen for it is changing professions. It is what it is... but if you don't enjoy what you do... why do it?

One does make an assessment of if they are willing to eat as much **** as they have to and if unwilling to eat the rx’d amount of **** then yes people will be happier leaving the **** eating assuming everything else is equal. But if what you love is patient care and there are significant barriers to that with extra unnecessary work added on in the form of documentation then I’m pretty sure the people who left would be fine with the job if not for the **** eating.

Depression comes about from many pathways. I think you are definitely intentionally trying not to see the real problem but simply calling it depressing. Let’s continue the war analogy. You are suggesting that when people in war zones get shot their problem is the billet wound. And if they don’t want bullet wounds they shouldn’t be in the war zone. When the real problem is that there is a ****ing war zone in the first place. It’s a tone deaf response to a person shot in a war zone.

 

[SurfingDoctor]

One does make an assessment of if they are willing to eat as much **** as they have to and if unwilling to eat the rx’d amount of **** then yes people will be happier leaving the **** eating assuming everything else is equal. But if what you love is patient care and there are significant barriers to that with extra unnecessary work added on in the form of documentation then I’m pretty sure the people who left would be fine with the job if not for the **** eating.

Depression comes about from many pathways. I think you are definitely intentionally trying not to see the real problem but simply calling it depressing. Let’s continue the war analogy. You are suggesting that when people in war zones get shot their problem is the billet wound. And if they don’t want bullet wounds they shouldn’t be in the war zone. When the real problem is that there is a ****ing war zone in the first place. It’s a tone deaf response to a person shot in a war zone.

I think my assessment is accurate but you disagree. It’s okay. There are probably plenty in both camps in their beliefs.

What is the difference between depression and burnout? An ongoing debate - PubMed

Burnout has been viewed as a syndrome developing in response to chronically adverse working conditions. Burnout is thought to comprise emotional exhaustion, depersonalization, and reduced personal accomplishment. Historically, however, burnout has been difficult to separate from depression...

www.ncbi.nlm.nih.gov

What I’ve seen manifest in colleagues was indistinguishable and the treatment was the same.

 

[SouthernGent]

I am very uncomfortable being compared to a soldier.

The term "moral injury" was coined for how PTSD developed in Vietnam War veterans by Johnathan Shay. There is much that goes into it, and I am not of fan of the community co-opting the term like this. The only thing I appreciate about the term being used in this is setting is Shay points part of the development being on crap and betraying leadership. That's a start. But flaming out cause folks are being ground to a stump as a cog in the machine is not the same class as PTSD.

 

[jdh71]

I think my assessment is accurate but you disagree. It’s okay. There are probably plenty in both camps in their beliefs.

What is the difference between depression and burnout? An ongoing debate - PubMed

Burnout has been viewed as a syndrome developing in response to chronically adverse working conditions. Burnout is thought to comprise emotional exhaustion, depersonalization, and reduced personal accomplishment. Historically, however, burnout has been difficult to separate from depression...

www.ncbi.nlm.nih.gov

What I’ve seen manifest in colleagues was indistinguishable and the treatment was the same.

You miss my point. We both agree that there is a bullet wound . . .

I like to tell kids living in civil war Syria to stop living there. Bullet wounds are their “problem”.

 

[SurfingDoctor]

You miss my point. We both agree that there is a bullet wound . . .

I like to tell kids living in civil war Syria to stop living there. Bullet wounds are their “problem”.

Sorry, but I think living in a war zone is not even close to not liking your job. That being said, plenty of people do flee war zones for their own wellbeing.

 

[NickNaylor]

I think the self-aggrandizing and implicit (even explicit?) moral superiority is a bit much and unlikely to garner much sympathy from the public or others at large. I don't think that's the optimal "line of attack" when it comes to addressing this issue.

That said, I think ZDogg is right when it comes to naming the problem and identifying the key issue. The fact is that the tasks that physicians spend the most time doing - documentation, dealing with insurers, dealing with systems-level issues that have very little to do with actual, meaningful patient care - are rarely critical to providing meaningful, fulfilling, and life-changing patient care that leaves patients better off than when we first met them. I think all of us fantasize about having that kind of impact on people. The EMR, rather than being the savior of healthcare and increasing efficiency, ease of information sharing, and increasing time with patients has done the exact opposite, with all healthcare workers spending more time documenting bull**** than actually spending time with patients. Ultimately, I get satisfaction from my work when I feel like I do something meaningful that actually improves a patient's life. That satisfaction typically requires spending actual time with patients, not documenting a ton of ultimately not-that-useful information to satisfy billing requirements or arguing with insurers about getting a medication covered or an inpatient hospitalization extended.

He's also right in naming that the response to this "crisis" is completely missing the mark. I'm working on a paper discussing burnout, and it's interesting to note that I have yet to find any burnout-specific interventions that address systematic change. Instead, the focus is on bolstering staff's ability to mold to the system rather than molding the system to better serve its true purpose: healing others. This increases the feeling of disingenuous "care" about the topic and, ironically, likely further contributes to healthcare staff being perceived as unimportant and their work useful only insofar as it can generate revenue. For residents specifically, it is demoralizing to see more superficially trained "providers" doing exactly the same work for nearly double the pay.

The fact that the "system" is duplicitous about acknowledging the real motivators that have caused the system to be constructed as it currently is leads to further satisfaction. Everyone knows what's going on, but the "system" seems to believe that by simply refusing to acknowledge these factors will somehow make them not true. Frankly, I would feel better if we were just honest about what is going on and what is contributing to widespread dissatisfaction among the healthcare workforce. That would at least allow people's experiences to be validated. Instead, we all see what the problems are, we know what's contributing to burnout (even if we don't have a well-designed RTC to "prove" it to us), and we know what the potential solutions are, but instead the "system" looks at itself and says, "what's going on here? How could this possibly happen?" By doing so, the experiences of many, many healthcare workers are indirectly invalidated and minimized.

 

[Neopolymath]

Why do we need a name for how the physician feels? How does that do anything to help? There needs to be a name for the problem which is administrative bastards ruining medicine. Telling the general public that a doctor feels burnt out/moral injury isn't going to garner any sympathy in this day and age. Telling the public that we are getting screwed by parasitic dirtbags is something any common, working man can relate to. If the goal is to address the issue, talk about the cancer not that the patient is sad they have cancer. Being sad isn't the problem that needs addressed.

 

[SurfingDoctor]

The reality is that many professions, nay all professions have burnout. The system issue isn’t unique to medicine. In fact the profession with the highest burnout is reportedly journalism.

I doubt any of the increased burnout in any profession can be fixed within a organization. They are more societal... never disconnecting from the internet, thus never really leaving work, leading to longer hours, etc.

3 reasons you feel so burned out at work

Overextending yourself on the job almost always leads to burnout. Take these steps to stop it.

www.nbcnews.com

The caveat is, lack of job satisfaction or ability to deal with stress don’t effect people equally. If one doesn’t want to do the perceived “meaningless task x”, I bet there is someone else willing to do it at the expense of their pay who doesn’t find that work as “meaningless”. Of course, maybe that’s okay because money isn’t everything.

 

[Eyeronic]

What is so LOL over the last decade is watching the mega-corporatized "health systems" hilariously try to simplify this issue with a simple "We have a wellness program for our healthcare workers blah blah blah." All the way down to the residency/fellowship level, where you're just another "employee". That is, after you get **** on for 14-16 hours by your senior resident, attending, the noncompliant patient on your service, the abusive family member, some EMR guru who questions your problem list on an EMR communication, and some snarky consulting service, you as the intern are supposed to remain in that same hospital and attend some yoga class and that that will make everything all better.

And oh yeah, it's your turn to get pimped at Morning Report tomorrow.

You aren't 100% every single day? You cry once at the hospital during those first 12 months? Clearly your fault, because your residency program provided you with the superficial band-aid and a "confidential" (but very much not) counseling service.

Everyone's sentiments here are in the ballpark. Yes, burnout is not unique to medicine, but it still stinks. Walls are closing in, very slowly but surely.

 

[jdh71]

Sorry, but I think living in a war zone is not even close to not liking your job. That being said, plenty of people do flee war zones for their own wellbeing.

People do unwilling flee war zones. So that’s the answer to the war zone. The war? Flee? Maybe people starving in Africa should just move to where the food is? I mean some do right? It is one kind of solution but none of that is actually adressing it fixing the actual problem. Those people would be perfectly happy living in their home countries if not for the war or the famine.

Should a physician through school and training and very happy to treat patients be forced into a decision to leave what they do love because they can’t stand dojng what they hate??

I guess it sucks to suck. Right bro?

 

[SurfingDoctor]

People do unwilling flee war zones. So that’s the answer to the war zone. The war? Flee? Maybe people starving in Africa should just move to where the food is? I mean some do right? It is one kind of solution but none of that is actually adressing it fixing the actual problem. Those people would be perfectly happy living in their home countries if not for the war or the famine.

Should a physician through school and training and very happy to treat patients be forced into a decision to leave what they do love because they can’t stand dojng what they hate??

I guess it sucks to suck. Right bro?

Those analogies are terrible. So now medicine is being a starving person in Africa? I mean, if you view yourself as that type of victim, there’s really no hope.

 

[jdh71]

Those analogies are terrible. So now medicine is being a starving person in Africa? I mean, if you view yourself as that type of victim, there’s really no hope.

I would think the analogy and what is being compared would be clear but I guess it is not. Or perhaps you are intentionally ignoring the comparison because it is inconvenient to your inane point. Regardless . . .

What is being compared are people who otherwise would be perfectly happy but are in a situation outside of their control influencing the perfectly happy bit of their lives. Your solution to simply leave the whole situation if you don’t like it is one type of solution but it’s not a solution fixing the problem. And if the problem in medicine were fixed then those who left because they could not stand the extra horse**** would be happy practicing physician the same way a Syrian would be happy living in Damascus were it not for the civil war that forced them to choose dodging bullets or a refugee camp.

Clearer?

 

[SurfingDoctor]

I would think the analogy and what is being compared would be clear but I guess it is not. Or perhaps you are intentionally ignoring the comparison because it is inconvenient to your inane point. Regardless . . .

What is being compared are people who otherwise would be perfectly happy but are in a situation outside of their control influencing the perfectly happy bit of their lives. Your solution to simply leave the whole situation if you don’t like it is one type of solution but it’s not a solution fixing the problem. And if the problem in medicine were fixed then those who left because they could not stand the extra horse**** would be happy practicing physician the same way a Syrian would be happy living in Damascus were it not for the civil war that forced them to choose dodging bullets or a refugee camp.

Clearer?

I guess, but I really can’t relate. I’m also not sure there is a system-based fixed for an individual-based problem or concern. Granted, I get there are people who are burned out, but there are just as many people (or more at least in my division) who aren’t. And the people who are burned out in my division all attempted different pathways to alleviate, though the only ones I’ve seen be successful are those who left.

 

[SurfingDoctor]

Seeing patients. That's what they were doing. I'd happily see all the patients in the hospital if I didn't have to document BS for 5 hours a day. EMRs need to exist SOLELY for patient care and nothing else.



Except that employees in every other profession can change jobs. Try telling a surgical intern that he/she can change jobs.



Burnout is not depression and calling it that sends an inaccurate and, I dare say, dangerous message. One can become depressed due to burnout. One may have a depressed mood due to burnout. But burnout does not equal depression.



Journalists can change jobs. They can even change duties. A journalism degree can do many other things - marketing/PR, politics (either as a press secretary, a legislative/speech writer, a campaign spokesperson, etc), writer (fiction or non-fiction), speech writing, publicist, radio host, television host/anchor/reporter, magazine editor or writer, newspaper writing/editing, publishing, website design and brand creation, spokesperson/communications director at any number of non-profit and for-profit companies (or hospital or school or virtually any other organization), etc, etc, etc. A medical degree? Not so much.

Sure, physicians can change jobs. I’ve seen it plenty of times. I actually have a colleague who’s quitting at the end of the year due to burnout. They are starting a gymnastics business.

 

[Mass Effect]

Sure, physicians can change jobs. I’ve seen it plenty of times. I actually have a colleague who’s quitting at the end of the year due to burnout. They are starting a gymnastics business.

Going into business for yourself is someone anyone in any field can do, but most wouldn't, no matter the field. I'm talking about changing jobs to another employed position. Sure, there's pharm, but even that would likely want you to complete residency. An MD degree just isn't as easily transferable as others, especially without completing residency and with a heavy debt burden, unlike most other professions.

 

[SurfingDoctor]

Going into business for yourself is someone anyone in any field can do, but most wouldn't, no matter the field. I'm talking about changing jobs to another employed position. Sure, there's pharm, but even that would likely want you to complete residency. An MD degree just isn't as easily transferable as others, especially without completing residency and with a heavy debt burden, unlike most other professions.

I’ve seen another go into consulting, another go into IT, another going into a app development startup, etc. Theres also medical writing, pharmaceuticals and device marketing, and so on and so on.

However, if you’re suggesting that people are getting burned out in residency, there’s no solution to that and probably deserves some soul-searching on that individuals part.

 

[Mass Effect]

I’ve seen another go into consulting, another go into IT, another going into a app development startup, etc. Theres also medical writing, pharmaceuticals and device marketing, and so on and so on.

After at least 7 years and 200K in debt, the answer to burnout is to become a device marketer.

However, if you’re suggesting that people are getting burned out in residency, there’s no solution to that and probably deserves some soul-searching on that individuals part.

Because burnout is the fault of the individual and not the medical system? I think that's the point of this entire thread.

 

[SurfingDoctor]

After at least 7 years and 200K in debt, the answer to burnout is to become a device marketer.



Because burnout is the fault of the individual and not the medical system? I think that's the point of this entire thread.

I don’t know whose “fault” it is. I do I know I and many of my colleagues don’t have burnout and we are part of the same medical system. The incidence and solution to burnout though is very individual. Applying systemic solutions to individual issues is unlikely to be fruitful.

 

[jdh71]

I guess, but I really can’t relate. I’m also not sure there is a system-based fixed for an individual-based problem or concern. Granted, I get there are people who are burned out, but there are just as many people (or more at least in my division) who aren’t. And the people who are burned out in my division all attempted different pathways to alleviate, though the only ones I’ve seen be successful are those who left.

Ok. I can see you are planning to dig in your heels here. I'll wait for the "meh" after you've been beat around awhile.

 

[863168]

@SurfingDoctor There is a significant difference between the jobs that @Mass Effect brought up in comparison to the examples you provided. A journalist going into an independent podcast or a political correspondent role is clearly a growth transition in terms of factors of independence and influence while still using the skills gained in their initial occupation. A physician going into IT or setting up a gymnastics business is clearly using a set of skills that are divorced from the knowledge they gained while practicing medicine which means that these transitions may be a step down or a horizontal move when considering both income and opportunity cost.

For physicians, there are limited straight & narrow growth options following residency with the exclusion of a possible fellowship. A major concern with the current model is that the students select specialties before they fully understand the scope of practice required of them. When it comes to residency, physicians don't have the flexibility that other healthcare specialists have in terms of dictating job location & terms. With little notice, our healthcare network has recently laid off a ton of mid-level practitioners, however all of them have landed safely in other careers within the same scope and some with arguably even better job/pay prospects. Although physician layoffs rarely occur, it begs to question the value of job security when it involves feeling like you have made a static decision without the ability to freely look or pursue potential new offers.

 

[SurfingDoctor]

@SurfingDoctor There is a significant difference between the jobs that @Mass Effect brought up in comparison to the examples you provided. A journalist going into an independent podcast or a political correspondent role is clearly a growth transition in terms of factors of independence and influence while still using the skills gained in their initial occupation. A physician going into IT or setting up a gymnastics business is clearly using a set of skills that are divorced from the knowledge they gained while practicing medicine which means that these transitions may be a step down or a horizontal move when considering both income and opportunity cost.

For physicians, there are limited straight & narrow growth options following residency with the exclusion of a possible fellowship. A major concern with the current model is that the students select specialties before they fully understand the scope of practice required of them. When it comes to residency, physicians don't have the flexibility that other healthcare specialists have in terms of dictating job location & terms. With little notice, our healthcare network has recently laid off a ton of mid-level practitioners, however all of them have landed safely in other careers within the same scope and some with arguably even better job/pay prospects. Although physician layoffs rarely occur, it begs to question the value of job security when it involves feeling like you have made a static decision without the ability to freely look or pursue potential new offers.

Well, actually people have quit I bit of flexibility in where they work in residency, it’s called the match. And physicians have very high job security. But job security wasn’t the discussion, it was job satisfaction.

Like I’ve stated, the burnout I’ve seen has nothing to do with security or where they work, it’s just that those people hate their job. Meanwhile, I work the same job and don’t hate it. The system solution to one person hating their job and another person not seems like it would be impossible. In fact, when we generally talk about it at meeting, the only solution I hear from burned out people is to work less... which is generally speaking, probably the best solution.

 

[Eyeronic]

Because burnout is the fault of the individual and not the medical system? I think that's the point of this entire thread.

A close cousin to my other favorite from the past 10+ years:
"If they aren't happy with a career in medicine, they MUST have chosen the medical field for the wrong reasons."

 

[allantois]

Maybe something isn't right but no one seems to have any productive solutions.
I've seen a few posters mention midlevels as the cause of their plight and dissatisfaction. This does not seem like a healthy line of thinking as one might as well compare themselves with RNs who are also making more than most residents. Salary increases for residents is something that the medical GME has to address, as this is not a zero sum game where Peter gets robbed to feed Paul.
Perhaps the US training could be restructured where the residencies are longer but weekly hours are reduced; or even allow physicians to practice as generalists upon completion of medical school (both of these options are common in Europe and elsewhere). I suppose that majority of residents would not opt out to prolong their training and that the medical community would want to protect themselves from people graduating medical school anywhere in the world and being able to practice in the US without completing residency training. So we are back at square one, where each individual has to change their own circumstances to avoid depression and burnout of training.

 

[SurfingDoctor]

Heard this song on the radio... reminded me of this thread discussion.

 

[anbuitachi]

The reality is that many professions, nay all professions have burnout. The system issue isn’t unique to medicine. In fact the profession with the highest burnout is reportedly journalism.

I doubt any of the increased burnout in any profession can be fixed within a organization. They are more societal... never disconnecting from the internet, thus never really leaving work, leading to longer hours, etc.

3 reasons you feel so burned out at work

Overextending yourself on the job almost always leads to burnout. Take these steps to stop it.

www.nbcnews.com

The caveat is, lack of job satisfaction or ability to deal with stress don’t effect people equally. If one doesn’t want to do the perceived “meaningless task x”, I bet there is someone else willing to do it at the expense of their pay who doesn’t find that work as “meaningless”. Of course, maybe that’s okay because money isn’t everything.

I mean i think the connection between moral injury in journalism and in medicine can be easily appreciated. Big companies run the country, and they only care about profits. That applies to journalism as well. People may want to write a great, impactful piece but if the boss doesn't think it will generate enough views, it will likely be shot down. That's why so much media today is clickbait, or exaggerations. It's no wonder journalists are tired of their work.

Same with us. We want to focus on patient care, but we have to climb over a mountain created by people in suits, to do so. It's tiring. Surgeons/anesthesiologists are pushed to work faster and do more cases, and are rewarded if they generate more revenue for the hospital, and punished if they are not. It's an ethical issue as well. It should be care oriented, not $$, but i guess that's how the country works today

 

[SurfingDoctor]

I mean i think the connection between moral injury in journalism and in medicine can be easily appreciated. Big companies run the country, and they only care about profits. That applies to journalism as well. People may want to write a great, impactful piece but if the boss doesn't think it will generate enough views, it will likely be shot down. That's why so much media today is clickbait, or exaggerations. It's no wonder journalists are tired of their work.

Same with us. We want to focus on patient care, but we have to climb over a mountain created by people in suits, to do so. It's tiring. Surgeons/anesthesiologists are pushed to work faster and do more cases, and are rewarded if they generate more revenue for the hospital, and punished if they are not. It's an ethical issue as well. It should be care oriented, not $$, but i guess that's how the country works today

Okay. So what’s your solution?

 

[anbuitachi]

Okay. So what’s your solution?

i dont have a realistic solution. there are idealistic solutions but i do not see them happening because it's just the way the world works.. the rich/powerful rules and determine the rules.

there are many changes that can help though. such as setting strict laws on when patients can sue, and capping total damages. right now doctor can get sued for any reason, and no matter how stupid it is it adds onto the MD's stress. hospitals keep piling on more documentations because of fear of big lawsuits.

also stuff like press ganey needs to go. stupid stuff from jhaco needs to go. and i think we'll also do better morally if doctors are paid a straight up salary instead of fee for service.

 

[SurfingDoctor]

i dont have a realistic solution. there are idealistic solutions but i do not see them happening because it's just the way the world works.. the rich/powerful rules and determine the rules.

there are many changes that can help though. such as setting strict laws on when patients can sue, and capping total damages. right now doctor can get sued for any reason, and no matter how stupid it is it adds onto the MD's stress. hospitals keep piling on more documentations because of fear of big lawsuits.

also stuff like press ganey needs to go. stupid stuff from jhaco needs to go. and i think we'll also do better morally if doctors are paid a straight up salary instead of fee for service.

Having practiced in a state with tort reform, I’m not sure it really made people happier. It certainly wasn’t my experience. I mean, Texas still beats out many states in burnout.

State-by-state breakdown: Physician burnout on the rise

With major changes being made to healthcare, physicians are feeling the pressure and the burn.

www.beckersspine.com

I’m totally fine with tort reform and think it is reasonable, but I doubt it will have any real effect on burnout. Maybe for a select few...

 

[Angus Avagadro]

We are merely witnessing the natural history of moving to centralized/ single payer healthcare. Business doesnt want to pay for instant access and government wants to manage costs on a budget. We can look to England and the 50+ year experience with the NHS. The International Red Cross has called it a humanitarian disaster. Where did Mick Jagger have his valve replacement? So where does it end? It ends with a single layer for the masses, who are willing to wait, and private insurance for those willing to pay. This is where England is. We need physician led consortiums contracting with companies, but these always get sold when when they become successful. Organized medicine has led us down this path. They, like our elected leaders, dont represent our best interests, doctors or patients. We are going to have to get noisy.

 

[anbuitachi]

Having practiced in a state with tort reform, I’m not sure it really made people happier. It certainly wasn’t my experience. I mean, Texas still beats out many states in burnout.

State-by-state breakdown: Physician burnout on the rise

With major changes being made to healthcare, physicians are feeling the pressure and the burn.

www.beckersspine.com

I’m totally fine with tort reform and think it is reasonable, but I doubt it will have any real effect on burnout. Maybe for a select few...

It's more than just tort reform. It's just one part. Most lawsuits don't result in doctors in the first place but just being sued and having to deal with that mess is very taxing and demoralizing. And tort reform is just non economic dmges. Hospitals can still take a huge loss so I'm not sure it changes any practice in real ways

 

[nimbus]

Surgeons/anesthesiologists are pushed to work faster and do more cases, and are rewarded if they generate more revenue for the hospital, and punished if they are not. It's an ethical issue as well. It should be care oriented, not $$, but i guess that's how the country works today

I’ve only ever seen surgeons and anesthesiologists work fast when they are working for themselves. In systems without productivity incentives, the pace is mind numbingly slow.

 

[nimbus]

We are merely witnessing the natural history of moving to centralized/ single payer healthcare. Business doesnt want to pay for instant access and government wants to manage costs on a budget. We can look to England and the 50+ year experience with the NHS. The International Red Cross has called it a humanitarian disaster. Where did Mick Jagger have his valve replacement? So where does it end? It ends with a single layer for the masses, who are willing to wait, and private insurance for those willing to pay. This is where England is. We need physician led consortiums contracting with companies, but these always get sold when when they become successful. Organized medicine has led us down this path. They, like our elected leaders, dont represent our best interests, doctors or patients. We are going to have to get noisy.

Wait for Brexit. It’ll be even worse.

 

[anbuitachi]

I’ve only ever seen surgeons and anesthesiologists work fast when they are working for themselves. In systems without productivity incentives, the pace is mind numbingly slow.

but the hospital/administration is always watching since the OR is their main source of revenue, and surgeon X may have their OR block time decreased/removed if another 'better' surgeon shows up

 

[evilbooyaa]

Well, actually people have quit I bit of flexibility in where they work in residency, it’s called the match. And physicians have very high job security. But job security wasn’t the discussion, it was job satisfaction.

Like I’ve stated, the burnout I’ve seen has nothing to do with security or where they work, it’s just that those people hate their job. Meanwhile, I work the same job and don’t hate it. The system solution to one person hating their job and another person not seems like it would be impossible. In fact, when we generally talk about it at meeting, the only solution I hear from burned out people is to work less... which is generally speaking, probably the best solution.

Dude(tte), we get it. You like your job and you don't have burnout. Good for you. Consider yourself fortunate. Just because you have not experienced systematic issues that ZDogg discusses in the video does not mean that they don't exist. While for some, it may just be that they hate their job, for many others, it's that they love their job of seeing patients, but don't love all the other nonsense they have to do (which generally takes more time).

In regards to flexibility where they work in residency - the match? What?? You realize that the match and residency is essentially the definition of not flexible, right? That if you don't like your job because the interview (which is always a polished representation of the program) was not truthful to the day-to-day crap people have to deal with, you can't realistically just up and leave without putting your entire medical career at extreme risk?

The main (and IMO, only) way to truly have a flexible job is to start a job, realize it's crap, and realize that you have the ability to tell your bosses to go f themselves and get yourself a new job. For nearly every field outside of medicine, this is a reasonable option when you were sold a turd (which was polished for interview day) without it having the potential to end your entire career. Not so in medicine.

 

[SurfingDoctor]

Dude(tte), we get it. You like your job and you don't have burnout. Good for you. Consider yourself fortunate. Just because you have not experienced systematic issues that ZDogg discusses in the video does not mean that they don't exist. While for some, it may just be that they hate their job, for many others, it's that they love their job of seeing patients, but don't love all the other nonsense they have to do (which generally takes more time).

In regards to flexibility where they work in residency - the match? What?? You realize that the match and residency is essentially the definition of not flexible, right? That if you don't like your job because the interview (which is always a polished representation of the program) was not truthful to the day-to-day crap people have to deal with, you can't realistically just up and leave without putting your entire medical career at extreme risk?

The main (and IMO, only) way to truly have a flexible job is to start a job, realize it's crap, and realize that you have the ability to tell your bosses to go f themselves and get yourself a new job. For nearly every field outside of medicine, this is a reasonable option when you were sold a turd (which was polished for interview day) without it having the potential to end your entire career. Not so in medicine.

Hmm. If you say so. You can transfer programs in residency. It’s not as stream-lined as the Match, well because it doesn’t have to be. It’s not trying to satisfy specific individuals. The fact that about 1/3 don’t complete residency at that initial program shows that’s it’s not impossible.

Although residency is a transient job. I do appreciate that there is a group of people who believe the grass is always greener... I wish them luck.

 

[evilbooyaa]

I agree with you that residency is a transient job, which is why, while it's not impossible (nowadays) to switch residency, most people just suck it up and graduate. The number of times I've read, in the general residency forums, the phrase "they can always hurt you more" in response to a resident considering some negative action against his/her residency program is quite a bit. Although the general residency forums is (almost always) just one side of the story with significant details coming out overtime in nearly every "my residency sucks" or "I got fired from residency unjustly" thread.

It's not all (or even most) residencies that are malignant and lead to resident burnout. I imagine > 90% of all residencies (across all specialties) in the US aren't like that. That being said, the negative experiences people have are more likely to end up on the internet, so we know that it does exist.

 

[SurfingDoctor]

I agree with you that residency is a transient job, which is why, while it's not impossible (nowadays) to switch residency, most people just suck it up and graduate. The number of times I've read, in the general residency forums, the phrase "they can always hurt you more" in response to a resident considering some negative action against his/her residency program is quite a bit. Although the general residency forums is (almost always) just one side of the story with significant details coming out overtime in nearly every "my residency sucks" or "I got fired from residency unjustly" thread.

It's not all (or even most) residencies that are malignant and lead to resident burnout. I imagine > 90% of all residencies (across all specialties) in the US aren't like that. That being said, the negative experiences people have are more likely to end up on the internet, so we know that it does exist.

It’s pretty hard to get fired from residency and usually speaks to deeper issues that aren’t immediately correctable, if at all. I also suspect that some of the burnout is attributable to personal factors that the residency or program can fix. I remember a co-resident of mine who was particularly weak for whatever reason. They really struggled. I’m sure they felt burned out. I’m not sure I knew what burn out was in residency, but in retrospect, they displayed the signs of it. The residency forced them to have a reduced patient load, and everyone else made up the difference. Clearly the residency did what they could to accommodate that person, but no one else in the class had the same issues. This is not to highlight anything except individual issues require individual solutions. Systemic solutions are unlikely to fix individual issues.

 

[evilbooyaa]

It’s pretty hard to get fired from residency and usually speaks to deeper issues that aren’t immediately correctable, if at all. I also suspect that some of the burnout is attributable to personal factors that the residency or program can fix. I remember a co-resident of mine who was particularly weak for whatever reason. They really struggled. I’m sure they felt burned out. The residency forced them to have a reduced patient load, and everyone else made up the difference. Clearly the residency did what they could to accommodate that person, but no one else in the class had the same issues. This is not to highlight anything except individual issues require individual solutions. Systemic solutions are unlikely to fix individual issues.

Sure, that does sound like an individual solution, which seems appropriate. I will agree that at the residency level most problem residents (unless the whole residency class is miserable) may benefit from individual solutions. I think the discussion points being made (unwieldiness of EMR, insurance/pre-auth requirements, documentation minimums for billing, etc.) likely affect attendings more so than residents, albeit likely field specific - for example, covering an inpatient service for a surgeon means you deal with patient care (good) and EMR documentation (may require certain amount of PE or ROS checkboxes to get paid), but not insurance authorization for the surgeries, figuring out billing requirements, etc.)

However, FM residents that I know have to do pre-auths and insurance appeals for their own stable of outpatients, have to place initial billing codes which are signed off by the attending (and thus need to know what needs to be included in the note to bill at what level), need to know quality of care (MIPS?) criteria mentioned in their own notes to ensure their patients are being screened appropriately. I'm not saying that all of this inevitably leads to burnout for every single FM resident - however, I can't imagine doing pre-auths is fun or stimulating for doctors who primarily want to treat patients, and is an impediment to patient care. I get why they are necessary, but these are the systematic issues that can be fixed. Having an insurance not cover a life-improving (even life-saving sometimes) medication despite pre-authorization application is an impediment to patient care.

That's not to say there is an easy solution to all of this, because it all comes down to the cost of healthcare. But I believe the video was taking the first step of trying to get people to define what the problem is, on a systematic level. First step to fixing a problem is to admit there is one.