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Recent data regarding burnout in PM&R

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cluelessme7

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In light of recent lectures at the AAPM&R conference as well as recent studies (see links below), I was just wondering if anyone in the field could share some insight onto why PM&R is listed in the top of some of these "burnout" surveys. Its understandable that in general, medicine is facing burnout issues across all specialities; less autonomy, increased bureaucratic tasks, EMR, etc. However as that is standardized across all fields, it still does not explain why PM&R sits so high on burn out charts. Maybe the "Plenty of Money and Relaxation" adage doesn't hold true anymore, but it still shocks me that the speciality is being presented as a high burnout prone field. Thoughts?

Medscape: Medscape Access

https://www.researchgate.net/profil...uld-We-Focus-More-on-Physiatrists-Mission.pdf

 

RangerBob

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I always assumed it was due to a low sample size. It’s interesting that Medscape never includes us in salary comparisons, but we did make it into the burnout survey.

I can’t speak for outpatient (which I think I would burn out much quicker in), but for inpatient one theory for why burnout may be high is no one wants to help with coverage. In the past the community/outpatient physiatrists would help cover the unit (partly because it brought them business/referrals), but now none of them want to cover. Being the only one or two physiatrists managing an inpatient unit is rough if you don’t have hospitalists to help manage call, weekend rounding, vacation coverage. That’s probably why the hospitalist-physiatrist combo model is getting more popular now...
 

Dr. Ice

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Outpatient pmr docs are mainly pain medicine/sports docs. We have to deal with a population for which our treatments are not great and we are essentially just kicking the can down the proverbial road. For a procedurally based speciality we don’t get paid “that” well for the population we treat and it’s not like we have a side anesthesia gig to roll back on. Most of us who chose outpatient medicine would rather risk burnout then have to do subacute rehab consults all day. I also think unfortunately that a lot of pmr docs who went into pmr were already burnt out from med school and so the promises of a no call lifestyle and decent pay enticed many med students, for them only to realize that they didn’t really like the speciality a whole lot to begin with.
 
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Dodgers75

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Outpatient pmr docs are mainly pain medicine/sports docs. We have to deal with a population for which our treatments are not great and we are essentially just kicking the can down the proverbial road. For a procedurally based speciality we don’t get paid “that” well for the population we treat and it’s not like we have a side anesthesia gig to roll back on. Most of us who chose outpatient medicine would rather risk burnout then have to do subacute rehab consults all day. I also think unfortunately that a lot of pmr docs who went into pmr were already burnt out from med school and so the promises of a no call lifestyle and decent pay enticed many med students, for them only to realize that they didn’t really like the speciality a whole lot to begin with.

Great insight. Pure gold. I will also add that working at subacute/inpatient unit in some facilities could be awful. Not much of pay and respect from other colleagues. Constant pressure to "prove" your worth becomes tiring.
 

DOctorJay

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I always assumed it was due to a low sample size. It’s interesting that Medscape never includes us in salary comparisons, but we did make it into the burnout survey.

I can’t speak for outpatient (which I think I would burn out much quicker in), but for inpatient one theory for why burnout may be high is no one wants to help with coverage. In the past the community/outpatient physiatrists would help cover the unit (partly because it brought them business/referrals), but now none of them want to cover. Being the only one or two physiatrists managing an inpatient unit is rough if you don’t have hospitalists to help manage call, weekend rounding, vacation coverage. That’s probably why the hospitalist-physiatrist combo model is getting more popular now...

Medscape: Medscape Access
here's the medscape info from 2018
 

SSdoc33

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Outpatient pmr docs are mainly pain medicine/sports docs. We have to deal with a population for which our treatments are not great and we are essentially just kicking the can down the proverbial road. For a procedurally based speciality we don’t get paid “that” well for the population we treat and it’s not like we have a side anesthesia gig to roll back on. Most of us who chose outpatient medicine would rather risk burnout then have to do subacute rehab consults all day. I also think unfortunately that a lot of pmr docs who went into pmr were already burnt out from med school and so the promises of a no call lifestyle and decent pay enticed many med students, for them only to realize that they didn’t really like the speciality a whole lot to begin with.

sounds like YOU dont really like the specialty.

i dont feel like i am kicking the can down the road

i think the burnout rate has is mostly linked to decreased reimbursements. if we get paid less for the same amount of work, we end up working more. thus, higher burnout. PMR has been hit a bit harder than most other specialties in terms of reimbursements.
 
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j4pac

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sounds like YOU dont really like the specialty.

i dont feel like i am kicking the can down the road

i think the burnout rate has is mostly linked to decreased reimbursements. if we get paid less for the same amount of work, we end up working more. thus, higher burnout. PMR has been hit a bit harder than most other specialties in terms of reimbursements.

Maybe a part...but it’s not the complete picture. Peds consistently ranks upon the specialties with the highest job satisfaction, and they get paid the least. Its probably due to many factors.
 

Gauss

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multifactorial, generational, hits everyone differently. One of my partners can't stand typing and has dictated for 20 or more years so when they wanted to eliminate transcriptionists without any replacement options other than typing, they lost it and nearly quit. Admin, being the clueless idiots that they are, didn't consider offering replacement options prior to making the announcement. But it was literally the straw that broke the camel's back

And that is probably a great example of why burnout is rising so fast, loss of control. In outpatient, most of us like to manage our clinics, make decisions, have autonomy, manage our own scheduling, be the boss. Take that all away while still putting all the liability on our shoulders, lower our pay/reimbursements and make us work more, create artificial standards with impossible goals (press ganey MU MIPS MACRA), and then admin dumps whatever undesirable patient population they want into your clinic and there's nothing much to like about your practice or career anymore. Voila burnout

NO CONTROL = SHORT CAREER! - Doctor of Finance MD
 
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SSdoc33

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Maybe a part...but it’s not the complete picture. Peds consistently ranks upon the specialties with the highest job satisfaction, and they get paid the least. Its probably due to many factors.

pediatricians are generally good, patient people. mostly women. physiatrists? maybe not quite as pure of heart.....
 
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RangerBob

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pediatricians are generally good, patient people. mostly women. physiatrists? maybe not quite as pure of heart.....

Peds is very self selecting as well-with low pay/low prestige, the people that go into it know what they’re getting into (like geriatrics, which also ranks high in satisfaction)

PM&R used to be backup for ortho. And as a “lifestyle” specialty, it attracts a lot of people who aren’t as into the specialty itself.

PM&R is probably no better or worse than any other specialty with regards to admin hassles, paperwork, etc. Though I’m guessing admins hire help for their surgeons that bring in a lot of revenue, and psychiatrists (who have the lowest rate by far for accepting any form of insurance) and dermatologists with cash based practices can avoid a lot of these hassles.
 

Gauss

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and psychiatrists (who have the lowest rate by far for accepting any form of insurance)

this blows my mind, I had no inkling that psych would turn itself around the way it has. Psychiatrists have figured it out: walk away from groups, go solo, take no insurance, set your rates and adjust as you want, select only cases you want, complete scheduling freedom, keep said cases indefinitely. And their overhead is ridiculous - small single room office, no staff or maybe one person to manage phones, no equipment, nothing to clean or have inspected by jcaho or state, no EMR, and they are all full and have waitlists! genius
 
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drusso

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this blows my mind, I had no inkling that psych would turn itself around the way it has. Psychiatrists have figured it out: walk away from groups, go solo, take no insurance, set your rates and adjust as you want, select only cases you want, complete scheduling freedom, keep said cases indefinitely. And their overhead is ridiculous - small single room office, no staff or maybe one person to manage phones, no equipment, nothing to clean or have inspected by jcaho or state, no EMR, and they are all full and have waitlists! genius

Good friend of mine is psych. He gets called and woo'ed by recruiters every week. He can moonlight making $3-5K per weekend "covering" in-patient psych ward in under-staffed parts of the country with hospitalist back up (one hospital even flew him in a private jet to do it.).
 

SSdoc33

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this blows my mind, I had no inkling that psych would turn itself around the way it has. Psychiatrists have figured it out: walk away from groups, go solo, take no insurance, set your rates and adjust as you want, select only cases you want, complete scheduling freedom, keep said cases indefinitely. And their overhead is ridiculous - small single room office, no staff or maybe one person to manage phones, no equipment, nothing to clean or have inspected by jcaho or state, no EMR, and they are all full and have waitlists! genius

and they only see the rich. good for them, bad for mental health nationwide. dont get me wrong, id do the same thing, but it is sad that we cant get mental health reimbursed better
 

Burnted_out

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While some psychs may be able to pull this off it is naive to think that the avg psych does. You have to have a wealthy population to pull this off willing to pay cash. I don’t think that many people are willing to do so. Sure on certain parts of the country some psychs can do that - but again to suggest that all psychs magically can get a ton of $$ is not realistically. If you check the avg psych salaries they are in the 200’s.
Just like there are a group of internists who do concierge medicine and make 400k a year but again that is not the typical experience.
 
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Shufflin

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and they only see the rich. good for them, bad for mental health nationwide. dont get me wrong, id do the same thing, but it is sad that we cant get mental health reimbursed better

This is a very common thought, that to run a cash practice we serve the rich. I run a cash practice, in a rich town, and more than half of my patients are hard-working middle-class families referred by word-of-mouth, who have severe mental health issues that have been poorly treated by the system. These patients are tight on money but are willing to pay whatever necessary for effective care (after run-ins with poor quality psychiatrists). The rich are funny about their money. Of all my patients, they are more often than not the ones who will just stop showing up one day, taking their money elsewhere at the slightest dissatisfaction with services even against what is best for them. In fact, the ones who keep showing up for several months paying $400 per hour are the hard-working middle class patients who feel excellent personalized mental health care is worth paying for.

But I agree, the reimbursement model for mental health needs improving.

The other misconception, at least in my experience, is that we just treat the worried well. None of my patients are worried well. They all have been through hurricanes of suffering that need focused expert care, and are rarely, rarely fully stable.
 
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drusso

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This is a very common thought, that to run a cash practice we serve the rich. I run a cash practice, in a rich town, and more than half of my patients are hard-working middle-class families referred by word-of-mouth, who have severe mental health issues that have been poorly treated by the system. These patients are tight on money but are willing to pay whatever necessary for effective care (after run-ins with poor quality psychiatrists). The rich are funny about their money. Of all my patients, they are more often than not the ones who will just stop showing up one day, taking their money elsewhere at the slightest dissatisfaction with services even against what is best for them. In fact, the ones who keep showing up for several months paying $400 per hour are the hard-working middle class patients who feel excellent personalized mental health care is worth paying for.

But I agree, the reimbursement model for mental health needs improving.

The other misconception, at least in my experience, is that we just treat the worried well. None of my patients are worried well. They all have been through hurricanes of suffering that need focused expert care, and are rarely, rarely fully stable.

I'm happy that there are docs like you stilling willing to risk their hides on providing patients care "outside the system." I hope you do some teaching or let students/residents shadow you so that they can see that that there exists another mode of delivery of health care besides Big-Box/Big-Hospital Employed "McMedicine."
 
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SSdoc33

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This is a very common thought, that to run a cash practice we serve the rich. I run a cash practice, in a rich town, and more than half of my patients are hard-working middle-class families referred by word-of-mouth, who have severe mental health issues that have been poorly treated by the system. These patients are tight on money but are willing to pay whatever necessary for effective care (after run-ins with poor quality psychiatrists). The rich are funny about their money. Of all my patients, they are more often than not the ones who will just stop showing up one day, taking their money elsewhere at the slightest dissatisfaction with services even against what is best for them. In fact, the ones who keep showing up for several months paying $400 per hour are the hard-working middle class patients who feel excellent personalized mental health care is worth paying for.

But I agree, the reimbursement model for mental health needs improving.

The other misconception, at least in my experience, is that we just treat the worried well. None of my patients are worried well. They all have been through hurricanes of suffering that need focused expert care, and are rarely, rarely fully stable.


if you are taking $400 a pop from teachers and construction workers, then that is an even bigger problem with the system. again, not that i blame you, but how is that level sustainable from those who arent "rich"?
 
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Shufflin

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if you are taking $400 a pop from teachers and construction workers, then that is an even bigger problem with the system. again, not that i blame you, but how is that level sustainable from those who arent "rich"?

Because the going rate in the entire city is normally $500 an hour and I'm $100 cheaper. That's how. And nobody takes insurance.

A few groups in neighboring towns do take insurance, and the wait is 3 months to be seen whereas I will drop everything to see my folks. They do get what they pay for. And I'm not taking it from them, they willfully give it.
 
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