Why a dramatic increase in burnout?

[alpinebrook]

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I haven't begun my career in pathology yet, but I was surprised to see that pathology burnout rates are right up there with specialties such as OB/GYN. How could that be? Some of these other specialties have brutal call schedules compared to pathology. Maybe it's not so much about insane hours and busy waiting rooms, but huge stacks of cases that are never-ending?

http://www.ama-assn.org/ama/ama-wir...campaign=article_alert-morning_rounds_weekend

 

[Torsed]

I think the ever glaring problem that no one wants to address is that you will never be your own master. This isn't taught to residents and I see many are misguided.
The security of academic pathologists from real world lab struggles are not appreciated by many who teach residents (just read the posts on this site and others if you don't believe me). I was fortunate that I knew many private pathologists before I was turned loose, but it still didn't prepare me for seeing the elephant.
Here's why most I see are burned and I see it in myself:
1) Drippings from the breasts of mother insurance (CMS included), ever diminishing, will evaporate and kill many smaller private pathology groups. Its a continuous struggle to get paid. In my own group I am tempted to say screw it and sell out to some bigger lab and be a worker bee without having to worry about billing / contracts /etc. Its often I feel terminal in pathology, like a hopeful cancer patient clinging on, but we all know how the story ends. Hope dies. I wonder how long I can cling.
a) Pathology is a poorly represented field, our advocates (CAP/ASCP/Fill in the blank) don't care about Joe Schmo pathologist's plight and we are too small of a field to have an effective voice against the clinicians who dominate medicine. On a related note to number 2 below, I was on a CAP committee in the later half of 2000 decade and saw first hand how many committee members were employees or had shares in the big labs (Quest etc), I didn't appreciate it at the time how the CAP and likely other groups I don't have carnal knowledge of are puppets. Result: Loss of faith in our professional management.
b) State societies don't care and won't help you against big insurance. I complained/protested when big insurance in our state cut by 1/3 for reimbursement and appealed to help from the state society (wow was I blind). The state society received a notice from big insurance saying if they helped us they would be sued for violating the Sherman anti-trust act or some garbage like that. Given I had no further use for the state society after that I left, I doubt my couple hundred dollars a year mattered, but whatever. Local societies? Good luck with that unless there is some magic guild where you live where you practice. Result: Loss of faith in local/state societies.
c) Advocating Congress etc.? Forget it. More powerful physicians than myself spent about a week or two attempting to meet with Congress people from my state and finally one of the plastic surgeons called me and said screw it, he's not wasting his time anymore because its too much valuable time and they kept getting put off or just meeting aides. No hope there unless you bring mega lobby dollars. Big labs already have this covered, no need to fret about this. Result: Loss of faith in big government changing the playing field. For years we have hoped client billing would die in our area, but see below (2).
2) Inability to compete and stick it to bigger labs (LabCorp / Quest) will come in and steal all your profitable clients. Even your/mine best friend clinicians will go to one of these for a profit, client billing will be on the grave of many pathology groups. I'll add this: despite being illegal/frowned on in many states for anatomic pathology it all carries on in some form or another. OIG doesn't care because it doesn't happen to Medicare/Medicaid so don't have to worry about the feds. Spend 10 minutes trying to get a hold of your local insurance company and they don't care who is raking it in as long as no one rocks the money boat. Result: Loss of faith in our colleagues.
3) Little care of anyone in pathology's plight from the suits, no matter how talented you are you are replaceable, no one cares if you get paid or not as an independent pathologist. Admin sees one thing, dollar signs $$$, no matter how good you are, how great you nail every diagnosis and the little magical things you do to improve patient care regardless, unless you are way in the black you are expendable. Remember Rambo II? "You no expendable Rambo!" Well, yes you are. I really don't have advice except burrow yourself in and try to make removing you as painful as yanking a tick off of your genitals.
Collections: My advice: watch your billing company like a hawk, its tedious and stressful, but if ye are to make it in private practice its the one pearl I can give you.
4) The patient contact I do have is ungrateful and usually to complain about small fries bills. I discount/write off many, I'm sure the surgery centers and endoscopy suites and hospitals don't share my bleeding heart, but that's why I guess I'll have less time in purgatory. The rare compliments I do hear from staff or patients does mean a lot, but the dump trucks full of crap I have to shovel to get these rare gems doesn't fill the gaps in my morale. I feel all of medicine is this way, everyone just trying to get to that magic retirement number. I see stress in all the specialties and struggles related to this morale loss.
5) Cannibalism. I mentioned it above in number 2. It occurs from outside and within. I've seen fantastic pathologists, moral and hardworking, turned on by members of their own group and the end result is forced out and/or throwing in the towel. Power over us comes from situations like this because if we fight among ourselves we can't fight the external problems that threaten us.

Advice: If you are a younger resident go into a volume producing field in pathology (GI or Derm). You will be a worker bee, you will be taken full advantage of for your talents, but you will have slight more job security. You can flush molecular down the toilet unless you have a patent cooking, the Ph.D's will smoke you and take far less pay than MDs.
I would also advocate that you invest your money well and live far below your means so when the time comes you may retire comfortably. If possible locate a second income source.
I'd network with pathology people so you can keep tabs on happenings. I've found this useful in my career.

Hope this diatribe helps, with regard to the OP above. I wish it was as simple as call and stacks of cases. 🙂
TORSED

 

[WEBB PINKERTON]

Look at how much Derm burnout increased. It's weird. In my area many of the derm offices are selling out their practices to entities like Forefront derm. I was wondering if that was a sign of serious issues going on in that field. It sucks for local pathology groups since the specimens are forced to go to a lab in Wisconsin I was disappointed to find.

 

[yaah]

I think a lot of it is simply personal issues and different expectations. People get burned out quicker these days because their expectations are different - they expect more free time and a work life balance. And administrative burdens keep increasing meanwhile renumeration does not. And if you start focusing on burnout, people will start to question themselves (am I actually burned out, could I be burned out, etc). I really don't know what it means. I doubt doctors are more overburdened than they used to be. Work life balance is likely better today for the vast majority of physicians than it was 20 years ago. But "chaos" and administrative burden and hassle are likely higher today for the vast majority of physicians. Which one leads you to burnout probably depends on your personality and your goals in life. I am not burned out. But people in my group are, and I don't get why. Some of it is financial, because pay has declined and the job seems less "worth it" from time to time. But other parts are just increasing demands for time. More meetings, more requests, more duties. You have to find your own balance somehow.

 

[gbwillner]

I think the ever glaring problem that no one wants to address is that you will never be your own master. This isn't taught to residents and I see many are misguided.
The security of academic pathologists from real world lab struggles are not appreciated by many who teach residents (just read the posts on this site and others if you don't believe me). I was fortunate that I knew many private pathologists before I was turned loose, but it still didn't prepare me for seeing the elephant.
Here's why most I see are burned and I see it in myself:
1) Drippings from the breasts of mother insurance (CMS included), ever diminishing, will evaporate and kill many smaller private pathology groups. Its a continuous struggle to get paid. In my own group I am tempted to say screw it and sell out to some bigger lab and be a worker bee without having to worry about billing / contracts /etc. Its often I feel terminal in pathology, like a hopeful cancer patient clinging on, but we all know how the story ends. Hope dies. I wonder how long I can cling.
a) Pathology is a poorly represented field, our advocates (CAP/ASCP/Fill in the blank) don't care about Joe Schmo pathologist's plight and we are too small of a field to have an effective voice against the clinicians who dominate medicine. On a related note to number 2 below, I was on a CAP committee in the later half of 2000 decade and saw first hand how many committee members were employees or had shares in the big labs (Quest etc), I didn't appreciate it at the time how the CAP and likely other groups I don't have carnal knowledge of are puppets. Result: Loss of faith in our professional management.
b) State societies don't care and won't help you against big insurance. I complained/protested when big insurance in our state cut by 1/3 for reimbursement and appealed to help from the state society (wow was I blind). The state society received a notice from big insurance saying if they helped us they would be sued for violating the Sherman anti-trust act or some garbage like that. Given I had no further use for the state society after that I left, I doubt my couple hundred dollars a year mattered, but whatever. Local societies? Good luck with that unless there is some magic guild where you live where you practice. Result: Loss of faith in local/state societies.
c) Advocating Congress etc.? Forget it. More powerful physicians than myself spent about a week or two attempting to meet with Congress people from my state and finally one of the plastic surgeons called me and said screw it, he's not wasting his time anymore because its too much valuable time and they kept getting put off or just meeting aides. No hope there unless you bring mega lobby dollars. Big labs already have this covered, no need to fret about this. Result: Loss of faith in big government changing the playing field. For years we have hoped client billing would die in our area, but see below (2).
2) Inability to compete and stick it to bigger labs (LabCorp / Quest) will come in and steal all your profitable clients. Even your/mine best friend clinicians will go to one of these for a profit, client billing will be on the grave of many pathology groups. I'll add this: despite being illegal/frowned on in many states for anatomic pathology it all carries on in some form or another. OIG doesn't care because it doesn't happen to Medicare/Medicaid so don't have to worry about the feds. Spend 10 minutes trying to get a hold of your local insurance company and they don't care who is raking it in as long as no one rocks the money boat. Result: Loss of faith in our colleagues.
3) Little care of anyone in pathology's plight from the suits, no matter how talented you are you are replaceable, no one cares if you get paid or not as an independent pathologist. Admin sees one thing, dollar signs $$$, no matter how good you are, how great you nail every diagnosis and the little magical things you do to improve patient care regardless, unless you are way in the black you are expendable. Remember Rambo II? "You no expendable Rambo!" Well, yes you are. I really don't have advice except burrow yourself in and try to make removing you as painful as yanking a tick off of your genitals.
Collections: My advice: watch your billing company like a hawk, its tedious and stressful, but if ye are to make it in private practice its the one pearl I can give you.
4) The patient contact I do have is ungrateful and usually to complain about small fries bills. I discount/write off many, I'm sure the surgery centers and endoscopy suites and hospitals don't share my bleeding heart, but that's why I guess I'll have less time in purgatory. The rare compliments I do hear from staff or patients does mean a lot, but the dump trucks full of crap I have to shovel to get these rare gems doesn't fill the gaps in my morale. I feel all of medicine is this way, everyone just trying to get to that magic retirement number. I see stress in all the specialties and struggles related to this morale loss.
5) Cannibalism. I mentioned it above in number 2. It occurs from outside and within. I've seen fantastic pathologists, moral and hardworking, turned on by members of their own group and the end result is forced out and/or throwing in the towel. Power over us comes from situations like this because if we fight among ourselves we can't fight the external problems that threaten us.

Advice: If you are a younger resident go into a volume producing field in pathology (GI or Derm). You will be a worker bee, you will be taken full advantage of for your talents, but you will have slight more job security. You can flush molecular down the toilet unless you have a patent cooking, the Ph.D's will smoke you and take far less pay than MDs.
I would also advocate that you invest your money well and live far below your means so when the time comes you may retire comfortably. If possible locate a second income source.
I'd network with pathology people so you can keep tabs on happenings. I've found this useful in my career.

Hope this diatribe helps, with regard to the OP above. I wish it was as simple as call and stacks of cases. 🙂
TORSED

Wow... you make me want to cry. Well stated though. I do think this is true of all fields. I was talking to a RadOnc buddy of mine a few days ago and he was saying much of the same stuff. We reminisced how lucky we are that we came out of training when we did and were able to be successful, because those coming out today have very little chance of sharing the same success. Why hire anyone to be partner track when everyone is expendable and can be chewed up and be spit out and replaced by another worker bee?

This all argues for the value of staying in academia, where, although the pay may be less, ignorance is bliss. You don't have to worry about billing, because you never see it (except for noting billing codes) and it's someone else's problem. You don't have to worry about contracts because you are unlikely to lose business from your own institution, and you are unlikely to be responsible for expanding business. You may also have preferred rates with insurers who have to have coverage of your institution, and if your physician org plays its cards right it can protect all physician rates. You don't have to worry about losing your morals because profit (although not totally absent as a motive) is not what is going to drive your salary, rather the pointless notion of seniority and rank is a bigger factor. While I was in academia, I had no idea what we made on any billing code. I saw no profit directly thus had little motive to be unethical in practice. There is no reason to doubt your leadership (unless incompetent) or your colleagues, because everyone's goal is loosely similar and tied to scientific progress and teaching. Now, don't get me wrong, the economics are the same- you will have to work harder for relatively less pay; my point is that you are more or less blinded to these details and their root causes so it is less likely that it will consume you.

I will disagree with you only on one thing though- Molecular. This is my field and can tell you that the sky is the limit for Path here if Path chooses to embrace it (ok, really NGS and oncology testing- traditional molecular could be left to ABMG certified PhDs). The rationale is that the sophistication of molecular testing cannot be understood by clinicians, and the clinical interpretation cannot be understood by PhDs. However, it is folly to think that a mere 1 year is sufficient to really understand this stuff. There is a great need to "guide the Oncologist's hand" with molecular, similar to what we've done with Surgeons with histology.

 

[Tiki]

Those of us in academia may not have to worry as much about the buisness side of pathology, but it does come with a whole different set of worries. I am constantly stressing about how I'm going to find the time to handle my service work and do research and publish, and teach the medical students and residents. I have to worry about how sucking at any of these things could mean a lack of promotion. And while some places may not have a high signout burden, I work in a subspeciality with a very heavy volume.

I can see burnout happening in academia. In order to get everything done, I work more hours than I did in residency. And I don't foresee an end to this unless I leave academics (which i'm not prepared to do anytime soon)