Human InterestOffice Practice InfoWellness


Medical pundits have written so many articles discussing physician burnout, the subject has become irrelevant. Medical Economics has articles on burnout almost every month. Other over-debated subjects are the incomes and lifestyles accompanying different specialties. Burnout is all too common among physicians in today’s medical world, and I think it is a direct result of  these other two issues. If you work long hours and don’t feel you’re being adequately compensated, you’re attitude toward your place in the profession is going to be affected, usually negatively.

Physicians have busy lives! At least I did during my time in practice. Doctors’ services and opinions are sought constantly by their patients and really, by anyone who learns you are a doctor. Once it’s known you’re an MD, it isn’t long before someone tells you about an ailment or asks you about something that’s been worrying them. It happens all the time. At first, such intrusions into my private time annoyed me, but because it happened so frequently, I got over it and saw it as flattering. If someone thought enough of me to share their medical problems, or to ask my opinion or advice, I should feel happy and appreciate they held me in high regard.  

How often a physician is asked questions depends upon the doctor’s approachability, availability, and specialty. Primary care physicians are the most susceptible because they are  easily approached, enjoy being with people, and probably know the answer to your question. Family physicians and pediatricians see their patients often enough that they develop a comfort level and rapport that makes patients feel more at ease about asking a pressing question. This is especially true when encountering people outside the office setting. Unless you’re a hermit or live many miles from where you practice, if you’re a family doctor, you will be asked questions, often.

Internists and obstetrician-gynecologists consider themselves primary care physicians, but their’s is a different milieu. These doctors don’t treat the entire family unit. Of course I mean, an internist will treat the husband, but maybe not the wife, and the gynecologist will treat the wife but not the husband. Neither ever treat the family children. The family doc treats everyone, possibly even grandma and grandpa. The pediatrician treats the kids and gets to know one or both parents. So the doctor-patient relationship develops more completely in these scenarios.

I mentioned the doctor’s specialty makes a difference, and it does. If you find out Dr. Smith is an anesthesiologist, what on earth would you ask him? What do you talk about? Maybe it’s something like, “Do all your patients wake up?” or “Do you really pass gas like they say you do?” Or, imagine you attend a gathering and learn the person you just met is a psychiatrist. After you get over the incredible uneasiness you feel, do you ask, “What was going through your mind when you met me?” or, are you so shaken you don’t ask anything and move on to talk to someone else? Or, if you meet a dermatologist do you ask about the rash on your arm? 

This and many other factors contribute to what we call “lifestyle issues.” Of course being peppered with questions is only a minor factor, but some doctors deal with this better than others. The really important lifestyle factors, though, are the number of hours the doctor works, the interruptions caused by emergency problems, the complexity of the problems treated, and the satisfaction one feels treating these problems. Another, and maybe the most influential, factor is the compensation the doctor receives for his work. Along with a strong sense of responsibility and dedication to the profession, income is often a big motivator in deciding what specialty to practice and how hard to work. 

Personality also plays a big role in the selection of a specialty. I never met a general surgeon who didn’t love being in the operating room. I never met a neurologist who wasn’t an intellectual. I never met a nephrologist (kidney specialist) who wasn’t knowledgeable about everything. And I never met a pediatrician who was arrogant and intolerant, and not so surprisingly, I never met a psychiatrist I thought was normal.

Doctors choose certain specialties because the lifestyle suits their temperament. If you don’t like losing sleep, you don’t go into OB. If you don’t like frequent interruptions in your life, you don’t become a neurosurgeon. If you like uninterrupted free time, you go into emergency medicine, dermatology, or ophthalmology. If you like to work with your hands and make things, orthopedics is probably your choice. Exposure to each specialty during medical school gives students a taste of what practicing that specialty is like and gives you the opportunity to decide if that field of medicine is right for you. 

Long hours, irregular work schedules, interruptions, and difficult or belligerent patients are but a few of the lifestyle issues with which a doctor must learn to deal. I think most doctors would say they absolutely love taking care of patients and the challenge of their problems. They chose their specialty because of that. Where lifestyle comes into play and burnout becomes evident is when the business side of medicine rears its intrusive, disruptive head. When the process of ordering a test becomes too complicated, when your judgement is repeatedly questioned or challenged, and the pay you receive for providing a service is denied, withheld, or reduced in amount, life becomes very frustrating.

Medicare physician reimbursement is so low it’s an insult. For thirty years, the massive Medicare bureaucracy has annually reduced payments to doctors to the point where now it is unsustainably low. You cannot run a business if you rely on Medicare revenues to pay your overhead. It can’t be done! As I’ve said many, many times, what physicians receive for taking care of patients makes selling insurance, appliance repair, or handyman work more enticing than a career in medicine. I’m very serious about that.

Recent examples: I paid a handyman $165.00 to repair two, two-inch holes in the stucco siding of my house. I paid a GE appliance repairman a $120 trip charge to look at my beverage refrigerator. Our refrigerator ice maker froze up so we spent $400 for a service call that didn’t fix it. For comparison, I saw my family physician for a 6-month check up. I spent 20-30 minutes with him for which he was paid $63.00. Ten years ago, a surgeon told me his entire payment for an appendectomy was $250. That includes his trip to the ER, pre-op diagnosis and care, the operation, and all post-op visits—all this for $250. I wonder what the payment is now. You can be certain it’s even less. 

Well, when I think of lifestyle in relation to individual specialties, the things that have the most influence are how much time the doctor has to spend away from his family and how much he gets paid for what he does. If you and your family are able to survive being apart from one another, if the non-physician parent is capable in the single parent role, if the doctor can give the family total attention when he is at home, and the pay you receive enables a comfortable lifestyle, you’re likely to have a successful career. 

If you do suffer burnout, it’s best to deal with it head on. You can reduce your work hours, say “no” to requests for consultations, eliminate non-essential patient-care activities, spend more time with the family, or take a vacation. You can also delegate non-physician-required jobs to employees, but realize you won’t be reimbursed for that employee’s work, nor will Medicare or insurance pay you any more. That just isn’t going to happen. Consequently, these changes will all cause your income to suffer, and you have to accept that lower physician incomes are a fact of life about which you can do nothing but complain. 

Sadly, too many physicians “fall in love” with a field of medicine and are “married” to their practice. Everything else becomes of secondary importance. They choose patients over family. They misplace their priorities and miss family events, holidays, and their kids activities. Their lifestyle becomes cluttered and chaotic, because they find it easier to be away treating patients than to be at home and face the problems resulting from their absence. They are on a course for marital discord, and their children are certain to have behavior problems. That’s not burnout! That is bad judgement, selfishness, and neglect! Balancing a doctor’s work life and home life can be very difficult, but must be done first to the satisfaction of the doctor’s family, and to a much lesser extent, his patients. The choice of a specialty is very important in determining the lifestyle a physician will experience. So, if having a happy home and happy patients are your goals, it is essential to choose the right one.

Reference: medicine/pop medicine/95599

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