When I graduated from my family medicine residency 35 years ago, nobody talked about physician burnout, let alone physician burnout getting worse. Nowadays such talk is commonplace. Everyone from physicians who spend all their time deep in patient care, to senior level leaders are aware of physician burnout getting worse. Some understand why this is happening. Fewer know what to do to reverse the trend. A very few are doing something meaningful to reverse the trend.
(Heads up: Each year in early January Medscape releases their physician Lifestyle Report, which lists burnout rates by specialty. The 2018 update should be due any day. I am looking forward to it, hoping this year may show a change in the trend. Realistically I expect to see physician burnout getting worse once again. I’ll be happy to be proven wrong.)
What’s Changed Over 35 Years?
A lot has changed. I’d like to share the changes that have affected the six drivers of burnout as described by Christina Maslach and Michael Leiter in their landmark book originally published in 1997, The Truth About Burnout. The six drivers are:
- Work Overload
- Lack of Control
- Insufficient Reward
- Breakdown of Community
- Absence of Fairness
- Conflicting Values
The changes that healthcare delivery has experienced over the past three and a half decades have had a significant impact on all of these. As a service to my readers, I’m going to devote a blog post each week over the next six weeks, one to each driver, to provide some insight into the root causes of why we see physician burnout getting worse. Hopefully these insights will help you in your work to reduce burnout in your organization. For today, I’ll share what I recall about how things were back then. You can start to form your own opinions regarding what’s changed and how those changes have impacted the drivers of burnout.
What Was Medicine Like in 1983?
While it seemed complex to us then, it was a much simpler time.
- The EHR did not exist in any meaningful way, despite my residency director’s efforts to develop one for us on his homegrown Heath-Kit desktop computer. Steve Jobs was just getting Apple off the ground. There was little need to chart after work, because we hand-wrote or dictated every note. Rx’s were refilled by my nurse asking me if it was OK while she was on the phone with the pharmacist.
- Patients were younger on average, with far fewer chronic conditions.
- Diagnostic testing was simpler, with fewer options for imaging or lab testing.
- Treatment options were fewer. We had one class of beta-blockers, but no ACE-Is, ARBs, or calcium channel blockers.
- Outpatient surgery was rare. Someone getting their gall bladder removed got admitted the night before to prep for an open procedure.
- Immunization schedules were simple and rarely changed.
- Medicare and Medicaid existed, but in a simpler fee for service form. DRGs were introduced in 1983, and I heard older colleagues predict the end of the “golden age of medicine.”
- Capitation existed in very few places, and at the time systems like Kaiser Permanente were considered less expensive but with inferior quality of care. Of course, no one could objectively assess quality because quality comparison data did not exist.
- There was no such thing as prior authorization.
- And of course, Google, Yelp, and WebMD were unimaginable in the days before the internet.
I could go on, but you get the picture. While we worked hard, talk of burnout was rare.
For the next six weeks, we’ll take a deeper dive into how changes from the “good old days” up to now have led to physician burnout getting worse. I suspect you’ll find the discussions of each of the burnout drivers will provide both verification and new challenges to your thoughts on the subject. I welcome you to join the discussion by contributing a comment.
See you next Sunday…