Burnout, burnout, burnout. There is a lot of talk about burnout, which is a good thing. BUT. One of the most commonly quoted reasons for burnout I disagree with… It is not just about how many hours we are working.
When you truly enjoy doing something, two things happen:
You don’t really care about how many hours you are doing it and You don’t typically need a whole lot, if any, external validation about it.
For example, I don’t count the minutes I spend with my children (well, okay, except during potty training, and then I’m like, how long is this going to take?!?!?!). Anyways. I don’t need my husband to give me a pat on my back for spending time with our children. I do on the other hand, like to get pats on the back for all the mental/administrative work I do for our family – finding the pediatrician, making the pediatrician’s appointments, double checking everyone’s schedules to make sure that the pediatrician’s appointments don’t fall on an operative day, a field trip day, Doughnuts with Dad’s day at school, a full moon, whatever. Now apply same process to swim lessons, soccer practice, etc, etc.
When you first start in medical school and residency, a lot or even the majority of how you spent your time was in doing things you didn’t necessarily enjoy. Aka, scut work. Transporting patients, making phone calls, calling consults, writing notes, putting in orders, doing discharge summaries, etc. Basically, a lot of administrative type duties. Yes, all of these things are important to patient care, but I don’t know too many physicians who go into medicine just because they like writing notes and making phone calls. However, you did it, because it was supposed to get better… and it did for the physicians and surgeons before us. Although scut work never went away completely, the proportion of time spent in doing did decrease. The further you progressed in training, and even in your career, there was noticeably more time taking care of patients, more time in the operating room, more time doing procedures, more time at the bedside.
However, this pyramid scheme of medicine – more scut on the bottom, less on the top – has now become a square. The administrative tasks, the menial tasks, the unenjoyable paperwork of medicine does not lessen in the same way it did for surgeons and physicians in the generations before us. Could you imagine asking Halsted to re-do his operative note for the very first mastectomy because it didn’t include his length of incision? Could you imagine telling Cooley his salary was going to be impacted because he didn’t use the right ICD 10 code in his notes allowing for maximal DRG payments?
DRG’s, RVU’s, CPT’s, ICD-10, Dot phrases, in-baskets, cosigns vs attestations, and emails. This is how we are now measured.
I don’t count the minutes I spend operating or talking with my patients and their families. I don’t need a pat on my back for spending extra time with my patients, holding their hand, or performing a successful surgery. I enjoy and value those things myself. But let me tell you, I know the exact number of notes in my inbox that I need to complete. I can tell you how long it takes to get through 100 notes. I can tell you how many emails I get a day about those 100 notes in my inbox.
Medicine is turning doctors into accountants.
A career in medicine has become about numbers … “metrics”. How many patients you see in how many hours, how many RVU’s you are generating, how many hours it takes to complete notes, how many addendums are needed to make sure all of the documentation uses the exact right words to equal the right DRG value.
Simply put, doctors don’t want to be accountants.
We didn’t go to medical school because we cared about numbers, because, quite frankly, if you judge a career in medicine solely on the numbers, it doesn’t add up. The amount of money it takes to apply to medical schools, residencies and fellowships plus the number of hours spent studying for the MCAT, medical school exams, Step 1, step 2, step 2B, step 3, first boards, second boards, recertifications, plus the differences in salaries between what my friends were making after college to me going into debt for medical school then the approximately $13 dollar an hour wage I earned in training, etc etc.
We went into medicine to sit at bedsides, operate, deliver babies… you know, do medical things.
But this is the double whammy. Physicians spend a huge portion of days (and nights and weekends) doing clerical work because this is what is now required of us AND there is very little to no appreciation for doing it. When the amount of time sitting in front of a computer equals or exceeds the time we are sitting in front of a patient, THERE IS A PROBLEM.
We are no longer being measured by the kind of medical care we provide. We are now measured by the documentation, billing, and numbers we provide.
And, the only way to cut back on the clerical work is to cut back on the clinical work. This is why people want to work fewer hours. We don’t want to take care of patients any less than the physicians before us. We want fewer hoops to jump through to actually get to our patients.
Want to help burnout? Make the computers (ie electronic medical records) work harder, so doctors can work smarter. Let’s acknowledge that a large portion of the work required by doctors doesn’t involve doctoring. Let’s create a healthcare system that lets doctors get back to what they are good at…. Taking care of people.
Jamie Coleman, MD 